|
HC SCREW CORTICAL 2.7MM 16MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602037
|
|
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 2.7MM 18MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602038
|
|
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 2.7MM 18MM
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602038
|
|
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 2.7 MM 20 MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602039
|
|
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 2.7 MM 20 MM
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602039
|
|
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 2.7MM 22MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602040
|
|
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 2.7MM 22MM
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602040
|
|
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 2.7MM 24MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602041
|
|
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 2.7MM 24MM
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602041
|
|
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 2.7 MM 6 MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602042
|
|
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 2.7 MM 6 MM
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602042
|
|
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 2.7 MM 8 MM
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602043
|
|
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 2.7 MM 8 MM
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602043
|
|
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 2 MM 10 MM
|
Facility
IP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$151.75 |
| Rate for Payer: Aetna Commercial |
$140.98
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
|
|
HC SCREW CORTICAL 2 MM 10 MM
|
Facility
OP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$137.72
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Centivo All Commercial |
$83.22
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Humana Medicare |
$83.22
|
| Rate for Payer: Lucent All Commercial |
$83.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.64
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.69
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
| Rate for Payer: United Healthcare Medicare |
$53.85
|
|
|
HC SCREW CORTICAL 2 MM 6 MM
|
Facility
IP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$151.75 |
| Rate for Payer: Aetna Commercial |
$140.98
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
|
|
HC SCREW CORTICAL 2 MM 6 MM
|
Facility
OP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$137.72
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Centivo All Commercial |
$83.22
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Humana Medicare |
$83.22
|
| Rate for Payer: Lucent All Commercial |
$83.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.64
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.69
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
| Rate for Payer: United Healthcare Medicare |
$53.85
|
|
|
HC SCREW CORTICAL 2 MM 8 MM
|
Facility
OP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$137.72
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Centivo All Commercial |
$83.22
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Humana Medicare |
$83.22
|
| Rate for Payer: Lucent All Commercial |
$83.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.64
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.69
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
| Rate for Payer: United Healthcare Medicare |
$53.85
|
|
|
HC SCREW CORTICAL 2 MM 8 MM
|
Facility
IP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$151.75 |
| Rate for Payer: Aetna Commercial |
$140.98
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
|
|
HC SCREW LP CORTEX 2.4 X 10 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 10 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 12 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 12 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 14 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 14 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
