|
HC Z PIN THREADED 3.0 305
|
Facility
IP
|
$605.92
|
|
| Hospital Charge Code |
41608305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.44 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$523.51
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
|
|
HC Z PIN THREADED 3.2, 508
|
Facility
OP
|
$838.95
|
|
| Hospital Charge Code |
41602573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$780.22 |
| Rate for Payer: Aetna Commercial |
$708.07
|
| Rate for Payer: Aetna Medicare |
$276.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$481.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$524.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.54
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Centivo All Commercial |
$427.86
|
| Rate for Payer: Cigna All Commercial |
$724.01
|
| Rate for Payer: CORVEL All Commercial |
$780.22
|
| Rate for Payer: Coventry All Commercial |
$738.28
|
| Rate for Payer: Encore All Commercial |
$772.25
|
| Rate for Payer: Frontpath All Commercial |
$771.83
|
| Rate for Payer: Humana ChoiceCare |
$724.60
|
| Rate for Payer: Humana Medicare |
$427.86
|
| Rate for Payer: Lucent All Commercial |
$427.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$755.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$629.21
|
| Rate for Payer: PHP All Commercial |
$636.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.19
|
| Rate for Payer: Sagamore Health Network All Products |
$647.67
|
| Rate for Payer: Signature Care EPO |
$696.33
|
| Rate for Payer: Signature Care PPO |
$738.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$713.11
|
| Rate for Payer: United Healthcare Commercial |
$661.09
|
| Rate for Payer: United Healthcare Medicare |
$276.85
|
|
|
HC Z PIN THREADED 3.2, 508
|
Facility
IP
|
$838.95
|
|
| Hospital Charge Code |
41602573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.21 |
| Max. Negotiated Rate |
$780.22 |
| Rate for Payer: Aetna Commercial |
$724.85
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Cigna All Commercial |
$724.01
|
| Rate for Payer: CORVEL All Commercial |
$780.22
|
| Rate for Payer: Coventry All Commercial |
$738.28
|
| Rate for Payer: Encore All Commercial |
$772.25
|
| Rate for Payer: Frontpath All Commercial |
$771.83
|
| Rate for Payer: Humana ChoiceCare |
$724.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$755.06
|
| Rate for Payer: PHCS All Commercial |
$629.21
|
| Rate for Payer: PHP All Commercial |
$636.26
|
| Rate for Payer: Sagamore Health Network All Products |
$647.67
|
| Rate for Payer: Signature Care EPO |
$696.33
|
| Rate for Payer: Signature Care PPO |
$738.28
|
| Rate for Payer: United Healthcare Commercial |
$661.09
|
|
|
HC Z PLATE 10-H 100/DEG TUB
|
Facility
OP
|
$699.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.98 |
| Max. Negotiated Rate |
$650.93 |
| Rate for Payer: Aetna Commercial |
$590.74
|
| Rate for Payer: Aetna Medicare |
$230.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.07
|
| Rate for Payer: Cash Price |
$433.96
|
| Rate for Payer: Cash Price |
$433.96
|
| Rate for Payer: Centivo All Commercial |
$356.96
|
| Rate for Payer: Cigna All Commercial |
$604.04
|
| Rate for Payer: CORVEL All Commercial |
$650.93
|
| Rate for Payer: Coventry All Commercial |
$615.94
|
| Rate for Payer: Encore All Commercial |
$644.29
|
| Rate for Payer: Frontpath All Commercial |
$643.94
|
| Rate for Payer: Humana ChoiceCare |
$604.53
|
| Rate for Payer: Humana Medicare |
$356.96
|
| Rate for Payer: Lucent All Commercial |
$356.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.94
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.95
|
| Rate for Payer: PHP All Commercial |
$530.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.97
|
| Rate for Payer: Sagamore Health Network All Products |
$540.35
|
| Rate for Payer: Signature Care EPO |
$580.94
|
| Rate for Payer: Signature Care PPO |
$615.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.94
|
| Rate for Payer: United Healthcare Commercial |
$551.54
|
| Rate for Payer: United Healthcare Medicare |
$230.98
|
|
|
HC Z PLATE 10-H 100/DEG TUB
|
Facility
IP
|
$699.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.95 |
| Max. Negotiated Rate |
$650.93 |
| Rate for Payer: Aetna Commercial |
