|
HC Z PLATE 2.5 LOCK WEB
|
Facility
IP
|
$2,358.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.76 |
| Max. Negotiated Rate |
$2,193.27 |
| Rate for Payer: Aetna Commercial |
$2,037.61
|
| Rate for Payer: Cash Price |
$1,462.18
|
| Rate for Payer: Cigna All Commercial |
$2,035.26
|
| Rate for Payer: CORVEL All Commercial |
$2,193.27
|
| Rate for Payer: Coventry All Commercial |
$2,075.35
|
| Rate for Payer: Encore All Commercial |
$2,170.86
|
| Rate for Payer: Frontpath All Commercial |
$2,169.68
|
| Rate for Payer: Humana ChoiceCare |
$2,036.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,122.52
|
| Rate for Payer: PHCS All Commercial |
$1,768.76
|
| Rate for Payer: PHP All Commercial |
$1,788.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,820.65
|
| Rate for Payer: Signature Care EPO |
$1,957.43
|
| Rate for Payer: Signature Care PPO |
$2,075.35
|
| Rate for Payer: United Healthcare Commercial |
$1,858.38
|
|
|
HC Z PLATE 2.5 LOCK WEB
|
Facility
OP
|
$2,358.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,193.27 |
| Rate for Payer: Aetna Commercial |
$1,990.45
|
| Rate for Payer: Aetna Medicare |
$778.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$778.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,354.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,474.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$894.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$856.08
|
| Rate for Payer: Cash Price |
$1,462.18
|
| Rate for Payer: Cash Price |
$1,462.18
|
| Rate for Payer: Centivo All Commercial |
$1,202.76
|
| Rate for Payer: Cigna All Commercial |
$2,035.26
|
| Rate for Payer: CORVEL All Commercial |
$2,193.27
|
| Rate for Payer: Coventry All Commercial |
$2,075.35
|
| Rate for Payer: Encore All Commercial |
$2,170.86
|
| Rate for Payer: Frontpath All Commercial |
$2,169.68
|
| Rate for Payer: Humana ChoiceCare |
$2,036.91
|
| Rate for Payer: Humana Medicare |
$1,202.76
|
| Rate for Payer: Lucent All Commercial |
$1,202.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,122.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,768.76
|
| Rate for Payer: PHP All Commercial |
$1,788.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$919.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,820.65
|
| Rate for Payer: Signature Care EPO |
$1,957.43
|
| Rate for Payer: Signature Care PPO |
$2,075.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,004.60
|
| Rate for Payer: United Healthcare Commercial |
$1,858.38
|
| Rate for Payer: United Healthcare Medicare |
$778.26
|
|
|
HC Z PLATE 2-H 100/DEG TUB
|
Facility
OP
|
$544.39
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: Aetna Medicare |
$179.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$312.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$206.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$197.61
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Centivo All Commercial |
$277.64
|
| Rate for Payer: Cigna All Commercial |
$469.81
|
| Rate for Payer: CORVEL All Commercial |
$506.28
|
| Rate for Payer: Coventry All Commercial |
$479.06
|
| Rate for Payer: Encore All Commercial |
$501.11
|
| Rate for Payer: Frontpath All Commercial |
$500.84
|
| Rate for Payer: Humana ChoiceCare |
$470.19
|
| Rate for Payer: Humana Medicare |
$277.64
|
| Rate for Payer: Lucent All Commercial |
$277.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.95
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$408.29
|
| Rate for Payer: PHP All Commercial |
$412.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.31
|
| Rate for Payer: Sagamore Health Network All Products |
$420.27
|
| Rate for Payer: Signature Care EPO |
$451.84
|
| Rate for Payer: Signature Care PPO |
$479.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.73
|
| Rate for Payer: United Healthcare Commercial |
$428.98
|
| Rate for Payer: United Healthcare Medicare |
$179.65
|
|
|
HC Z PLATE 2-H 100/DEG TUB
|
Facility
IP
|
$544.39
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.29 |
| Max. Negotiated Rate |
$506.28 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cigna All Commercial |
$469.81
|
| Rate for Payer: CORVEL All Commercial |
$506.28
|
| Rate for Payer: Coventry All Commercial |
$479.06
|
| Rate for Payer: Encore All Commercial |
$501.11
|
| Rate for Payer: Frontpath All Commercial |
$500.84
|
| Rate for Payer: Humana ChoiceCare |
