|
HC Z PEG 2.2X18 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606259
|
|
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 2.2X18 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606426
|
|
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 STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606426
|
|
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 2.2X20 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606260
|
|
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 2.2X20 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606260
|
|
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 2.2X20 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606427
|
|
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 2.2X20 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606427
|
|
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 2.2X22 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606261
|
|
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 2.2X22 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606261
|
|
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 2.2X24 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606262
|
|
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 2.2X24 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606262
|
|
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 2.2X26 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606263
|
|
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 2.2X26 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606263
|
|
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 2.2X28 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606264
|
|
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 2.2X28 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606264
|
|
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 2.2X30 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606265
|
|
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 2.2X30 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606265
|
|
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 2.2X8 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606250
|
|
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 2.2X8 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606250
|
|
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 2.2X9 LOCK
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606251
|
|
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 2.2X9 LOCK
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606251
|
|
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 2.5X18 MD
|
Facility
IP
|
$1,046.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.77 |
| Max. Negotiated Rate |
$973.11 |
| Rate for Payer: Aetna Commercial |
$904.06
|
| Rate for Payer: Cash Price |
$648.74
|
| Rate for Payer: Cigna All Commercial |
$903.01
|
| Rate for Payer: CORVEL All Commercial |
$973.11
|
| Rate for Payer: Coventry All Commercial |
$920.80
|
| Rate for Payer: Encore All Commercial |
$963.17
|
| Rate for Payer: Frontpath All Commercial |
$962.65
|
| Rate for Payer: Humana ChoiceCare |
$903.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$941.72
|
| Rate for Payer: PHCS All Commercial |
$784.77
|
| Rate for Payer: PHP All Commercial |
$793.56
|
| Rate for Payer: Sagamore Health Network All Products |
$807.79
|
| Rate for Payer: Signature Care EPO |
$868.48
|
| Rate for Payer: Signature Care PPO |
$920.80
|
| Rate for Payer: United Healthcare Commercial |
$824.53
|
|
|
HC Z PEG 2.5X18 MD
|
Facility
OP
|
$1,046.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.30 |
| Max. Negotiated Rate |
$973.11 |
| Rate for Payer: Aetna Commercial |
$883.13
|
| Rate for Payer: Aetna Medicare |
$345.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$345.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$600.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$654.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$397.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.83
|
| Rate for Payer: Cash Price |
$648.74
|
| Rate for Payer: Cash Price |
$648.74
|
| Rate for Payer: Centivo All Commercial |
$533.64
|
| Rate for Payer: Cigna All Commercial |
$903.01
|
| Rate for Payer: CORVEL All Commercial |
$973.11
|
| Rate for Payer: Coventry All Commercial |
$920.80
|
| Rate for Payer: Encore All Commercial |
$963.17
|
| Rate for Payer: Frontpath All Commercial |
$962.65
|
| Rate for Payer: Humana ChoiceCare |
$903.74
|
| Rate for Payer: Humana Medicare |
$533.64
|
| Rate for Payer: Lucent All Commercial |
$533.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$941.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$784.77
|
| Rate for Payer: PHP All Commercial |
$793.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$408.08
|
| Rate for Payer: Sagamore Health Network All Products |
$807.79
|
| Rate for Payer: Signature Care EPO |
$868.48
|
| Rate for Payer: Signature Care PPO |
$920.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$889.41
|
| Rate for Payer: United Healthcare Commercial |
$824.53
|
| Rate for Payer: United Healthcare Medicare |
$345.30
|
|
|
HC Z PEG 3.2X20 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.79 |
| Max. Negotiated Rate |
$756.14 |
| Rate for Payer: Aetna Commercial |
$702.48
|
| Rate for Payer: Cash Price |
$504.09
|
| Rate for Payer: Cigna All Commercial |
$701.66
|
| Rate for Payer: CORVEL All Commercial |
$756.14
|
| Rate for Payer: Coventry All Commercial |
$715.48
|
| Rate for Payer: Encore All Commercial |
$748.41
|
| Rate for Payer: Frontpath All Commercial |
$748.01
|
| Rate for Payer: Humana ChoiceCare |
$702.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$731.74
|
| Rate for Payer: PHCS All Commercial |
$609.79
|
| Rate for Payer: PHP All Commercial |
$616.62
|
| Rate for Payer: Sagamore Health Network All Products |
$627.67
|
| Rate for Payer: Signature Care EPO |
$674.83
|
| Rate for Payer: Signature Care PPO |
$715.48
|
| Rate for Payer: United Healthcare Commercial |
$640.68
|
|
|
HC Z PEG 3.2X20 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.31 |
| Max. Negotiated Rate |
$756.14 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: Aetna Medicare |
$268.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$268.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$466.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$508.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$308.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$295.14
|
| Rate for Payer: Cash Price |
$504.09
|
| Rate for Payer: Cash Price |
$504.09
|
| Rate for Payer: Centivo All Commercial |
$414.66
|
| Rate for Payer: Cigna All Commercial |
$701.66
|
| Rate for Payer: CORVEL All Commercial |
$756.14
|
| Rate for Payer: Coventry All Commercial |
$715.48
|
| Rate for Payer: Encore All Commercial |
$748.41
|
| Rate for Payer: Frontpath All Commercial |
$748.01
|
| Rate for Payer: Humana ChoiceCare |
$702.23
|
| Rate for Payer: Humana Medicare |
$414.66
|
| Rate for Payer: Lucent All Commercial |
$414.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$731.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$609.79
|
| Rate for Payer: PHP All Commercial |
$616.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$317.09
|
| Rate for Payer: Sagamore Health Network All Products |
$627.67
|
| Rate for Payer: Signature Care EPO |
$674.83
|
| Rate for Payer: Signature Care PPO |
$715.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$691.09
|
| Rate for Payer: United Healthcare Commercial |
$640.68
|
| Rate for Payer: United Healthcare Medicare |
$268.31
|
|
