|
HC ACU .045X5.75 ST GUIDE WIRE TI
|
Facility
OP
|
$413.00
|
|
| Hospital Charge Code |
41603245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$384.09 |
| Rate for Payer: Aetna Commercial |
$348.57
|
| Rate for Payer: Aetna Medicare |
$136.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$258.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.92
|
| Rate for Payer: Cash Price |
$256.06
|
| Rate for Payer: Cash Price |
$256.06
|
| Rate for Payer: Centivo All Commercial |
$210.63
|
| Rate for Payer: Cigna All Commercial |
$356.42
|
| Rate for Payer: CORVEL All Commercial |
$384.09
|
| Rate for Payer: Coventry All Commercial |
$363.44
|
| Rate for Payer: Encore All Commercial |
$380.17
|
| Rate for Payer: Frontpath All Commercial |
$379.96
|
| Rate for Payer: Humana ChoiceCare |
$356.71
|
| Rate for Payer: Humana Medicare |
$210.63
|
| Rate for Payer: Lucent All Commercial |
$210.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$371.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$309.75
|
| Rate for Payer: PHP All Commercial |
$313.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.07
|
| Rate for Payer: Sagamore Health Network All Products |
$318.84
|
| Rate for Payer: Signature Care EPO |
$342.79
|
| Rate for Payer: Signature Care PPO |
$363.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$351.05
|
| Rate for Payer: United Healthcare Commercial |
$325.44
|
| Rate for Payer: United Healthcare Medicare |
$136.29
|
|
|
HC ACU .045X5.75 ST GUIDE WIRE TI
|
Facility
IP
|
$413.00
|
|
| Hospital Charge Code |
41603245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.75 |
| Max. Negotiated Rate |
$384.09 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: Cash Price |
$256.06
|
| Rate for Payer: Cigna All Commercial |
$356.42
|
| Rate for Payer: CORVEL All Commercial |
$384.09
|
| Rate for Payer: Coventry All Commercial |
$363.44
|
| Rate for Payer: Encore All Commercial |
$380.17
|
| Rate for Payer: Frontpath All Commercial |
$379.96
|
| Rate for Payer: Humana ChoiceCare |
$356.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$371.70
|
| Rate for Payer: PHCS All Commercial |
$309.75
|
| Rate for Payer: PHP All Commercial |
$313.22
|
| Rate for Payer: Sagamore Health Network All Products |
$318.84
|
| Rate for Payer: Signature Care EPO |
$342.79
|
| Rate for Payer: Signature Care PPO |
$363.44
|
| Rate for Payer: United Healthcare Commercial |
$325.44
|
|
|
HC ACU .045X6 ST GUIDE WIRE
|
Facility
OP
|
$168.00
|
|
| Hospital Charge Code |
41602818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$156.24 |
| Rate for Payer: Aetna Commercial |
$141.79
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.98
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Centivo All Commercial |
$85.68
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.24
|
| Rate for Payer: Coventry All Commercial |
$147.84
|
| Rate for Payer: Encore All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.56
|
| Rate for Payer: Humana ChoiceCare |
$145.10
|
| Rate for Payer: Humana Medicare |
$85.68
|
| Rate for Payer: Lucent All Commercial |
$85.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.00
|
| Rate for Payer: PHP All Commercial |
$127.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.52
|
| Rate for Payer: Sagamore Health Network All Products |
$129.70
|
| Rate for Payer: Signature Care EPO |
$139.44
|
| Rate for Payer: Signature Care PPO |
$147.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
| Rate for Payer: United Healthcare Medicare |
$55.44
|
|
|
HC ACU .045X6 ST GUIDE WIRE
|
Facility
IP
|
$168.00
|
|
| Hospital Charge Code |
41602818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$156.24 |
| Rate for Payer: Aetna Commercial |
$145.15
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.24
|
| Rate for Payer: Coventry All Commercial |
$147.84
|
| Rate for Payer: Encore All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.56
|
| Rate for Payer: Humana ChoiceCare |
$145.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.20
|
| Rate for Payer: PHCS All Commercial |
$126.00
|
| Rate for Payer: PHP All Commercial |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$129.70
|
| Rate for Payer: Signature Care EPO |
$139.44
|
| Rate for Payer: Signature Care PPO |
$147.84
