|
HC Z SCREW VPC 4.0X36
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 4.0X38
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 4.0X38
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 4.0X40
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 4.0X40
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SELEX MOD HD 40MM STD
|
Facility
IP
|
$1,980.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,485.00 |
| Max. Negotiated Rate |
$1,841.40 |
| Rate for Payer: Aetna Commercial |
$1,710.72
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cigna All Commercial |
$1,708.74
|
| Rate for Payer: CORVEL All Commercial |
$1,841.40
|
| Rate for Payer: Coventry All Commercial |
$1,742.40
|
| Rate for Payer: Encore All Commercial |
$1,822.59
|
| Rate for Payer: Frontpath All Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$1,710.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,782.00
|
| Rate for Payer: PHCS All Commercial |
$1,485.00
|
| Rate for Payer: PHP All Commercial |
$1,501.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,528.56
|
| Rate for Payer: Signature Care EPO |
$1,643.40
|
| Rate for Payer: Signature Care PPO |
$1,742.40
|
| Rate for Payer: United Healthcare Commercial |
$1,560.24
|
|
|
HC Z SELEX MOD HD 40MM STD
|
Facility
OP
|
$1,980.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,841.40 |
| Rate for Payer: Aetna Commercial |
$1,671.12
|
| Rate for Payer: Aetna Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,137.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,237.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$751.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$718.74
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Centivo All Commercial |
$1,009.80
|
| Rate for Payer: Cigna All Commercial |
$1,708.74
|
| Rate for Payer: CORVEL All Commercial |
$1,841.40
|
| Rate for Payer: Coventry All Commercial |
$1,742.40
|
| Rate for Payer: Encore All Commercial |
$1,822.59
|
| Rate for Payer: Frontpath All Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$1,710.13
|
| Rate for Payer: Humana Medicare |
$1,009.80
|
| Rate for Payer: Lucent All Commercial |
$1,009.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,782.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,485.00
|
| Rate for Payer: PHP All Commercial |
$1,501.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$772.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,528.56
|
| Rate for Payer: Signature Care EPO |
$1,643.40
|
| Rate for Payer: Signature Care PPO |
$1,742.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,560.24
|
| Rate for Payer: United Healthcare Medicare |
$653.40
|
|
|
HC Z SEMIT W/GRACILIS ALLOGRAFT
|
Facility
OP
|
$6,318.43
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,876.14 |
| Rate for Payer: Aetna Commercial |
$5,332.75
|
| Rate for Payer: Aetna Medicare |
$2,085.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,085.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,628.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,949.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,397.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,293.59
|
| Rate for Payer: Cash Price |
$3,917.43
|
| Rate for Payer: Cash Price |
$3,917.43
|
| Rate for Payer: Centivo All Commercial |
$3,222.40
|
| Rate for Payer: Cigna All Commercial |
$5,452.81
|
| Rate for Payer: CORVEL All Commercial |
$5,876.14
|
| Rate for Payer: Coventry All Commercial |
$5,560.22
|
| Rate for Payer: Encore All Commercial |
$5,816.11
|
| Rate for Payer: Frontpath All Commercial |
$5,812.96
|
| Rate for Payer: Humana ChoiceCare |
$5,457.23
|
| Rate for Payer: Humana Medicare |
$3,222.40
|
| Rate for Payer: Lucent All Commercial |
$3,222.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,686.59
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,738.82
|
| Rate for Payer: PHP All Commercial |
$4,791.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,464.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,877.83
|
| Rate for Payer: Signature Care EPO |
$5,244.30
|
| Rate for Payer: Signature Care PPO |
$5,560.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,370.67
|
| Rate for Payer: United Healthcare Commercial |
$4,978.92
|
| Rate for Payer: United Healthcare Medicare |
$2,085.08
|
|
|
HC Z SEMIT W/GRACILIS ALLOGRAFT
|
Facility
IP
|
$6,318.43
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,738.82 |
| Max. Negotiated Rate |
$5,876.14 |
| Rate for Payer: Aetna Commercial |
$5,459.12
|
| Rate for Payer: Cash Price |
$3,917.43
|
| Rate for Payer: Cigna All Commercial |