$604.74
|
| Rate for Payer: Cash Price |
$433.96
|
| Rate for Payer: Cigna All Commercial |
$604.04
|
| Rate for Payer: CORVEL All Commercial |
$650.93
|
| Rate for Payer: Coventry All Commercial |
$615.94
|
| Rate for Payer: Encore All Commercial |
$644.29
|
| Rate for Payer: Frontpath All Commercial |
$643.94
|
| Rate for Payer: Humana ChoiceCare |
$604.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.94
|
| Rate for Payer: PHCS All Commercial |
$524.95
|
| Rate for Payer: PHP All Commercial |
$530.83
|
| Rate for Payer: Sagamore Health Network All Products |
$540.35
|
| Rate for Payer: Signature Care EPO |
$580.94
|
| Rate for Payer: Signature Care PPO |
$615.94
|
| Rate for Payer: United Healthcare Commercial |
$551.54
|
|
|
HC Z PLATE 10X146 NCB STR NRW L
|
Facility
OP
|
$1,996.38
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,856.63 |
| Rate for Payer: Aetna Commercial |
$1,684.94
|
| Rate for Payer: Aetna Medicare |
$658.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$658.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,146.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,247.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$757.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$724.69
|
| Rate for Payer: Cash Price |
$1,237.76
|
| Rate for Payer: Cash Price |
$1,237.76
|
| Rate for Payer: Centivo All Commercial |
$1,018.15
|
| Rate for Payer: Cigna All Commercial |
$1,722.88
|
| Rate for Payer: CORVEL All Commercial |
$1,856.63
|
| Rate for Payer: Coventry All Commercial |
$1,756.81
|
| Rate for Payer: Encore All Commercial |
$1,837.67
|
| Rate for Payer: Frontpath All Commercial |
$1,836.67
|
| Rate for Payer: Humana ChoiceCare |
$1,724.27
|
| Rate for Payer: Humana Medicare |
$1,018.15
|
| Rate for Payer: Lucent All Commercial |
$1,018.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,796.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,497.28
|
| Rate for Payer: PHP All Commercial |
$1,514.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$778.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,541.21
|
| Rate for Payer: Signature Care EPO |
$1,657.00
|
| Rate for Payer: Signature Care PPO |
$1,756.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,696.92
|
| Rate for Payer: United Healthcare Commercial |
$1,573.15
|
| Rate for Payer: United Healthcare Medicare |
$658.81
|
|
|
HC Z PLATE 10X146 NCB STR NRW L
|
Facility
IP
|
$1,996.38
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.28 |
| Max. Negotiated Rate |
$1,856.63 |
| Rate for Payer: Aetna Commercial |
$1,724.87
|
| Rate for Payer: Cash Price |
$1,237.76
|
| Rate for Payer: Cigna All Commercial |
$1,722.88
|
| Rate for Payer: CORVEL All Commercial |
$1,856.63
|
| Rate for Payer: Coventry All Commercial |
$1,756.81
|
| Rate for Payer: Encore All Commercial |
$1,837.67
|
| Rate for Payer: Frontpath All Commercial |
$1,836.67
|
| Rate for Payer: Humana ChoiceCare |
$1,724.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,796.74
|
| Rate for Payer: PHCS All Commercial |
$1,497.28
|
| Rate for Payer: PHP All Commercial |
$1,514.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,541.21
|
| Rate for Payer: Signature Care EPO |
$1,657.00
|
| Rate for Payer: Signature Care PPO |
$1,756.81
|
| Rate for Payer: United Healthcare Commercial |
$1,573.15
|
|
|
HC Z PLATE 12-H 100/DEG TUB
|
Facility
IP
|
$699.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.95 |
| Max. Negotiated Rate |
$650.93 |
| Rate for Payer: Aetna Commercial |
$604.74
|
| Rate for Payer: Cash Price |
$433.96
|
| Rate for Payer: Cigna All Commercial |
$604.04
|
| Rate for Payer: CORVEL All Commercial |
$650.93
|
| Rate for Payer: Coventry All Commercial |
$615.94
|
| Rate for Payer: Encore All Commercial |
$644.29
|
| Rate for Payer: Frontpath All Commercial |
$643.94
|
| Rate for Payer: Humana ChoiceCare |
$604.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.94
|
| Rate for Payer: PHCS All Commercial |
$524.95
|
| Rate for Payer: PHP All Commercial |
$530.83
|
| Rate for Payer: Sagamore Health Network All Products |
$540.35
|
| Rate for Payer: Signature Care EPO |
$580.94
|
| Rate for Payer: Signature Care PPO |
$615.94
|
| Rate for Payer: United Healthcare Commercial |
