|
HC SCREW CORTEX 2.7 X 48 ST PL
|
Facility
|
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SCREW CORTEX 2.7 X 50 ST PL
|
Facility
|
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SCREW CORTEX 2.7 X 50 ST PL
|
Facility
|
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SCREW CORTEX 2.7 X 55 ST PL
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
HC SCREW CORTEX 2.7 X 55 ST PL
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$128.20
|
| Rate for Payer: Aetna Medicare |
$50.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.14
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Centivo All Commercial |
$77.47
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Humana Medicare |
$77.47
|
| Rate for Payer: Lucent All Commercial |
$77.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.24
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.12
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare |
$50.13
|
|
|
HC SCREW CORTEX 2.7 X 60 ST PL
|
Facility
|
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SCREW CORTEX 2.7 X 60 ST PL
|
Facility
|
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SCREW CORTEX 3.5MM 36MM
|
Facility
|
IP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$128.57 |
| Rate for Payer: Aetna Commercial |
$119.45
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
|
|
HC SCREW CORTEX 3.5MM 36MM
|
Facility
|
OP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$116.68
|
| Rate for Payer: Aetna Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.18
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Centivo All Commercial |
$70.51
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Humana Medicare |
$70.51
|
| Rate for Payer: Lucent All Commercial |
$70.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.92
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.51
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
| Rate for Payer: United Healthcare Medicare |
$45.62
|
|
|
HC SCREW CORTEX 3.5MM 40MM
|
Facility
|
OP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$116.68
|
| Rate for Payer: Aetna Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.18
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Centivo All Commercial |
$70.51
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Humana Medicare |
$70.51
|
| Rate for Payer: Lucent All Commercial |
$70.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.92
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.51
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
| Rate for Payer: United Healthcare Medicare |
$45.62
|
|
|
HC SCREW CORTEX 3.5MM 40MM
|
Facility
|
IP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$128.57 |
| Rate for Payer: Aetna Commercial |
$119.45
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
|
|
HC SCREW CORTEX 3.5MM 45MM
|
Facility
|
OP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$116.68
|
| Rate for Payer: Aetna Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.18
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Centivo All Commercial |
$70.51
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Humana Medicare |
$70.51
|
| Rate for Payer: Lucent All Commercial |
$70.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.92
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.51
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
| Rate for Payer: United Healthcare Medicare |
$45.62
|
|
|
HC SCREW CORTEX 3.5MM 45MM
|
Facility
|
IP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$128.57 |
| Rate for Payer: Aetna Commercial |
$119.45
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
|
|
HC SCREW CORTEX 3.5MM 50MM
|
Facility
|
OP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$116.68
|
| Rate for Payer: Aetna Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.18
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Centivo All Commercial |
$70.51
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Humana Medicare |
$70.51
|
| Rate for Payer: Lucent All Commercial |
$70.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.92
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.51
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
| Rate for Payer: United Healthcare Medicare |
$45.62
|
|
|
HC SCREW CORTEX 3.5MM 50MM
|
Facility
|
IP
|
$138.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$128.57 |
| Rate for Payer: Aetna Commercial |
$119.45
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cigna All Commercial |
$119.31
|
| Rate for Payer: CORVEL All Commercial |
$128.57
|
| Rate for Payer: Coventry All Commercial |
$121.66
|
| Rate for Payer: Encore All Commercial |
$127.26
|
| Rate for Payer: Frontpath All Commercial |
$127.19
|
| Rate for Payer: Humana ChoiceCare |
$119.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.42
|
| Rate for Payer: PHCS All Commercial |
$103.69
|
| Rate for Payer: PHP All Commercial |
$104.85
|
| Rate for Payer: Sagamore Health Network All Products |
$106.73
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$121.66
|
| Rate for Payer: United Healthcare Commercial |
$108.94
|
|
|
HC SCREW CORTICAL 1.5 MM 10 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC SCREW CORTICAL 1.5 MM 10 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 1.5 MM 11 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC SCREW CORTICAL 1.5 MM 11 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 1.5 MM 12 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC SCREW CORTICAL 1.5 MM 12 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 1.5 MM 14 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC SCREW CORTICAL 1.5 MM 14 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 1.5 MM 16 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 1.5 MM 16 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