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
|
|
HC ACU .054X6 GUIDE WIRE
|
Facility
IP
|
$168.00
|
|
| Hospital Charge Code |
41602633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$156.24 |
| Rate for Payer: Aetna Commercial |
$145.15
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.24
|
| Rate for Payer: Coventry All Commercial |
$147.84
|
| Rate for Payer: Encore All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.56
|
| Rate for Payer: Humana ChoiceCare |
$145.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.20
|
| Rate for Payer: PHCS All Commercial |
$126.00
|
| Rate for Payer: PHP All Commercial |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$129.70
|
| Rate for Payer: Signature Care EPO |
$139.44
|
| Rate for Payer: Signature Care PPO |
$147.84
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
|
|
HC ACU .054X6 GUIDE WIRE
|
Facility
OP
|
$168.00
|
|
| Hospital Charge Code |
41602633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$156.24 |
| Rate for Payer: Aetna Commercial |
$141.79
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.98
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Centivo All Commercial |
$85.68
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.24
|
| Rate for Payer: Coventry All Commercial |
$147.84
|
| Rate for Payer: Encore All Commercial |
$154.64
|
| Rate for Payer: Frontpath All Commercial |
$154.56
|
| Rate for Payer: Humana ChoiceCare |
$145.10
|
| Rate for Payer: Humana Medicare |
$85.68
|
| Rate for Payer: Lucent All Commercial |
$85.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$126.00
|
| Rate for Payer: PHP All Commercial |
$127.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.52
|
| Rate for Payer: Sagamore Health Network All Products |
$129.70
|
| Rate for Payer: Signature Care EPO |
$139.44
|
| Rate for Payer: Signature Care PPO |
$147.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
| Rate for Payer: United Healthcare Medicare |
$55.44
|
|
|
HC ACU .062X3 PLATE TACK THREADED
|
Facility
IP
|
$399.00
|
|
| Hospital Charge Code |
41602815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$344.74
|
| Rate for Payer: Cash Price |
$247.38
|
| Rate for Payer: Cigna All Commercial |
$344.34
|
| Rate for Payer: CORVEL All Commercial |
$371.07
|
| Rate for Payer: Coventry All Commercial |
$351.12
|
| Rate for Payer: Encore All Commercial |
$367.28
|
| Rate for Payer: Frontpath All Commercial |
$367.08
|
| Rate for Payer: Humana ChoiceCare |
$344.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$359.10
|
| Rate for Payer: PHCS All Commercial |
$299.25
|
| Rate for Payer: PHP All Commercial |
$302.60
|
| Rate for Payer: Sagamore Health Network All Products |
$308.03
|
| Rate for Payer: Signature Care EPO |
$331.17
|
| Rate for Payer: Signature Care PPO |
$351.12
|
| Rate for Payer: United Healthcare Commercial |
$314.41
|
|
|
HC ACU .062X3 PLATE TACK THREADED
|
Facility
OP
|
$399.00
|
|
| Hospital Charge Code |
41602815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$336.76
|
| Rate for Payer: Aetna Medicare |
$131.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$229.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.84
|
| Rate for Payer: Cash Price |
$247.38
|
| Rate for Payer: Cash Price |
$247.38
|
| Rate for Payer: Centivo All Commercial |
$203.49
|
| Rate for Payer: Cigna All Commercial |
$344.34
|
| Rate for Payer: CORVEL All Commercial |
$371.07
|
| Rate for Payer: Coventry All Commercial |
$351.12
|
| Rate for Payer: Encore All Commercial |
$367.28
|
| Rate for Payer: Frontpath All Commercial |
$367.08
|
| Rate for Payer: Humana ChoiceCare |
$344.62
|
| Rate for Payer: Humana Medicare |
$203.49
|
| Rate for Payer: Lucent All Commercial |
$203.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$359.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$299.25
|
| Rate for Payer: PHP All Commercial |
$302.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.61
|
| Rate for Payer: Sagamore Health Network All Products |
$308.03
|
| Rate for Payer: Signature Care EPO |
$331.17
|
| Rate for Payer: Signature Care PPO |
$351.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$314.41
|
| Rate for Payer: United Healthcare Medicare |
$131.67
|
|
|
HC ACU .062X5.75 ST GUIDE WIRE TI
|
Facility
OP
|
$546.00
|
|
| Hospital Charge Code |
