|
HC Z PEG SCREW 2.5X13
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606497
|
|
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 2.5X13
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606497
|
|
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 2.5X14
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606498
|
|
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 2.5X14
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606498
|
|
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 2.5X15
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607002
|
|
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 2.5X15
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607002
|
|
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 2.5X16
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606690
|
|
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 2.5X16
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606690
|
|
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 2.5X18
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606499
|
|
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 2.5X18
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606499
|
|
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 2.5X20
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606691
|
|
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 2.5X20
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606691
|
|
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 2.5X22
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606692
|
|
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 2.5X22
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606692
|
|
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 2.5X24
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606693
|
|
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 2.5X24
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606693
|
|
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 2.5X26
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606694
|
|
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 2.5X26
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606694
|
|
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 2.5X28
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606695
|
|
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 2.5X28
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606695
|
|
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 2.5X30
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606696
|
|
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 2.5X30
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606696
|
|
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 2.5X32
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606697
|
|
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 2.5X32
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606697
|
|
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 2.5X34
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606698
|
|
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
|
|