$470.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.95
|
| Rate for Payer: PHCS All Commercial |
$408.29
|
| Rate for Payer: PHP All Commercial |
$412.87
|
| Rate for Payer: Sagamore Health Network All Products |
$420.27
|
| Rate for Payer: Signature Care EPO |
$451.84
|
| Rate for Payer: Signature Care PPO |
$479.06
|
| Rate for Payer: United Healthcare Commercial |
$428.98
|
|
|
HC Z PLATE 3-H 100/DEG TUB
|
Facility
IP
|
$544.39
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.29 |
| Max. Negotiated Rate |
$506.28 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cigna All Commercial |
$469.81
|
| Rate for Payer: CORVEL All Commercial |
$506.28
|
| Rate for Payer: Coventry All Commercial |
$479.06
|
| Rate for Payer: Encore All Commercial |
$501.11
|
| Rate for Payer: Frontpath All Commercial |
$500.84
|
| Rate for Payer: Humana ChoiceCare |
$470.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.95
|
| Rate for Payer: PHCS All Commercial |
$408.29
|
| Rate for Payer: PHP All Commercial |
$412.87
|
| Rate for Payer: Sagamore Health Network All Products |
$420.27
|
| Rate for Payer: Signature Care EPO |
$451.84
|
| Rate for Payer: Signature Care PPO |
$479.06
|
| Rate for Payer: United Healthcare Commercial |
$428.98
|
|
|
HC Z PLATE 3-H 100/DEG TUB
|
Facility
OP
|
$544.39
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: Aetna Medicare |
$179.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$312.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$206.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$197.61
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Centivo All Commercial |
$277.64
|
| Rate for Payer: Cigna All Commercial |
$469.81
|
| Rate for Payer: CORVEL All Commercial |
$506.28
|
| Rate for Payer: Coventry All Commercial |
$479.06
|
| Rate for Payer: Encore All Commercial |
$501.11
|
| Rate for Payer: Frontpath All Commercial |
$500.84
|
| Rate for Payer: Humana ChoiceCare |
$470.19
|
| Rate for Payer: Humana Medicare |
$277.64
|
| Rate for Payer: Lucent All Commercial |
$277.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.95
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$408.29
|
| Rate for Payer: PHP All Commercial |
$412.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.31
|
| Rate for Payer: Sagamore Health Network All Products |
$420.27
|
| Rate for Payer: Signature Care EPO |
$451.84
|
| Rate for Payer: Signature Care PPO |
$479.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.73
|
| Rate for Payer: United Healthcare Commercial |
$428.98
|
| Rate for Payer: United Healthcare Medicare |
$179.65
|
|
|
HC Z PLATE 4-H 100/DEG TUB
|
Facility
IP
|
$544.39
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.29 |
| Max. Negotiated Rate |
$506.28 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cigna All Commercial |
$469.81
|
| Rate for Payer: CORVEL All Commercial |
$506.28
|
| Rate for Payer: Coventry All Commercial |
$479.06
|
| Rate for Payer: Encore All Commercial |
$501.11
|
| Rate for Payer: Frontpath All Commercial |
$500.84
|
| Rate for Payer: Humana ChoiceCare |
$470.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.95
|
| Rate for Payer: PHCS All Commercial |
$408.29
|
| Rate for Payer: PHP All Commercial |
$412.87
|
| Rate for Payer: Sagamore Health Network All Products |
$420.27
|
| Rate for Payer: Signature Care EPO |
$451.84
|
| Rate for Payer: Signature Care PPO |
$479.06
|
| Rate for Payer: United Healthcare Commercial |
$428.98
|
|
|
HC Z PLATE 4-H 100/DEG TUB
|
Facility
OP
|
$544.39
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: Aetna Medicare |
$179.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$312.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$206.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$197.61
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Centivo All Commercial |
$277.64
|
| Rate for Payer: Cigna All Commercial |
$469.81
|
| Rate for Payer: CORVEL All Commercial |
$506.28
|
| Rate for Payer: Coventry All Commercial |
$479.06
|
| Rate for Payer: Encore All Commercial |
$501.11
|
| Rate for Payer: Frontpath All Commercial |
$500.84
|
| Rate for Payer: Humana ChoiceCare |
$470.19
|
| Rate for Payer: Humana Medicare |
$277.64
|
| Rate for Payer: Lucent All Commercial |
$277.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.95
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$408.29
|
| Rate for Payer: PHP All Commercial |