$551.54
|
|
|
HC Z PLATE 12-H 100/DEG TUB
|
Facility
OP
|
$699.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.98 |
| Max. Negotiated Rate |
$650.93 |
| Rate for Payer: Aetna Commercial |
$590.74
|
| Rate for Payer: Aetna Medicare |
$230.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.07
|
| Rate for Payer: Cash Price |
$433.96
|
| Rate for Payer: Cash Price |
$433.96
|
| Rate for Payer: Centivo All Commercial |
$356.96
|
| Rate for Payer: Cigna All Commercial |
$604.04
|
| Rate for Payer: CORVEL All Commercial |
$650.93
|
| Rate for Payer: Coventry All Commercial |
$615.94
|
| Rate for Payer: Encore All Commercial |
$644.29
|
| Rate for Payer: Frontpath All Commercial |
$643.94
|
| Rate for Payer: Humana ChoiceCare |
$604.53
|
| Rate for Payer: Humana Medicare |
$356.96
|
| Rate for Payer: Lucent All Commercial |
$356.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.94
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.95
|
| Rate for Payer: PHP All Commercial |
$530.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.97
|
| Rate for Payer: Sagamore Health Network All Products |
$540.35
|
| Rate for Payer: Signature Care EPO |
$580.94
|
| Rate for Payer: Signature Care PPO |
$615.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.94
|
| Rate for Payer: United Healthcare Commercial |
$551.54
|
| Rate for Payer: United Healthcare Medicare |
$230.98
|
|
|
HC Z PLATE 1/3 TUB 7-H 85
|
Facility
OP
|
$456.82
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$385.56
|
| Rate for Payer: Aetna Medicare |
$150.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$262.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$285.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.83
|
| Rate for Payer: Cash Price |
$283.23
|
| Rate for Payer: Cash Price |
$283.23
|
| Rate for Payer: Centivo All Commercial |
$232.98
|
| Rate for Payer: Cigna All Commercial |
$394.24
|
| Rate for Payer: CORVEL All Commercial |
$424.84
|
| Rate for Payer: Coventry All Commercial |
$402.00
|
| Rate for Payer: Encore All Commercial |
$420.50
|
| Rate for Payer: Frontpath All Commercial |
$420.27
|
| Rate for Payer: Humana ChoiceCare |
$394.56
|
| Rate for Payer: Humana Medicare |
$232.98
|
| Rate for Payer: Lucent All Commercial |
$232.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$411.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$342.62
|
| Rate for Payer: PHP All Commercial |
$346.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.16
|
| Rate for Payer: Sagamore Health Network All Products |
$352.67
|
| Rate for Payer: Signature Care EPO |
$379.16
|
| Rate for Payer: Signature Care PPO |
$402.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$388.30
|
| Rate for Payer: United Healthcare Commercial |
$359.97
|
| Rate for Payer: United Healthcare Medicare |
$150.75
|
|
|
HC Z PLATE 1/3 TUB 7-H 85
|
Facility
IP
|
$456.82
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.62 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$394.69
|
| Rate for Payer: Cash Price |
$283.23
|
| Rate for Payer: Cigna All Commercial |
$394.24
|
| Rate for Payer: CORVEL All Commercial |
$424.84
|
| Rate for Payer: Coventry All Commercial |
$402.00
|
| Rate for Payer: Encore All Commercial |
$420.50
|
| Rate for Payer: Frontpath All Commercial |
$420.27
|
| Rate for Payer: Humana ChoiceCare |
$394.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$411.14
|
| Rate for Payer: PHCS All Commercial |
$342.62
|
| Rate for Payer: PHP All Commercial |
$346.45
|
| Rate for Payer: Sagamore Health Network All Products |
$352.67
|
| Rate for Payer: Signature Care EPO |
$379.16
|
| Rate for Payer: Signature Care PPO |
$402.00
|
| Rate for Payer: United Healthcare Commercial |
$359.97
|
|
|
HC Z PLATE 1/4 TUB 6-H 70
|
Facility
OP
|
$978.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.98 |
| Max. Negotiated Rate |
$910.23 |
| Rate for Payer: Aetna Commercial |
$826.06
|
| Rate for Payer: Aetna Medicare |
$322.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$322.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$562.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$611.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$371.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.28