41603244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$507.78 |
| Rate for Payer: Aetna Commercial |
$460.82
|
| Rate for Payer: Aetna Medicare |
$180.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$180.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$313.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$341.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.20
|
| Rate for Payer: Cash Price |
$338.52
|
| Rate for Payer: Cash Price |
$338.52
|
| Rate for Payer: Centivo All Commercial |
$278.46
|
| Rate for Payer: Cigna All Commercial |
$471.20
|
| Rate for Payer: CORVEL All Commercial |
$507.78
|
| Rate for Payer: Coventry All Commercial |
$480.48
|
| Rate for Payer: Encore All Commercial |
$502.59
|
| Rate for Payer: Frontpath All Commercial |
$502.32
|
| Rate for Payer: Humana ChoiceCare |
$471.58
|
| Rate for Payer: Humana Medicare |
$278.46
|
| Rate for Payer: Lucent All Commercial |
$278.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$491.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$409.50
|
| Rate for Payer: PHP All Commercial |
$414.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.94
|
| Rate for Payer: Sagamore Health Network All Products |
$421.51
|
| Rate for Payer: Signature Care EPO |
$453.18
|
| Rate for Payer: Signature Care PPO |
$480.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$464.10
|
| Rate for Payer: United Healthcare Commercial |
$430.25
|
| Rate for Payer: United Healthcare Medicare |
$180.18
|
|
|
HC ACU .062X5.75 ST GUIDE WIRE TI
|
Facility
IP
|
$546.00
|
|
| Hospital Charge Code |
41603244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$507.78 |
| Rate for Payer: Aetna Commercial |
$471.74
|
| Rate for Payer: Cash Price |
$338.52
|
| Rate for Payer: Cigna All Commercial |
$471.20
|
| Rate for Payer: CORVEL All Commercial |
$507.78
|
| Rate for Payer: Coventry All Commercial |
$480.48
|
| Rate for Payer: Encore All Commercial |
$502.59
|
| Rate for Payer: Frontpath All Commercial |
$502.32
|
| Rate for Payer: Humana ChoiceCare |
$471.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$491.40
|
| Rate for Payer: PHCS All Commercial |
$409.50
|
| Rate for Payer: PHP All Commercial |
$414.09
|
| Rate for Payer: Sagamore Health Network All Products |
$421.51
|
| Rate for Payer: Signature Care EPO |
$453.18
|
| Rate for Payer: Signature Care PPO |
$480.48
|
| Rate for Payer: United Healthcare Commercial |
$430.25
|
|
|
HC ACU .062X6 GUIDE WIRE
|
Facility
OP
|
$105.00
|
|
| Hospital Charge Code |
41602819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.62
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.12
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.95
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC ACU .062X6 GUIDE WIRE
|
Facility
IP
|
$105.00
|
|
| Hospital Charge Code |
41602819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$90.72
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$90.62
|
| Rate for Payer: CORVEL All Commercial |
$97.65
|
| Rate for Payer: Coventry All Commercial |
$92.40
|
| Rate for Payer: Encore All Commercial |
$96.65
|
| Rate for Payer: Frontpath All Commercial |
$96.60
|
| Rate for Payer: Humana ChoiceCare |
$90.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.50
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$79.63
|
| Rate for Payer: Sagamore Health Network All Products |
$81.06
|
| Rate for Payer: Signature Care EPO |
$87.15
|
| Rate for Payer: Signature Care PPO |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$82.74
|
|
|
HC ACU 0.8MM AVULSION HOOK PLATE
|
Facility
OP
|
$1,765.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,641.45 |
| Rate for Payer: Aetna Commercial |
$1,489.66
|
| Rate for Payer: Aetna Medicare |
$582.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,013.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,103.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$669.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$640.70
|
| Rate for Payer: Cash Price |
$1,094.30
|
| Rate for Payer: Cash Price |
$1,094.30
|
| Rate for Payer: Centivo All Commercial |
$900.15
|
| Rate for Payer: Cigna All Commercial |
$1,523.20
|
| Rate for Payer: CORVEL All Commercial |
$1,641.45
|
| Rate for Payer: Coventry All Commercial |
$1,553.20
|
| Rate for Payer: Encore All Commercial |
