|
HC Z PEG 202X26 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 202X26 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PEG 202X28 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 202X28 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PEG 202X30 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 202X30 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PEG 2.2X10 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X10 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X11 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X11 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X12 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X12 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X13 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X13 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X14 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X14 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X14 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 2.2X14 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PEG 2.2X15 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X15 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X16 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z PEG 2.2X16 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
|
HC Z PEG 2.2X16 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PEG 2.2X16 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 2.2X18 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