$5,452.81
|
| Rate for Payer: CORVEL All Commercial |
$5,876.14
|
| Rate for Payer: Coventry All Commercial |
$5,560.22
|
| Rate for Payer: Encore All Commercial |
$5,816.11
|
| Rate for Payer: Frontpath All Commercial |
$5,812.96
|
| Rate for Payer: Humana ChoiceCare |
$5,457.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,686.59
|
| Rate for Payer: PHCS All Commercial |
$4,738.82
|
| Rate for Payer: PHP All Commercial |
$4,791.90
|
| Rate for Payer: Sagamore Health Network All Products |
$4,877.83
|
| Rate for Payer: Signature Care EPO |
$5,244.30
|
| Rate for Payer: Signature Care PPO |
$5,560.22
|
| Rate for Payer: United Healthcare Commercial |
$4,978.92
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
OP
|
$1,025.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$865.40
|
| Rate for Payer: Aetna Medicare |
$338.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$588.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$640.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.21
|
| Rate for Payer: Cash Price |
$635.72
|
| Rate for Payer: Cash Price |
$635.72
|
| Rate for Payer: Centivo All Commercial |
$522.93
|
| Rate for Payer: Cigna All Commercial |
$884.89
|
| Rate for Payer: CORVEL All Commercial |
$953.58
|
| Rate for Payer: Coventry All Commercial |
$902.32
|
| Rate for Payer: Encore All Commercial |
$943.84
|
| Rate for Payer: Frontpath All Commercial |
$943.33
|
| Rate for Payer: Humana ChoiceCare |
$885.60
|
| Rate for Payer: Humana Medicare |
$522.93
|
| Rate for Payer: Lucent All Commercial |
$522.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$769.02
|
| Rate for Payer: PHP All Commercial |
$777.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.89
|
| Rate for Payer: Sagamore Health Network All Products |
$791.58
|
| Rate for Payer: Signature Care EPO |
$851.05
|
| Rate for Payer: Signature Care PPO |
$902.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.56
|
| Rate for Payer: United Healthcare Commercial |
$807.98
|
| Rate for Payer: United Healthcare Medicare |
$338.37
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
IP
|
$1,048.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.45 |
| Max. Negotiated Rate |
$975.20 |
| Rate for Payer: Aetna Commercial |
$905.99
|
| Rate for Payer: Cash Price |
$650.13
|
| Rate for Payer: Cigna All Commercial |
$904.94
|
| Rate for Payer: CORVEL All Commercial |
$975.20
|
| Rate for Payer: Coventry All Commercial |
$922.77
|
| Rate for Payer: Encore All Commercial |
$965.24
|
| Rate for Payer: Frontpath All Commercial |
$964.71
|
| Rate for Payer: Humana ChoiceCare |
$905.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$943.74
|
| Rate for Payer: PHCS All Commercial |
$786.45
|
| Rate for Payer: PHP All Commercial |
$795.26
|
| Rate for Payer: Sagamore Health Network All Products |
$809.52
|
| Rate for Payer: Signature Care EPO |
$870.34
|
| Rate for Payer: Signature Care PPO |
$922.77
|
| Rate for Payer: United Healthcare Commercial |
$826.30
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
OP
|
$1,048.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.04 |
| Max. Negotiated Rate |
$975.20 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$346.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$602.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$655.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$397.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$380.64
|
| Rate for Payer: Cash Price |
$650.13
|
| Rate for Payer: Cash Price |
$650.13
|
| Rate for Payer: Centivo All Commercial |
$534.79
|
| Rate for Payer: Cigna All Commercial |
$904.94
|
| Rate for Payer: CORVEL All Commercial |
$975.20
|
| Rate for Payer: Coventry All Commercial |
$922.77
|
| Rate for Payer: Encore All Commercial |
$965.24
|
| Rate for Payer: Frontpath All Commercial |
$964.71
|
| Rate for Payer: Humana ChoiceCare |
$905.68
|
| Rate for Payer: Humana Medicare |
$534.79
|
| Rate for Payer: Lucent All Commercial |
$534.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$943.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$786.45
|
| Rate for Payer: PHP All Commercial |
$795.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$408.95
|
| Rate for Payer: Sagamore Health Network All Products |
$809.52
|
| Rate for Payer: Signature Care EPO |
$870.34
|
| Rate for Payer: Signature Care PPO |
$922.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$891.31
|
| Rate for Payer: United Healthcare Commercial |
$826.30
|
| Rate for Payer: United Healthcare Medicare |
$346.04