$1,624.68
|
| Rate for Payer: Frontpath All Commercial |
$1,623.80
|
| Rate for Payer: Humana ChoiceCare |
$1,524.43
|
| Rate for Payer: Humana Medicare |
$900.15
|
| Rate for Payer: Lucent All Commercial |
$900.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,588.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,323.75
|
| Rate for Payer: PHP All Commercial |
$1,338.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$688.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,362.58
|
| Rate for Payer: Signature Care EPO |
$1,464.95
|
| Rate for Payer: Signature Care PPO |
$1,553.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,500.25
|
| Rate for Payer: United Healthcare Commercial |
$1,390.82
|
| Rate for Payer: United Healthcare Medicare |
$582.45
|
|
|
HC ACU 0.8MM AVULSION HOOK PLATE
|
Facility
IP
|
$1,765.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.75 |
| Max. Negotiated Rate |
$1,641.45 |
| Rate for Payer: Aetna Commercial |
$1,524.96
|
| Rate for Payer: Cash Price |
$1,094.30
|
| Rate for Payer: Cigna All Commercial |
$1,523.20
|
| Rate for Payer: CORVEL All Commercial |
$1,641.45
|
| Rate for Payer: Coventry All Commercial |
$1,553.20
|
| Rate for Payer: Encore All Commercial |
$1,624.68
|
| Rate for Payer: Frontpath All Commercial |
$1,623.80
|
| Rate for Payer: Humana ChoiceCare |
$1,524.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,588.50
|
| Rate for Payer: PHCS All Commercial |
$1,323.75
|
| Rate for Payer: PHP All Commercial |
$1,338.58
|
| Rate for Payer: Sagamore Health Network All Products |
$1,362.58
|
| Rate for Payer: Signature Care EPO |
$1,464.95
|
| Rate for Payer: Signature Care PPO |
$1,553.20
|
| Rate for Payer: United Healthcare Commercial |
$1,390.82
|
|
|
HC ACU 0.8MM COMP PLATE 6 HOLE
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC ACU 0.8MM COMP PLATE 6 HOLE
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC ACU 0.8MM CVD MED/LAT PLATE
|
Facility
IP
|
$2,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.00 |
| Max. Negotiated Rate |
$2,477.52 |
| Rate for Payer: Aetna Commercial |
$2,301.70
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Cigna All Commercial |
$2,299.03
|
| Rate for Payer: CORVEL All Commercial |
$2,477.52
|
| Rate for Payer: Coventry All Commercial |
$2,344.32
|
| Rate for Payer: Encore All Commercial |
$2,452.21
|
| Rate for Payer: Frontpath All Commercial |
$2,450.88
|
| Rate for Payer: Humana ChoiceCare |
$2,300.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,397.60
|
| Rate for Payer: PHCS All Commercial |
$1,998.00
|
| Rate for Payer: PHP All Commercial |
$2,020.38
|
| Rate for Payer: Sagamore Health Network All Products |
$2,056.61
|
| Rate for Payer: Signature Care EPO |
$2,211.12
|
| Rate for Payer: Signature Care PPO |
$2,344.32
|
| Rate for Payer: United Healthcare Commercial |
$2,099.23
|
|
|
HC ACU 0.8MM CVD MED/LAT PLATE
|
Facility
OP
|
$2,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,477.52 |
| Rate for Payer: Aetna Commercial |
$2,248.42
|
| Rate for Payer: Aetna Medicare |
$879.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$879.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,529.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,665.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,010.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$967.03
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Centivo All Commercial |
$1,358.64
|
| Rate for Payer: Cigna All Commercial |
$2,299.03
|
| Rate for Payer: CORVEL All Commercial |
$2,477.52
|
| Rate for Payer: Coventry All Commercial |
$2,344.32
|
| Rate for Payer: Encore All Commercial |
$2,452.21
|
| Rate for Payer: Frontpath All Commercial |
$2,450.88
|
| Rate for Payer: Humana ChoiceCare |
$2,300.90
|
| Rate for Payer: Humana Medicare |
$1,358.64
|
| Rate for Payer: Lucent All Commercial |
$1,358.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,397.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,998.00
|
| Rate for Payer: PHP All Commercial |
$2,020.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,038.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,056.61
|
| Rate for Payer: Signature Care EPO |
$2,211.12
|
| Rate for Payer: Signature Care PPO |
$2,344.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,264.40