|
| Rate for Payer: Cash Price |
$606.82
|
| Rate for Payer: Cash Price |
$606.82
|
| Rate for Payer: Centivo All Commercial |
$499.16
|
| Rate for Payer: Cigna All Commercial |
$844.65
|
| Rate for Payer: CORVEL All Commercial |
$910.23
|
| Rate for Payer: Coventry All Commercial |
$861.29
|
| Rate for Payer: Encore All Commercial |
$900.93
|
| Rate for Payer: Frontpath All Commercial |
$900.44
|
| Rate for Payer: Humana ChoiceCare |
$845.34
|
| Rate for Payer: Humana Medicare |
$499.16
|
| Rate for Payer: Lucent All Commercial |
$499.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$880.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$734.06
|
| Rate for Payer: PHP All Commercial |
$742.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$381.71
|
| Rate for Payer: Sagamore Health Network All Products |
$755.59
|
| Rate for Payer: Signature Care EPO |
$812.35
|
| Rate for Payer: Signature Care PPO |
$861.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$831.93
|
| Rate for Payer: United Healthcare Commercial |
$771.25
|
| Rate for Payer: United Healthcare Medicare |
$322.98
|
|
|
HC Z PLATE 1/4 TUB 6-H 70
|
Facility
IP
|
$978.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.06 |
| Max. Negotiated Rate |
$910.23 |
| Rate for Payer: Aetna Commercial |
$845.63
|
| Rate for Payer: Cash Price |
$606.82
|
| Rate for Payer: Cigna All Commercial |
$844.65
|
| Rate for Payer: CORVEL All Commercial |
$910.23
|
| Rate for Payer: Coventry All Commercial |
$861.29
|
| Rate for Payer: Encore All Commercial |
$900.93
|
| Rate for Payer: Frontpath All Commercial |
$900.44
|
| Rate for Payer: Humana ChoiceCare |
$845.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$880.87
|
| Rate for Payer: PHCS All Commercial |
$734.06
|
| Rate for Payer: PHP All Commercial |
$742.28
|
| Rate for Payer: Sagamore Health Network All Products |
$755.59
|
| Rate for Payer: Signature Care EPO |
$812.35
|
| Rate for Payer: Signature Care PPO |
$861.29
|
| Rate for Payer: United Healthcare Commercial |
$771.25
|
|
|
HC Z PLATE 1.5 LOCK ST
|
Facility
OP
|
$2,055.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna Commercial |
$1,734.72
|
| Rate for Payer: Aetna Medicare |
$678.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$678.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,180.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,284.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$780.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$746.09
|
| Rate for Payer: Cash Price |
$1,274.32
|
| Rate for Payer: Cash Price |
$1,274.32
|
| Rate for Payer: Centivo All Commercial |
$1,048.23
|
| Rate for Payer: Cigna All Commercial |
$1,773.77
|
| Rate for Payer: CORVEL All Commercial |
$1,911.48
|
| Rate for Payer: Coventry All Commercial |
$1,808.71
|
| Rate for Payer: Encore All Commercial |
$1,891.95
|
| Rate for Payer: Frontpath All Commercial |
$1,890.92
|
| Rate for Payer: Humana ChoiceCare |
$1,775.21
|
| Rate for Payer: Humana Medicare |
$1,048.23
|
| Rate for Payer: Lucent All Commercial |
$1,048.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,541.51
|
| Rate for Payer: PHP All Commercial |
$1,558.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$801.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.73
|
| Rate for Payer: Signature Care EPO |
$1,705.94
|
| Rate for Payer: Signature Care PPO |
$1,808.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,747.05
|
| Rate for Payer: United Healthcare Commercial |
$1,619.62
|
| Rate for Payer: United Healthcare Medicare |
$678.27
|
|
|
HC Z PLATE 1.5 LOCK ST
|
Facility
IP
|
$2,055.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.51 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna Commercial |
$1,775.82
|
| Rate for Payer: Cash Price |
$1,274.32
|
| Rate for Payer: Cigna All Commercial |
$1,773.77
|
| Rate for Payer: CORVEL All Commercial |
$1,911.48
|
| Rate for Payer: Coventry All Commercial |
$1,808.71
|
| Rate for Payer: Encore All Commercial |
$1,891.95
|
| Rate for Payer: Frontpath All Commercial |
$1,890.92
|
| Rate for Payer: Humana ChoiceCare |
$1,775.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.82
|
| Rate for Payer: PHCS All Commercial |
$1,541.51
