|
HC SN PL SCREW 4.0X22 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X22 CANC PT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X22 CANC PT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X22 CANN PT
|
Facility
OP
|
$1,129.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.83 |
| Max. Negotiated Rate |
$1,050.71 |
| Rate for Payer: Aetna Commercial |
$953.55
|
| Rate for Payer: Aetna Medicare |
$372.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$648.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$706.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$428.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.12
|
| Rate for Payer: Cash Price |
$700.48
|
| Rate for Payer: Cash Price |
$700.48
|
| Rate for Payer: Centivo All Commercial |
$576.20
|
| Rate for Payer: Cigna All Commercial |
$975.02
|
| Rate for Payer: CORVEL All Commercial |
$1,050.71
|
| Rate for Payer: Coventry All Commercial |
$994.22
|
| Rate for Payer: Encore All Commercial |
$1,039.98
|
| Rate for Payer: Frontpath All Commercial |
$1,039.42
|
| Rate for Payer: Humana ChoiceCare |
$975.81
|
| Rate for Payer: Humana Medicare |
$576.20
|
| Rate for Payer: Lucent All Commercial |
$576.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,016.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$847.35
|
| Rate for Payer: PHP All Commercial |
$856.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$440.62
|
| Rate for Payer: Sagamore Health Network All Products |
$872.21
|
| Rate for Payer: Signature Care EPO |
$937.73
|
| Rate for Payer: Signature Care PPO |
$994.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$960.33
|
| Rate for Payer: United Healthcare Commercial |
$890.28
|
| Rate for Payer: United Healthcare Medicare |
$372.83
|
|
|
HC SN PL SCREW 4.0X22 CANN PT
|
Facility
IP
|
$1,129.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$847.35 |
| Max. Negotiated Rate |
$1,050.71 |
| Rate for Payer: Aetna Commercial |
$976.15
|
| Rate for Payer: Cash Price |
$700.48
|
| Rate for Payer: Cigna All Commercial |
$975.02
|
| Rate for Payer: CORVEL All Commercial |
$1,050.71
|
| Rate for Payer: Coventry All Commercial |
$994.22
|
| Rate for Payer: Encore All Commercial |
$1,039.98
|
| Rate for Payer: Frontpath All Commercial |
$1,039.42
|
| Rate for Payer: Humana ChoiceCare |
$975.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,016.82
|
| Rate for Payer: PHCS All Commercial |
$847.35
|
| Rate for Payer: PHP All Commercial |
$856.84
|
| Rate for Payer: Sagamore Health Network All Products |
$872.21
|
| Rate for Payer: Signature Care EPO |
$937.73
|
| Rate for Payer: Signature Care PPO |
$994.22
|
| Rate for Payer: United Healthcare Commercial |
$890.28
|
|
|
HC SN PL SCREW 4.0X24 CANC FT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X24 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X24 CANC PT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X24 CANC PT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X24 CANN PT
|
Facility
OP
|
$1,019.27
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.36 |
| Max. Negotiated Rate |
$947.92 |
| Rate for Payer: Aetna Commercial |
$860.26
|
| Rate for Payer: Aetna Medicare |
$336.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$336.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$585.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$370.00
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Centivo All Commercial |
$519.83
|
| Rate for Payer: Cigna All Commercial |
$879.63
|
| Rate for Payer: CORVEL All Commercial |
$947.92
|
| Rate for Payer: Coventry All Commercial |
$896.96
|
| Rate for Payer: Encore All Commercial |
$938.24
|
| Rate for Payer: Frontpath All Commercial |
$937.73
|
| Rate for Payer: Humana ChoiceCare |
$880.34
|
| Rate for Payer: Humana Medicare |
$519.83
|
| Rate for Payer: Lucent All Commercial |
$519.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$917.34
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$764.45
|
| Rate for Payer: PHP All Commercial |
$773.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.52
|
| Rate for Payer: Sagamore Health Network All Products |
$786.88
|
| Rate for Payer: Signature Care EPO |
$845.99
|
| Rate for Payer: Signature Care PPO |
$896.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$866.38
|
| Rate for Payer: United Healthcare Commercial |
$803.18
|
| Rate for Payer: United Healthcare Medicare |
$336.36
|
|
|
HC SN PL SCREW 4.0X24 CANN PT
|
Facility
IP
|
$1,019.27
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.45 |
| Max. Negotiated Rate |
$947.92 |
| Rate for Payer: Aetna Commercial |
$880.65
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Cigna All Commercial |
$879.63
|
| Rate for Payer: CORVEL All Commercial |
$947.92
|
| Rate for Payer: Coventry All Commercial |
$896.96
|
| Rate for Payer: Encore All Commercial |
$938.24
|
| Rate for Payer: Frontpath All Commercial |
$937.73
|
| Rate for Payer: Humana ChoiceCare |
$880.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$917.34
|
| Rate for Payer: PHCS All Commercial |
$764.45
|
| Rate for Payer: PHP All Commercial |
$773.01
|
| Rate for Payer: Sagamore Health Network All Products |
$786.88
|
| Rate for Payer: Signature Care EPO |
$845.99
|
| Rate for Payer: Signature Care PPO |
$896.96
|
| Rate for Payer: United Healthcare Commercial |
$803.18
|
|
|