|
| Rate for Payer: United Healthcare Commercial |
$2,099.23
|
| Rate for Payer: United Healthcare Medicare |
$879.12
|
|
|
HC ACU 0.8MM OFFSET PLATE
|
Facility
IP
|
$2,383.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.40 |
| Max. Negotiated Rate |
$2,216.38 |
| Rate for Payer: Aetna Commercial |
$2,059.08
|
| Rate for Payer: Cash Price |
$1,477.58
|
| Rate for Payer: Cigna All Commercial |
$2,056.70
|
| Rate for Payer: CORVEL All Commercial |
$2,216.38
|
| Rate for Payer: Coventry All Commercial |
$2,097.22
|
| Rate for Payer: Encore All Commercial |
$2,193.74
|
| Rate for Payer: Frontpath All Commercial |
$2,192.54
|
| Rate for Payer: Humana ChoiceCare |
$2,058.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,144.88
|
| Rate for Payer: PHCS All Commercial |
$1,787.40
|
| Rate for Payer: PHP All Commercial |
$1,807.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,839.83
|
| Rate for Payer: Signature Care EPO |
$1,978.06
|
| Rate for Payer: Signature Care PPO |
$2,097.22
|
| Rate for Payer: United Healthcare Commercial |
$1,877.96
|
|
|
HC ACU 0.8MM OFFSET PLATE
|
Facility
OP
|
$2,383.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,216.38 |
| Rate for Payer: Aetna Commercial |
$2,011.42
|
| Rate for Payer: Aetna Medicare |
$786.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$786.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,368.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,489.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$904.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$865.10
|
| Rate for Payer: Cash Price |
$1,477.58
|
| Rate for Payer: Cash Price |
$1,477.58
|
| Rate for Payer: Centivo All Commercial |
$1,215.43
|
| Rate for Payer: Cigna All Commercial |
$2,056.70
|
| Rate for Payer: CORVEL All Commercial |
$2,216.38
|
| Rate for Payer: Coventry All Commercial |
$2,097.22
|
| Rate for Payer: Encore All Commercial |
$2,193.74
|
| Rate for Payer: Frontpath All Commercial |
$2,192.54
|
| Rate for Payer: Humana ChoiceCare |
$2,058.37
|
| Rate for Payer: Humana Medicare |
$1,215.43
|
| Rate for Payer: Lucent All Commercial |
$1,215.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,144.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,787.40
|
| Rate for Payer: PHP All Commercial |
$1,807.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$929.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,839.83
|
| Rate for Payer: Signature Care EPO |
$1,978.06
|
| Rate for Payer: Signature Care PPO |
$2,097.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,025.72
|
| Rate for Payer: United Healthcare Commercial |
$1,877.96
|
| Rate for Payer: United Healthcare Medicare |
$786.46
|
|
|
HC ACU 0.8MM ST PLATE 10 HOLE
|
Facility
OP
|
$2,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,204.10 |
| Rate for Payer: Aetna Commercial |
$2,000.28
|
| Rate for Payer: Aetna Medicare |
$782.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,361.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,481.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$899.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$860.31
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Centivo All Commercial |
$1,208.70
|
| Rate for Payer: Cigna All Commercial |
$2,045.31
|
| Rate for Payer: CORVEL All Commercial |
$2,204.10
|
| Rate for Payer: Coventry All Commercial |
$2,085.60
|
| Rate for Payer: Encore All Commercial |
$2,181.58
|
| Rate for Payer: Frontpath All Commercial |
$2,180.40
|
| Rate for Payer: Humana ChoiceCare |
$2,046.97
|
| Rate for Payer: Humana Medicare |
$1,208.70
|
| Rate for Payer: Lucent All Commercial |
$1,208.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,133.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,777.50
|
| Rate for Payer: PHP All Commercial |
$1,797.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$924.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,829.64
|
| Rate for Payer: Signature Care EPO |
$1,967.10
|
| Rate for Payer: Signature Care PPO |
$2,085.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,014.50
|
| Rate for Payer: United Healthcare Commercial |
$1,867.56
|
| Rate for Payer: United Healthcare Medicare |
$782.10
|
|
|
HC ACU 0.8MM ST PLATE 10 HOLE
|
Facility
IP
|
$2,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.50 |