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$296.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$283.99
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Centivo All Commercial |
$399.00
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Humana Medicare |
$399.00
|
| Rate for Payer: Lucent All Commercial |
$399.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.12
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.00
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
| Rate for Payer: United Healthcare Medicare |
$258.18
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
IP
|
$815.65
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.74 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Aetna Commercial |
$704.72
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Cigna All Commercial |
$703.91
|
| Rate for Payer: CORVEL All Commercial |
$758.55
|
| Rate for Payer: Coventry All Commercial |
$717.77
|
| Rate for Payer: Encore All Commercial |
$750.81
|
| Rate for Payer: Frontpath All Commercial |
$750.40
|
| Rate for Payer: Humana ChoiceCare |
$704.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.08
|
| Rate for Payer: PHCS All Commercial |
$611.74
|
| Rate for Payer: PHP All Commercial |
$618.59
|
| Rate for Payer: Sagamore Health Network All Products |
$629.68
|
| Rate for Payer: Signature Care EPO |
$676.99
|
| Rate for Payer: Signature Care PPO |
$717.77
|
| Rate for Payer: United Healthcare Commercial |
$642.73
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
IP
|
$1,025.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.02 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$885.91
|
| Rate for Payer: Cash Price |
$635.72
|
| Rate for Payer: Cigna All Commercial |
$884.89
|
| Rate for Payer: CORVEL All Commercial |
$953.58
|
| Rate for Payer: Coventry All Commercial |
$902.32
|
| Rate for Payer: Encore All Commercial |
$943.84
|
| Rate for Payer: Frontpath All Commercial |
$943.33
|
| Rate for Payer: Humana ChoiceCare |
$885.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.82
|
| Rate for Payer: PHCS All Commercial |
$769.02
|
| Rate for Payer: PHP All Commercial |
$777.63
|
| Rate for Payer: Sagamore Health Network All Products |
$791.58
|
| Rate for Payer: Signature Care EPO |
$851.05
|
| Rate for Payer: Signature Care PPO |
$902.32
|
| Rate for Payer: United Healthcare Commercial |
$807.98
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
OP
|
$832.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.64 |
| Max. Negotiated Rate |
$773.99 |
| Rate for Payer: Aetna Commercial |
$702.42
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$274.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$477.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$520.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$302.11
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Centivo All Commercial |
$424.45
|
| Rate for Payer: Cigna All Commercial |
$718.23
|
| Rate for Payer: CORVEL All Commercial |
$773.99
|
| Rate for Payer: Coventry All Commercial |
$732.38
|
| Rate for Payer: Encore All Commercial |
$766.09
|
| Rate for Payer: Frontpath All Commercial |
$765.67
|
| Rate for Payer: Humana ChoiceCare |
$718.81
|
| Rate for Payer: Humana Medicare |
$424.45
|
| Rate for Payer: Lucent All Commercial |
$424.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$749.02
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$624.19
|
| Rate for Payer: PHP All Commercial |
$631.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.58
|
| Rate for Payer: Sagamore Health Network All Products |
$642.50
|
| Rate for Payer: Signature Care EPO |
$690.77
|
| Rate for Payer: Signature Care PPO |
$732.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$707.41
|
| Rate for Payer: United Healthcare Commercial |
$655.81
|
| Rate for Payer: United Healthcare Medicare |
$274.64
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
IP
|
$832.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.19 |
| Max. Negotiated Rate |
$773.99 |
| Rate for Payer: Aetna Commercial |
$719.06
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna All Commercial |
$718.23
|
| Rate for Payer: CORVEL All Commercial |
$773.99
|
| Rate for Payer: Coventry All Commercial |
$732.38
|
| Rate for Payer: Encore All Commercial |
$766.09
|
| Rate for Payer: Frontpath All Commercial |
$765.67
|
| Rate for Payer: Humana ChoiceCare |
$718.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$749.02
|
| Rate for Payer: PHCS All Commercial |
$624.19
|
| Rate for Payer: PHP All Commercial |
$631.18
|
| Rate for Payer: Sagamore Health Network All Products |
