|
HC Z PEG 3.2X46 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603763
|
|
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
|
|
|
HC Z PEG 3.2X48 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603762
|
|
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
|
|
|
HC Z PEG 3.2X48 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603762
|
|
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 3.2X50 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603761
|
|
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
|
|
|
HC Z PEG 3.2X50 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603761
|
|
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 3.2X52 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603760
|
|
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
|
|
|
HC Z PEG 3.2X52 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603760
|
|
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 3.2X54 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603759
|
|
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 3.2X54 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603759
|
|
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
|
|
|
HC Z PEG 3.2X56 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603758
|
|
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
|
|
|
HC Z PEG 3.2X56 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603758
|
|
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 3.2X58 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603757
|
|
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
|
|
|
HC Z PEG 3.2X58 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603757
|
|
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 3.2X60 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603756
|
|
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
|
|
|
HC Z PEG 3.2X60 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603756
|
|
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 3.2X65 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603755
|
|
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 3.2X65 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603755
|
|
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
|
|
|
HC Z PEG 3.2X70 LOCK
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603754
|
|
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
|
|
|
HC Z PEG 3.2X70 LOCK
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603754
|
|
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 SCREW 2.5X10
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.62 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$537.55
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
|
|
HC Z PEG SCREW 2.5X10
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.31 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.84
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Centivo All Commercial |
$317.30
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Humana Medicare |
$317.30
|
| Rate for Payer: Lucent All Commercial |
$317.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.64
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$528.84
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
| Rate for Payer: United Healthcare Medicare |
$205.31
|
|
|
HC Z PEG SCREW 2.5X11
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.62 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$537.55
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
|
|
HC Z PEG SCREW 2.5X11
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.31 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.84
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Centivo All Commercial |
$317.30
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Humana Medicare |
$317.30
|
| Rate for Payer: Lucent All Commercial |
$317.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.64
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$528.84
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
| Rate for Payer: United Healthcare Medicare |
$205.31
|
|
|
HC Z PEG SCREW 2.5 X12
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.62 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$537.55
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
|
|
HC Z PEG SCREW 2.5 X12
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.31 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.84
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Centivo All Commercial |
$317.30
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Humana Medicare |
$317.30
|
| Rate for Payer: Lucent All Commercial |
$317.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.64
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$528.84
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
| Rate for Payer: United Healthcare Medicare |
$205.31
|
|