| Max. Negotiated Rate |
$2,204.10 |
| Rate for Payer: Aetna Commercial |
$2,047.68
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cigna All Commercial |
$2,045.31
|
| Rate for Payer: CORVEL All Commercial |
$2,204.10
|
| Rate for Payer: Coventry All Commercial |
$2,085.60
|
| Rate for Payer: Encore All Commercial |
$2,181.58
|
| Rate for Payer: Frontpath All Commercial |
$2,180.40
|
| Rate for Payer: Humana ChoiceCare |
$2,046.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,133.00
|
| Rate for Payer: PHCS All Commercial |
$1,777.50
|
| Rate for Payer: PHP All Commercial |
$1,797.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,829.64
|
| Rate for Payer: Signature Care EPO |
$1,967.10
|
| Rate for Payer: Signature Care PPO |
$2,085.60
|
| Rate for Payer: United Healthcare Commercial |
$1,867.56
|
|
|
HC ACU 0.8MM T-PLATE
|
Facility
IP
|
$2,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.00 |
| Max. Negotiated Rate |
$2,477.52 |
| Rate for Payer: Aetna Commercial |
$2,301.70
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Cigna All Commercial |
$2,299.03
|
| Rate for Payer: CORVEL All Commercial |
$2,477.52
|
| Rate for Payer: Coventry All Commercial |
$2,344.32
|
| Rate for Payer: Encore All Commercial |
$2,452.21
|
| Rate for Payer: Frontpath All Commercial |
$2,450.88
|
| Rate for Payer: Humana ChoiceCare |
$2,300.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,397.60
|
| Rate for Payer: PHCS All Commercial |
$1,998.00
|
| Rate for Payer: PHP All Commercial |
$2,020.38
|
| Rate for Payer: Sagamore Health Network All Products |
$2,056.61
|
| Rate for Payer: Signature Care EPO |
$2,211.12
|
| Rate for Payer: Signature Care PPO |
$2,344.32
|
| Rate for Payer: United Healthcare Commercial |
$2,099.23
|
|
|
HC ACU 0.8MM T-PLATE
|
Facility
OP
|
$2,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,477.52 |
| Rate for Payer: Aetna Commercial |
$2,248.42
|
| Rate for Payer: Aetna Medicare |
$879.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$879.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,529.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,665.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,010.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$967.03
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Centivo All Commercial |
$1,358.64
|
| Rate for Payer: Cigna All Commercial |
$2,299.03
|
| Rate for Payer: CORVEL All Commercial |
$2,477.52
|
| Rate for Payer: Coventry All Commercial |
$2,344.32
|
| Rate for Payer: Encore All Commercial |
$2,452.21
|
| Rate for Payer: Frontpath All Commercial |
$2,450.88
|
| Rate for Payer: Humana ChoiceCare |
$2,300.90
|
| Rate for Payer: Humana Medicare |
$1,358.64
|
| Rate for Payer: Lucent All Commercial |
$1,358.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,397.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,998.00
|
| Rate for Payer: PHP All Commercial |
$2,020.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,038.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,056.61
|
| Rate for Payer: Signature Care EPO |
$2,211.12
|
| Rate for Payer: Signature Care PPO |
$2,344.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,264.40
|
| Rate for Payer: United Healthcare Commercial |
$2,099.23
|
| Rate for Payer: United Healthcare Medicare |
$879.12
|
|
|
HC ACU 1.1MMX3.5 SURGIBIT DRILL
|
Facility
IP
|
$889.00
|
|
| Hospital Charge Code |
41603240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.75 |
| Max. Negotiated Rate |
$826.77 |
| Rate for Payer: Aetna Commercial |
$768.10
|
| Rate for Payer: Cash Price |
$551.18
|
| Rate for Payer: Cigna All Commercial |
$767.21
|
| Rate for Payer: CORVEL All Commercial |
$826.77
|
| Rate for Payer: Coventry All Commercial |
$782.32
|
| Rate for Payer: Encore All Commercial |
$818.32
|
| Rate for Payer: Frontpath All Commercial |
$817.88
|
| Rate for Payer: Humana ChoiceCare |
$767.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$800.10
|
| Rate for Payer: PHCS All Commercial |
$666.75
|
| Rate for Payer: PHP All Commercial |
$674.22
|
| Rate for Payer: Sagamore Health Network All Products |
$686.31
|
| Rate for Payer: Signature Care EPO |
$737.87
|
| Rate for Payer: Signature Care PPO |
$782.32
|
| Rate for Payer: United Healthcare Commercial |
$700.53
|
|