$642.50
|
| Rate for Payer: Signature Care EPO |
$690.77
|
| Rate for Payer: Signature Care PPO |
$732.38
|
| Rate for Payer: United Healthcare Commercial |
$655.81
|
|
|
HC Z SF PLATE 1/3TUB 3.5
|
Facility
OP
|
$815.65
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.16 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Aetna Commercial |
$688.41
|
| Rate for Payer: Aetna Medicare |
$269.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$468.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$509.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.08
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Centivo All Commercial |
$415.98
|
| Rate for Payer: Cigna All Commercial |
$703.91
|
| Rate for Payer: CORVEL All Commercial |
$758.55
|
| Rate for Payer: Coventry All Commercial |
$717.77
|
| Rate for Payer: Encore All Commercial |
$750.81
|
| Rate for Payer: Frontpath All Commercial |
$750.40
|
| Rate for Payer: Humana ChoiceCare |
$704.48
|
| Rate for Payer: Humana Medicare |
$415.98
|
| Rate for Payer: Lucent All Commercial |
$415.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$611.74
|
| Rate for Payer: PHP All Commercial |
$618.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.10
|
| Rate for Payer: Sagamore Health Network All Products |
$629.68
|
| Rate for Payer: Signature Care EPO |
$676.99
|
| Rate for Payer: Signature Care PPO |
$717.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.30
|
| Rate for Payer: United Healthcare Commercial |
$642.73
|
| Rate for Payer: United Healthcare Medicare |
$269.16
|
|
|
HC Z SF PLATE 3.5 3-H 40
|
Facility
OP
|
$1,864.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,733.75 |
| Rate for Payer: Aetna Commercial |
$1,573.43
|
| Rate for Payer: Aetna Medicare |
$615.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$615.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,070.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,165.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$707.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$676.72
|
| Rate for Payer: Cash Price |
$1,155.84
|
| Rate for Payer: Cash Price |
$1,155.84
|
| Rate for Payer: Centivo All Commercial |
$950.77
|
| Rate for Payer: Cigna All Commercial |
$1,608.85
|
| Rate for Payer: CORVEL All Commercial |
$1,733.75
|
| Rate for Payer: Coventry All Commercial |
$1,640.54
|
| Rate for Payer: Encore All Commercial |
$1,716.04
|
| Rate for Payer: Frontpath All Commercial |
$1,715.11
|
| Rate for Payer: Humana ChoiceCare |
$1,610.15
|
| Rate for Payer: Humana Medicare |
$950.77
|
| Rate for Payer: Lucent All Commercial |
$950.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,677.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,398.19
|
| Rate for Payer: PHP All Commercial |
$1,413.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$727.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,439.20
|
| Rate for Payer: Signature Care EPO |
$1,547.33
|
| Rate for Payer: Signature Care PPO |
$1,640.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,584.61
|
| Rate for Payer: United Healthcare Commercial |
$1,469.03
|
| Rate for Payer: United Healthcare Medicare |
$615.20
|
|
|
HC Z SF PLATE 3.5 3-H 40
|
Facility
IP
|
$1,864.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.19 |
| Max. Negotiated Rate |
$1,733.75 |
| Rate for Payer: Aetna Commercial |
$1,610.71
|
| Rate for Payer: Cash Price |
$1,155.84
|
| Rate for Payer: Cigna All Commercial |
$1,608.85
|
| Rate for Payer: CORVEL All Commercial |
$1,733.75
|
| Rate for Payer: Coventry All Commercial |
$1,640.54
|
| Rate for Payer: Encore All Commercial |
$1,716.04
|
| Rate for Payer: Frontpath All Commercial |
$1,715.11
|
| Rate for Payer: Humana ChoiceCare |
$1,610.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,677.82
|
| Rate for Payer: PHCS All Commercial |
$1,398.19
|
| Rate for Payer: PHP All Commercial |
$1,413.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,439.20
|
| Rate for Payer: Signature Care EPO |
$1,547.33
|
| Rate for Payer: Signature Care PPO |
$1,640.54
|
| Rate for Payer: United Healthcare Commercial |
$1,469.03
|
|
|
HC Z SF PLATE COMP 3.5 10
|
Facility
IP
|
$1,664.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.38 |
| Max. Negotiated Rate |
$1,547.98 |
| Rate for Payer: Aetna Commercial |
$1,438.13
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cigna All Commercial |
$1,436.46
|
| Rate for Payer: CORVEL All Commercial |
$1,547.98
|
| Rate for Payer: Coventry All Commercial |
$1,464.76
|
| Rate for Payer: Encore All Commercial |
$1,532.17
|
| Rate for Payer: Frontpath All Commercial |
