|
HC AR DBL COMP SCREW 3.5X48 CANN
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X48 CORT
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X48 CORT
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X48 LOCK
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC AR DBL COMP SCREW 3.5X48 LOCK
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC AR DBL COMP SCREW 3.5X50 CANN
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X50 CANN
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X50 CORT
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X50 CORT
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X50 LOCK
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC AR DBL COMP SCREW 3.5X50 LOCK
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC AR DBL COMP SCREW 3.5X55 CANN
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X55 CANN
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X55 CORT
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X55 CORT
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X60 CANN
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X60 CANN
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DBL COMP SCREW 3.5X60 CORT
|
Facility
IP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.64 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR DBL COMP SCREW 3.5X60 CORT
|
Facility
OP
|
$269.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.83
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Cash Price |
$167.09
|
| Rate for Payer: Centivo All Commercial |
$137.44
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.64
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$137.44
|
| Rate for Payer: Lucent All Commercial |
$137.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.10
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.68
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.08
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
|
|
HC AR DISP INST KIT FOR S-TAK
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41607713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC AR DISP INST KIT FOR S-TAK
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41607713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR DISP MINI KIT
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41608160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.98
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Centivo All Commercial |
$744.60
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$744.60
|
| Rate for Payer: Lucent All Commercial |
$744.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
|
|
HC AR DISP MINI KIT
|
Facility
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41608160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
|
HC AR DISTAL BICEP
|
Facility
IP
|
$6,602.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.80 |
| Max. Negotiated Rate |
$6,140.23 |
| Rate for Payer: Aetna Commercial |
$5,704.47
|
| Rate for Payer: Cash Price |
$4,093.49
|
| Rate for Payer: Cigna All Commercial |
$5,697.87
|
| Rate for Payer: CORVEL All Commercial |
$6,140.23
|
| Rate for Payer: Coventry All Commercial |
$5,810.11
|
| Rate for Payer: Encore All Commercial |
$6,077.51
|
| Rate for Payer: Frontpath All Commercial |
$6,074.21
|
| Rate for Payer: Humana ChoiceCare |
$5,702.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,942.16
|
| Rate for Payer: PHCS All Commercial |
$4,951.80
|
| Rate for Payer: PHP All Commercial |
$5,007.26
|
| Rate for Payer: Sagamore Health Network All Products |
$5,097.05
|
| Rate for Payer: Signature Care EPO |
$5,479.99
|
| Rate for Payer: Signature Care PPO |
$5,810.11
|
| Rate for Payer: United Healthcare Commercial |
$5,202.69
|
|
|
HC AR DISTAL BICEP
|
Facility
OP
|
$6,602.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,140.23 |
| Rate for Payer: Aetna Commercial |
$5,572.43
|
| Rate for Payer: Aetna Medicare |
$2,178.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,178.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,791.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,127.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,505.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,396.67
|
| Rate for Payer: Cash Price |
$4,093.49
|
| Rate for Payer: Cash Price |
$4,093.49
|
| Rate for Payer: Centivo All Commercial |
$3,367.22
|
| Rate for Payer: Cigna All Commercial |
$5,697.87
|
| Rate for Payer: CORVEL All Commercial |
$6,140.23
|
| Rate for Payer: Coventry All Commercial |
$5,810.11
|
| Rate for Payer: Encore All Commercial |
$6,077.51
|
| Rate for Payer: Frontpath All Commercial |
$6,074.21
|
| Rate for Payer: Humana ChoiceCare |
$5,702.49
|
| Rate for Payer: Humana Medicare |
$3,367.22
|
| Rate for Payer: Lucent All Commercial |
$3,367.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,942.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,951.80
|
| Rate for Payer: PHP All Commercial |
$5,007.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,574.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,097.05
|
| Rate for Payer: Signature Care EPO |
$5,479.99
|
| Rate for Payer: Signature Care PPO |
$5,810.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,612.04
|
| Rate for Payer: United Healthcare Commercial |
$5,202.69
|
| Rate for Payer: United Healthcare Medicare |
$2,178.79
|
|