$412.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.31
|
| Rate for Payer: Sagamore Health Network All Products |
$420.27
|
| Rate for Payer: Signature Care EPO |
$451.84
|
| Rate for Payer: Signature Care PPO |
$479.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.73
|
| Rate for Payer: United Healthcare Commercial |
$428.98
|
| Rate for Payer: United Healthcare Medicare |
$179.65
|
|
|
HC Z PLATE 5-H 100/DEG TUB
|
Facility
OP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.31 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$489.30
|
| Rate for Payer: Aetna Medicare |
$191.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$332.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.45
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Centivo All Commercial |
$295.67
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Humana Medicare |
$295.67
|
| Rate for Payer: Lucent All Commercial |
$295.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.10
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$492.78
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
| Rate for Payer: United Healthcare Medicare |
$191.31
|
|
|
HC Z PLATE 5-H 100/DEG TUB
|
Facility
IP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$500.90
|
| Rate for Payer: Cash Price |
$359.44
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: PHCS All Commercial |
$434.80
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
|
|
HC Z PLATE 6-H 100/DEG TUB
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PLATE 6-H 100/DEG TUB
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PLATE 7-H 100/DEG TUB
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PLATE 7-H 100/DEG TUB
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PLATE 8-H 100/DEG TUB
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PLATE 8-H 100/DEG TUB
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PLATE CLAVICLE 8H 90MM
|
Facility
IP
|
$5,057.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,793.26 |
| Max. Negotiated Rate |
$4,703.64 |
| Rate for Payer: Aetna Commercial |
$4,369.84
|
| Rate for Payer: Cash Price |
$3,135.76
|
| Rate for Payer: Cigna All Commercial |
$4,364.78
|
| Rate for Payer: CORVEL All Commercial |
$4,703.64
|
| Rate for Payer: Coventry All Commercial |
$4,450.76
|
| Rate for Payer: Encore All Commercial |
$4,655.59
|
| Rate for Payer: Frontpath All Commercial |
$4,653.07
|
| Rate for Payer: Humana ChoiceCare |
$4,368.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,551.91
|
| Rate for Payer: PHCS All Commercial |
$3,793.26
|
| Rate for Payer: PHP All Commercial |
$3,835.74
|
| Rate for Payer: Sagamore Health Network All Products |
$3,904.53
|
| Rate for Payer: Signature Care EPO |
$4,197.87
|
| Rate for Payer: Signature Care PPO |
$4,450.76
|
| Rate for Payer: United Healthcare Commercial |
$3,985.45
|
|
|
HC Z PLATE CLAVICLE 8H 90MM
|
Facility
OP
|
$5,057.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,703.64 |
| Rate for Payer: Aetna Commercial |
$4,268.68
|
| Rate for Payer: Aetna Medicare |
$1,669.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,669.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,904.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,161.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,919.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,835.94
|
| Rate for Payer: Cash Price |
$3,135.76
|
| Rate for Payer: Cash Price |
$3,135.76
|
| Rate for Payer: Centivo All Commercial |
$2,579.42
|
| Rate for Payer: Cigna All Commercial |
$4,364.78
|
| Rate for Payer: CORVEL All Commercial |
$4,703.64
|
| Rate for Payer: Coventry All Commercial |
$4,450.76
|
| Rate for Payer: Encore All Commercial |
$4,655.59
|
| Rate for Payer: Frontpath All Commercial |
$4,653.07
|
| Rate for Payer: Humana ChoiceCare |
$4,368.32
|
| Rate for Payer: Humana Medicare |
$2,579.42
|
| Rate for Payer: Lucent All Commercial |
$2,579.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,551.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,793.26
|
| Rate for Payer: PHP All Commercial |
$3,835.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,972.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3,904.53
|
| Rate for Payer: Signature Care EPO |
$4,197.87
|
| Rate for Payer: Signature Care PPO |
$4,450.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,299.03
|
| Rate for Payer: United Healthcare Commercial |