|
| Rate for Payer: PHP All Commercial |
$1,558.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.73
|
| Rate for Payer: Signature Care EPO |
$1,705.94
|
| Rate for Payer: Signature Care PPO |
$1,808.71
|
| Rate for Payer: United Healthcare Commercial |
$1,619.62
|
|
|
HC Z PLATE 1.5 LOCK T SM
|
Facility
OP
|
$1,833.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,704.83 |
| Rate for Payer: Aetna Commercial |
$1,547.18
|
| Rate for Payer: Aetna Medicare |
$604.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$604.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,052.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,145.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$695.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$665.43
|
| Rate for Payer: Cash Price |
$1,136.55
|
| Rate for Payer: Cash Price |
$1,136.55
|
| Rate for Payer: Centivo All Commercial |
$934.91
|
| Rate for Payer: Cigna All Commercial |
$1,582.01
|
| Rate for Payer: CORVEL All Commercial |
$1,704.83
|
| Rate for Payer: Coventry All Commercial |
$1,613.17
|
| Rate for Payer: Encore All Commercial |
$1,687.41
|
| Rate for Payer: Frontpath All Commercial |
$1,686.50
|
| Rate for Payer: Humana ChoiceCare |
$1,583.29
|
| Rate for Payer: Humana Medicare |
$934.91
|
| Rate for Payer: Lucent All Commercial |
$934.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,649.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,374.86
|
| Rate for Payer: PHP All Commercial |
$1,390.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$714.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,415.19
|
| Rate for Payer: Signature Care EPO |
$1,521.51
|
| Rate for Payer: Signature Care PPO |
$1,613.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,558.18
|
| Rate for Payer: United Healthcare Commercial |
$1,444.52
|
| Rate for Payer: United Healthcare Medicare |
$604.94
|
|
|
HC Z PLATE 1.5 LOCK T SM
|
Facility
IP
|
$1,833.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.86 |
| Max. Negotiated Rate |
$1,704.83 |
| Rate for Payer: Aetna Commercial |
$1,583.84
|
| Rate for Payer: Cash Price |
$1,136.55
|
| Rate for Payer: Cigna All Commercial |
$1,582.01
|
| Rate for Payer: CORVEL All Commercial |
$1,704.83
|
| Rate for Payer: Coventry All Commercial |
$1,613.17
|
| Rate for Payer: Encore All Commercial |
$1,687.41
|
| Rate for Payer: Frontpath All Commercial |
$1,686.50
|
| Rate for Payer: Humana ChoiceCare |
$1,583.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,649.84
|
| Rate for Payer: PHCS All Commercial |
$1,374.86
|
| Rate for Payer: PHP All Commercial |
$1,390.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,415.19
|
| Rate for Payer: Signature Care EPO |
$1,521.51
|
| Rate for Payer: Signature Care PPO |
$1,613.17
|
| Rate for Payer: United Healthcare Commercial |
$1,444.52
|
|
|
HC Z PLATE 16 SPIDER SMFRAG
|
Facility
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.68 |
| Max. Negotiated Rate |
$833.28 |
| Rate for Payer: Aetna Commercial |
$756.22
|
| Rate for Payer: Aetna Medicare |
$295.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$295.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$514.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$560.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.25
|
| Rate for Payer: Cash Price |
$555.52
|
| Rate for Payer: Cash Price |
$555.52
|
| Rate for Payer: Centivo All Commercial |
$456.96
|
| Rate for Payer: Cigna All Commercial |
$773.25
|
| Rate for Payer: CORVEL All Commercial |
$833.28
|
| Rate for Payer: Coventry All Commercial |
$788.48
|
| Rate for Payer: Encore All Commercial |
$824.77
|
| Rate for Payer: Frontpath All Commercial |
$824.32
|
| Rate for Payer: Humana ChoiceCare |
$773.88
|
| Rate for Payer: Humana Medicare |
$456.96
|
| Rate for Payer: Lucent All Commercial |
$456.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$672.00
|
| Rate for Payer: PHP All Commercial |
$679.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$349.44
|
| Rate for Payer: Sagamore Health Network All Products |
$691.71
|
| Rate for Payer: Signature Care EPO |
$743.68
|
| Rate for Payer: Signature Care PPO |
$788.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$761.60
|