$1,531.34
|
| Rate for Payer: Humana ChoiceCare |
$1,437.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,498.05
|
| Rate for Payer: PHCS All Commercial |
$1,248.38
|
| Rate for Payer: PHP All Commercial |
$1,262.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,284.99
|
| Rate for Payer: Signature Care EPO |
$1,381.54
|
| Rate for Payer: Signature Care PPO |
$1,464.76
|
| Rate for Payer: United Healthcare Commercial |
$1,311.63
|
|
|
HC Z SF PLATE COMP 3.5 10
|
Facility
OP
|
$1,664.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,547.98 |
| Rate for Payer: Aetna Commercial |
$1,404.84
|
| Rate for Payer: Aetna Medicare |
$549.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$549.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$955.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,040.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$631.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$604.21
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Centivo All Commercial |
$848.90
|
| Rate for Payer: Cigna All Commercial |
$1,436.46
|
| Rate for Payer: CORVEL All Commercial |
$1,547.98
|
| Rate for Payer: Coventry All Commercial |
$1,464.76
|
| Rate for Payer: Encore All Commercial |
$1,532.17
|
| Rate for Payer: Frontpath All Commercial |
$1,531.34
|
| Rate for Payer: Humana ChoiceCare |
$1,437.63
|
| Rate for Payer: Humana Medicare |
$848.90
|
| Rate for Payer: Lucent All Commercial |
$848.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,498.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,248.38
|
| Rate for Payer: PHP All Commercial |
$1,262.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$649.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,284.99
|
| Rate for Payer: Signature Care EPO |
$1,381.54
|
| Rate for Payer: Signature Care PPO |
$1,464.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,414.82
|
| Rate for Payer: United Healthcare Commercial |
$1,311.63
|
| Rate for Payer: United Healthcare Medicare |
$549.28
|
|
|
HC Z SF PLATE COMP 3.5 12
|
Facility
OP
|
$1,830.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,702.78 |
| Rate for Payer: Aetna Commercial |
$1,545.32
|
| Rate for Payer: Aetna Medicare |
$604.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$604.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,051.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,144.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$694.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$664.63
|
| Rate for Payer: Cash Price |
$1,135.19
|
| Rate for Payer: Cash Price |
$1,135.19
|
| Rate for Payer: Centivo All Commercial |
$933.78
|
| Rate for Payer: Cigna All Commercial |
$1,580.11
|
| Rate for Payer: CORVEL All Commercial |
$1,702.78
|
| Rate for Payer: Coventry All Commercial |
$1,611.24
|
| Rate for Payer: Encore All Commercial |
$1,685.39
|
| Rate for Payer: Frontpath All Commercial |
$1,684.47
|
| Rate for Payer: Humana ChoiceCare |
$1,581.39
|
| Rate for Payer: Humana Medicare |
$933.78
|
| Rate for Payer: Lucent All Commercial |
$933.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,647.86
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,373.21
|
| Rate for Payer: PHP All Commercial |
$1,388.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$714.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,413.49
|
| Rate for Payer: Signature Care EPO |
$1,519.69
|
| Rate for Payer: Signature Care PPO |
$1,611.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,556.31
|
| Rate for Payer: United Healthcare Commercial |
$1,442.79
|
| Rate for Payer: United Healthcare Medicare |
$604.21
|
|
|
HC Z SF PLATE COMP 3.5 12
|
Facility
IP
|
$1,830.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,373.21 |
| Max. Negotiated Rate |
$1,702.78 |
| Rate for Payer: Aetna Commercial |
$1,581.94
|
| Rate for Payer: Cash Price |
$1,135.19
|
| Rate for Payer: Cigna All Commercial |
$1,580.11
|
| Rate for Payer: CORVEL All Commercial |
$1,702.78
|
| Rate for Payer: Coventry All Commercial |
$1,611.24
|
| Rate for Payer: Encore All Commercial |
$1,685.39
|
| Rate for Payer: Frontpath All Commercial |
$1,684.47
|
| Rate for Payer: Humana ChoiceCare |
$1,581.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,647.86
|
| Rate for Payer: PHCS All Commercial |
$1,373.21
|
| Rate for Payer: PHP All Commercial |
$1,388.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,413.49
|
| Rate for Payer: Signature Care EPO |
$1,519.69
|
| Rate for Payer: Signature Care PPO |
$1,611.24
|
| Rate for Payer: United Healthcare Commercial |
$1,442.79
|
|