HC SN PL SCREW 4.0X26 CANC FT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X26 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X26 CANC PT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X26 CANC PT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X26 CANN PT
|
Facility
OP
|
$1,177.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.44 |
| Max. Negotiated Rate |
$1,094.70 |
| Rate for Payer: Aetna Commercial |
$993.47
|
| Rate for Payer: Aetna Medicare |
$388.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$676.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$735.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.29
|
| Rate for Payer: Cash Price |
$729.80
|
| Rate for Payer: Cash Price |
$729.80
|
| Rate for Payer: Centivo All Commercial |
$600.32
|
| Rate for Payer: Cigna All Commercial |
$1,015.84
|
| Rate for Payer: CORVEL All Commercial |
$1,094.70
|
| Rate for Payer: Coventry All Commercial |
$1,035.85
|
| Rate for Payer: Encore All Commercial |
$1,083.52
|
| Rate for Payer: Frontpath All Commercial |
$1,082.93
|
| Rate for Payer: Humana ChoiceCare |
$1,016.66
|
| Rate for Payer: Humana Medicare |
$600.32
|
| Rate for Payer: Lucent All Commercial |
$600.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,059.39
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$882.82
|
| Rate for Payer: PHP All Commercial |
$892.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$459.07
|
| Rate for Payer: Sagamore Health Network All Products |
$908.72
|
| Rate for Payer: Signature Care EPO |
$976.99
|
| Rate for Payer: Signature Care PPO |
$1,035.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,000.54
|
| Rate for Payer: United Healthcare Commercial |
$927.55
|
| Rate for Payer: United Healthcare Medicare |
$388.44
|
|
|
HC SN PL SCREW 4.0X26 CANN PT
|
Facility
IP
|
$1,177.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.82 |
| Max. Negotiated Rate |
$1,094.70 |
| Rate for Payer: Aetna Commercial |
$1,017.01
|
| Rate for Payer: Cash Price |
$729.80
|
| Rate for Payer: Cigna All Commercial |
$1,015.84
|
| Rate for Payer: CORVEL All Commercial |
$1,094.70
|
| Rate for Payer: Coventry All Commercial |
$1,035.85
|
| Rate for Payer: Encore All Commercial |
$1,083.52
|
| Rate for Payer: Frontpath All Commercial |
$1,082.93
|
| Rate for Payer: Humana ChoiceCare |
$1,016.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,059.39
|
| Rate for Payer: PHCS All Commercial |
$882.82
|
| Rate for Payer: PHP All Commercial |
$892.71
|
| Rate for Payer: Sagamore Health Network All Products |
$908.72
|
| Rate for Payer: Signature Care EPO |
$976.99
|
| Rate for Payer: Signature Care PPO |
$1,035.85
|
| Rate for Payer: United Healthcare Commercial |
$927.55
|
|
|
HC SN PL SCREW 4.0X28 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X28 CANC FT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X28 CANC PT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X28 CANC PT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X28 CANN PT
|
Facility
OP
|
$1,177.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.44 |
| Max. Negotiated Rate |
$1,094.70 |
| Rate for Payer: Aetna Commercial |
$993.47
|
| Rate for Payer: Aetna Medicare |
$388.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$676.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$735.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.29
|
| Rate for Payer: Cash Price |
$729.80
|
| Rate for Payer: Cash Price |
$729.80
|
| Rate for Payer: Centivo All Commercial |
$600.32
|
| Rate for Payer: Cigna All Commercial |
$1,015.84
|
| Rate for Payer: CORVEL All Commercial |
$1,094.70
|
| Rate for Payer: Coventry All Commercial |
$1,035.85
|
| Rate for Payer: Encore All Commercial |
$1,083.52
|
| Rate for Payer: Frontpath All Commercial |
$1,082.93
|
| Rate for Payer: Humana ChoiceCare |
$1,016.66
|
| Rate for Payer: Humana Medicare |
$600.32
|
| Rate for Payer: Lucent All Commercial |
$600.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,059.39
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$882.82
|
| Rate for Payer: PHP All Commercial |
$892.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$459.07
|
| Rate for Payer: Sagamore Health Network All Products |
$908.72
|
| Rate for Payer: Signature Care EPO |
$976.99
|
| Rate for Payer: Signature Care PPO |
$1,035.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,000.54
|
| Rate for Payer: United Healthcare Commercial |
$927.55
|
| Rate for Payer: United Healthcare Medicare |
$388.44
|
|
|
HC SN PL SCREW 4.0X28 CANN PT
|
Facility
IP
|
$1,177.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.82 |
| Max. Negotiated Rate |
$1,094.70 |
| Rate for Payer: Aetna Commercial |
$1,017.01
|
| Rate for Payer: Cash Price |
$729.80
|
| Rate for Payer: Cigna All Commercial |
$1,015.84
|
| Rate for Payer: CORVEL All Commercial |
$1,094.70
|
| Rate for Payer: Coventry All Commercial |
$1,035.85
|
| Rate for Payer: Encore All Commercial |
$1,083.52
|
| Rate for Payer: Frontpath All Commercial |
$1,082.93
|
| Rate for Payer: Humana ChoiceCare |
$1,016.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,059.39
|
| Rate for Payer: PHCS All Commercial |
$882.82
|
| Rate for Payer: PHP All Commercial |
$892.71
|
| Rate for Payer: Sagamore Health Network All Products |
$908.72
|
| Rate for Payer: Signature Care EPO |
$976.99
|
| Rate for Payer: Signature Care PPO |
$1,035.85
|
| Rate for Payer: United Healthcare Commercial |
$927.55
|
|
|
HC SN PL SCREW 4.0X30 CANC FT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X30 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