$3,985.45
|
| Rate for Payer: United Healthcare Medicare |
$1,669.03
|
|
|
HC Z PLATE CLAVICLE SUP 8H 90MM R
|
Facility
OP
|
$5,057.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,703.64 |
| Rate for Payer: Aetna Commercial |
$4,268.68
|
| Rate for Payer: Aetna Medicare |
$1,669.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,669.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,904.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,161.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,919.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,835.94
|
| Rate for Payer: Cash Price |
$3,135.76
|
| Rate for Payer: Cash Price |
$3,135.76
|
| Rate for Payer: Centivo All Commercial |
$2,579.42
|
| Rate for Payer: Cigna All Commercial |
$4,364.78
|
| Rate for Payer: CORVEL All Commercial |
$4,703.64
|
| Rate for Payer: Coventry All Commercial |
$4,450.76
|
| Rate for Payer: Encore All Commercial |
$4,655.59
|
| Rate for Payer: Frontpath All Commercial |
$4,653.07
|
| Rate for Payer: Humana ChoiceCare |
$4,368.32
|
| Rate for Payer: Humana Medicare |
$2,579.42
|
| Rate for Payer: Lucent All Commercial |
$2,579.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,551.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,793.26
|
| Rate for Payer: PHP All Commercial |
$3,835.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,972.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3,904.53
|
| Rate for Payer: Signature Care EPO |
$4,197.87
|
| Rate for Payer: Signature Care PPO |
$4,450.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,299.03
|
| Rate for Payer: United Healthcare Commercial |
$3,985.45
|
| Rate for Payer: United Healthcare Medicare |
$1,669.03
|
|
|
HC Z PLATE CLAVICLE SUP 8H 90MM R
|
Facility
IP
|
$5,057.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,793.26 |
| Max. Negotiated Rate |
$4,703.64 |
| Rate for Payer: Aetna Commercial |
$4,369.84
|
| Rate for Payer: Cash Price |
$3,135.76
|
| Rate for Payer: Cigna All Commercial |
$4,364.78
|
| Rate for Payer: CORVEL All Commercial |
$4,703.64
|
| Rate for Payer: Coventry All Commercial |
$4,450.76
|
| Rate for Payer: Encore All Commercial |
$4,655.59
|
| Rate for Payer: Frontpath All Commercial |
$4,653.07
|
| Rate for Payer: Humana ChoiceCare |
$4,368.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,551.91
|
| Rate for Payer: PHCS All Commercial |
$3,793.26
|
| Rate for Payer: PHP All Commercial |
$3,835.74
|
| Rate for Payer: Sagamore Health Network All Products |
$3,904.53
|
| Rate for Payer: Signature Care EPO |
$4,197.87
|
| Rate for Payer: Signature Care PPO |
$4,450.76
|
| Rate for Payer: United Healthcare Commercial |
$3,985.45
|
|
|
HC Z PLATE CLAV SUP 10H 110M L
|
Facility
IP
|
$5,199.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,899.61 |
| Max. Negotiated Rate |
$4,835.52 |
| Rate for Payer: Aetna Commercial |
$4,492.35
|
| Rate for Payer: Cash Price |
$3,223.68
|
| Rate for Payer: Cigna All Commercial |
$4,487.15
|
| Rate for Payer: CORVEL All Commercial |
$4,835.52
|
| Rate for Payer: Coventry All Commercial |
$4,575.54
|
| Rate for Payer: Encore All Commercial |
$4,786.12
|
| Rate for Payer: Frontpath All Commercial |
$4,783.52
|
| Rate for Payer: Humana ChoiceCare |
$4,490.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,679.53
|
| Rate for Payer: PHCS All Commercial |
$3,899.61
|
| Rate for Payer: PHP All Commercial |
$3,943.29
|
| Rate for Payer: Sagamore Health Network All Products |
$4,014.00
|
| Rate for Payer: Signature Care EPO |
$4,315.57
|
| Rate for Payer: Signature Care PPO |
$4,575.54
|
| Rate for Payer: United Healthcare Commercial |
$4,097.19
|
|
|
HC Z PLATE CLAV SUP 10H 110M L
|
Facility
OP
|
$5,199.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,835.52 |
| Rate for Payer: Aetna Commercial |
$4,388.36
|
| Rate for Payer: Aetna Medicare |
$1,715.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,715.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,986.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,250.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,973.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,887.41
|
| Rate for Payer: Cash Price |
$3,223.68
|
| Rate for Payer: Cash Price |
$3,223.68
|
| Rate for Payer: Centivo All Commercial |
$2,651.73
|
| Rate for Payer: Cigna All Commercial |
$4,487.15
|
| Rate for Payer: CORVEL All Commercial |
$4,835.52
|