| Rate for Payer: United Healthcare Commercial |
$706.05
|
| Rate for Payer: United Healthcare Medicare |
$295.68
|
|
|
HC Z PLATE 16 SPIDER SMFRAG
|
Facility
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$833.28 |
| Rate for Payer: Aetna Commercial |
$774.14
|
| Rate for Payer: Cash Price |
$555.52
|
| Rate for Payer: Cigna All Commercial |
$773.25
|
| Rate for Payer: CORVEL All Commercial |
$833.28
|
| Rate for Payer: Coventry All Commercial |
$788.48
|
| Rate for Payer: Encore All Commercial |
$824.77
|
| Rate for Payer: Frontpath All Commercial |
$824.32
|
| Rate for Payer: Humana ChoiceCare |
$773.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.40
|
| Rate for Payer: PHCS All Commercial |
$672.00
|
| Rate for Payer: PHP All Commercial |
$679.53
|
| Rate for Payer: Sagamore Health Network All Products |
$691.71
|
| Rate for Payer: Signature Care EPO |
$743.68
|
| Rate for Payer: Signature Care PPO |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$706.05
|
|
|
HC Z PLATE 20 SPIDER SM
|
Facility
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$833.28 |
| Rate for Payer: Aetna Commercial |
$774.14
|
| Rate for Payer: Cash Price |
$555.52
|
| Rate for Payer: Cigna All Commercial |
$773.25
|
| Rate for Payer: CORVEL All Commercial |
$833.28
|
| Rate for Payer: Coventry All Commercial |
$788.48
|
| Rate for Payer: Encore All Commercial |
$824.77
|
| Rate for Payer: Frontpath All Commercial |
$824.32
|
| Rate for Payer: Humana ChoiceCare |
$773.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.40
|
| Rate for Payer: PHCS All Commercial |
$672.00
|
| Rate for Payer: PHP All Commercial |
$679.53
|
| Rate for Payer: Sagamore Health Network All Products |
$691.71
|
| Rate for Payer: Signature Care EPO |
$743.68
|
| Rate for Payer: Signature Care PPO |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$706.05
|
|
|
HC Z PLATE 20 SPIDER SM
|
Facility
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.68 |
| Max. Negotiated Rate |
$833.28 |
| Rate for Payer: Aetna Commercial |
$756.22
|
| Rate for Payer: Aetna Medicare |
$295.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$295.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$514.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$560.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.25
|
| Rate for Payer: Cash Price |
$555.52
|
| Rate for Payer: Cash Price |
$555.52
|
| Rate for Payer: Centivo All Commercial |
$456.96
|
| Rate for Payer: Cigna All Commercial |
$773.25
|
| Rate for Payer: CORVEL All Commercial |
$833.28
|
| Rate for Payer: Coventry All Commercial |
$788.48
|
| Rate for Payer: Encore All Commercial |
$824.77
|
| Rate for Payer: Frontpath All Commercial |
$824.32
|
| Rate for Payer: Humana ChoiceCare |
$773.88
|
| Rate for Payer: Humana Medicare |
$456.96
|
| Rate for Payer: Lucent All Commercial |
$456.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$672.00
|
| Rate for Payer: PHP All Commercial |
$679.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$349.44
|
| Rate for Payer: Sagamore Health Network All Products |
$691.71
|
| Rate for Payer: Signature Care EPO |
$743.68
|
| Rate for Payer: Signature Care PPO |
$788.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$761.60
|
| Rate for Payer: United Healthcare Commercial |
$706.05
|
| Rate for Payer: United Healthcare Medicare |
$295.68
|
|
|
HC Z PLATE 2.5 LOCK ST
|
Facility
IP
|
$2,136.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.11 |
| Max. Negotiated Rate |
$1,986.62 |
| Rate for Payer: Aetna Commercial |
$1,845.63
|
| Rate for Payer: Cash Price |
$1,324.41
|
| Rate for Payer: Cigna All Commercial |
$1,843.50
|
| Rate for Payer: CORVEL All Commercial |
$1,986.62
|
| Rate for Payer: Coventry All Commercial |
$1,879.81
|
| Rate for Payer: Encore All Commercial |
$1,966.33
|
| Rate for Payer: Frontpath All Commercial |
$1,965.26
|
| Rate for Payer: Humana ChoiceCare |
$1,844.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,922.54
|
| Rate for Payer: PHCS All Commercial |
$1,602.11
|
| Rate for Payer: PHP All Commercial |
$1,620.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,649.11
|
| Rate for Payer: Signature Care EPO |
$1,773.00
|
| Rate for Payer: Signature Care PPO |
$1,879.81
|