| Rate for Payer: Coventry All Commercial |
$4,575.54
|
| Rate for Payer: Encore All Commercial |
$4,786.12
|
| Rate for Payer: Frontpath All Commercial |
$4,783.52
|
| Rate for Payer: Humana ChoiceCare |
$4,490.79
|
| Rate for Payer: Humana Medicare |
$2,651.73
|
| Rate for Payer: Lucent All Commercial |
$2,651.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,679.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,899.61
|
| Rate for Payer: PHP All Commercial |
$3,943.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,027.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,014.00
|
| Rate for Payer: Signature Care EPO |
$4,315.57
|
| Rate for Payer: Signature Care PPO |
$4,575.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,419.56
|
| Rate for Payer: United Healthcare Commercial |
$4,097.19
|
| Rate for Payer: United Healthcare Medicare |
$1,715.83
|
|
|
HC Z PLATE CLAV SUP 10H 110 R
|
Facility
OP
|
$5,199.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,835.52 |
| Rate for Payer: Aetna Commercial |
$4,388.36
|
| Rate for Payer: Aetna Medicare |
$1,715.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,715.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,986.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,250.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,973.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,887.41
|
| Rate for Payer: Cash Price |
$3,223.68
|
| Rate for Payer: Cash Price |
$3,223.68
|
| Rate for Payer: Centivo All Commercial |
$2,651.73
|
| Rate for Payer: Cigna All Commercial |
$4,487.15
|
| Rate for Payer: CORVEL All Commercial |
$4,835.52
|
| Rate for Payer: Coventry All Commercial |
$4,575.54
|
| Rate for Payer: Encore All Commercial |
$4,786.12
|
| Rate for Payer: Frontpath All Commercial |
$4,783.52
|
| Rate for Payer: Humana ChoiceCare |
$4,490.79
|
| Rate for Payer: Humana Medicare |
$2,651.73
|
| Rate for Payer: Lucent All Commercial |
$2,651.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,679.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,899.61
|
| Rate for Payer: PHP All Commercial |
$3,943.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,027.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,014.00
|
| Rate for Payer: Signature Care EPO |
$4,315.57
|
| Rate for Payer: Signature Care PPO |
$4,575.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,419.56
|
| Rate for Payer: United Healthcare Commercial |
$4,097.19
|
| Rate for Payer: United Healthcare Medicare |
$1,715.83
|
|
|
HC Z PLATE CLAV SUP 10H 110 R
|
Facility
IP
|
$5,199.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,899.61 |
| Max. Negotiated Rate |
$4,835.52 |
| Rate for Payer: Aetna Commercial |
$4,492.35
|
| Rate for Payer: Cash Price |
$3,223.68
|
| Rate for Payer: Cigna All Commercial |
$4,487.15
|
| Rate for Payer: CORVEL All Commercial |
$4,835.52
|
| Rate for Payer: Coventry All Commercial |
$4,575.54
|
| Rate for Payer: Encore All Commercial |
$4,786.12
|
| Rate for Payer: Frontpath All Commercial |
$4,783.52
|
| Rate for Payer: Humana ChoiceCare |
$4,490.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,679.53
|
| Rate for Payer: PHCS All Commercial |
$3,899.61
|
| Rate for Payer: PHP All Commercial |
$3,943.29
|
| Rate for Payer: Sagamore Health Network All Products |
$4,014.00
|
| Rate for Payer: Signature Care EPO |
$4,315.57
|
| Rate for Payer: Signature Care PPO |
$4,575.54
|
| Rate for Payer: United Healthcare Commercial |
$4,097.19
|
|
|
HC Z PLATE CLAV SUP 12H 125M R
|
Facility
IP
|
$5,479.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,109.59 |
| Max. Negotiated Rate |
$5,095.89 |
| Rate for Payer: Aetna Commercial |
$4,734.24
|
| Rate for Payer: Cash Price |
$3,397.26
|
| Rate for Payer: Cigna All Commercial |
$4,728.77
|
| Rate for Payer: CORVEL All Commercial |
$5,095.89
|
| Rate for Payer: Coventry All Commercial |
$4,821.92
|
| Rate for Payer: Encore All Commercial |
$5,043.83
|
| Rate for Payer: Frontpath All Commercial |
$5,041.09
|
| Rate for Payer: Humana ChoiceCare |
$4,732.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,931.50
|
| Rate for Payer: PHCS All Commercial |
$4,109.59
|
| Rate for Payer: PHP All Commercial |
$4,155.61
|
| Rate for Payer: Sagamore Health Network All Products |
$4,230.14
|
| Rate for Payer: Signature Care EPO |
$4,547.94
|
| Rate for Payer: Signature Care PPO |
$4,821.92
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
|