| Rate for Payer: United Healthcare Commercial |
$1,683.29
|
|
|
HC Z PLATE 2.5 LOCK ST
|
Facility
OP
|
$2,136.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,986.62 |
| Rate for Payer: Aetna Commercial |
$1,802.91
|
| Rate for Payer: Aetna Medicare |
$704.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$704.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,226.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,335.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$810.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$775.42
|
| Rate for Payer: Cash Price |
$1,324.41
|
| Rate for Payer: Cash Price |
$1,324.41
|
| Rate for Payer: Centivo All Commercial |
$1,089.44
|
| Rate for Payer: Cigna All Commercial |
$1,843.50
|
| Rate for Payer: CORVEL All Commercial |
$1,986.62
|
| Rate for Payer: Coventry All Commercial |
$1,879.81
|
| Rate for Payer: Encore All Commercial |
$1,966.33
|
| Rate for Payer: Frontpath All Commercial |
$1,965.26
|
| Rate for Payer: Humana ChoiceCare |
$1,844.99
|
| Rate for Payer: Humana Medicare |
$1,089.44
|
| Rate for Payer: Lucent All Commercial |
$1,089.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,922.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,602.11
|
| Rate for Payer: PHP All Commercial |
$1,620.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$833.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,649.11
|
| Rate for Payer: Signature Care EPO |
$1,773.00
|
| Rate for Payer: Signature Care PPO |
$1,879.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,815.73
|
| Rate for Payer: United Healthcare Commercial |
$1,683.29
|
| Rate for Payer: United Healthcare Medicare |
$704.93
|
|
|
HC Z PLATE 2.5 LOCK T SHAPE
|
Facility
IP
|
$2,136.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.11 |
| Max. Negotiated Rate |
$1,986.62 |
| Rate for Payer: Aetna Commercial |
$1,845.63
|
| Rate for Payer: Cash Price |
$1,324.41
|
| Rate for Payer: Cigna All Commercial |
$1,843.50
|
| Rate for Payer: CORVEL All Commercial |
$1,986.62
|
| Rate for Payer: Coventry All Commercial |
$1,879.81
|
| Rate for Payer: Encore All Commercial |
$1,966.33
|
| Rate for Payer: Frontpath All Commercial |
$1,965.26
|
| Rate for Payer: Humana ChoiceCare |
$1,844.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,922.54
|
| Rate for Payer: PHCS All Commercial |
$1,602.11
|
| Rate for Payer: PHP All Commercial |
$1,620.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,649.11
|
| Rate for Payer: Signature Care EPO |
$1,773.00
|
| Rate for Payer: Signature Care PPO |
$1,879.81
|
| Rate for Payer: United Healthcare Commercial |
$1,683.29
|
|
|
HC Z PLATE 2.5 LOCK T SHAPE
|
Facility
OP
|
$2,136.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,986.62 |
| Rate for Payer: Aetna Commercial |
$1,802.91
|
| Rate for Payer: Aetna Medicare |
$704.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$704.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,226.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,335.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$810.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$775.42
|
| Rate for Payer: Cash Price |
$1,324.41
|
| Rate for Payer: Cash Price |
$1,324.41
|
| Rate for Payer: Centivo All Commercial |
$1,089.44
|
| Rate for Payer: Cigna All Commercial |
$1,843.50
|
| Rate for Payer: CORVEL All Commercial |
$1,986.62
|
| Rate for Payer: Coventry All Commercial |
$1,879.81
|
| Rate for Payer: Encore All Commercial |
$1,966.33
|
| Rate for Payer: Frontpath All Commercial |
$1,965.26
|
| Rate for Payer: Humana ChoiceCare |
$1,844.99
|
| Rate for Payer: Humana Medicare |
$1,089.44
|
| Rate for Payer: Lucent All Commercial |
$1,089.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,922.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,602.11
|
| Rate for Payer: PHP All Commercial |
$1,620.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$833.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,649.11
|
| Rate for Payer: Signature Care EPO |
$1,773.00
|
| Rate for Payer: Signature Care PPO |
$1,879.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,815.73
|
| Rate for Payer: United Healthcare Commercial |
$1,683.29
|
| Rate for Payer: United Healthcare Medicare |
$704.93
|
|
