|
HC ACU 2.0 QR SURGIBIT DRILL DM
|
Facility
IP
|
$790.00
|
|
| Hospital Charge Code |
41603278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.50 |
| Max. Negotiated Rate |
$734.70 |
| Rate for Payer: Aetna Commercial |
$682.56
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Cigna All Commercial |
$681.77
|
| Rate for Payer: CORVEL All Commercial |
$734.70
|
| Rate for Payer: Coventry All Commercial |
$695.20
|
| Rate for Payer: Encore All Commercial |
$727.20
|
| Rate for Payer: Frontpath All Commercial |
$726.80
|
| Rate for Payer: Humana ChoiceCare |
$682.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$711.00
|
| Rate for Payer: PHCS All Commercial |
$592.50
|
| Rate for Payer: PHP All Commercial |
$599.14
|
| Rate for Payer: Sagamore Health Network All Products |
$609.88
|
| Rate for Payer: Signature Care EPO |
$655.70
|
| Rate for Payer: Signature Care PPO |
$695.20
|
| Rate for Payer: United Healthcare Commercial |
$622.52
|
|
|
HC ACU 2.0 QR SURGIBIT DRILL DM
|
Facility
OP
|
$790.00
|
|
| Hospital Charge Code |
41603278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$734.70 |
| Rate for Payer: Aetna Commercial |
$666.76
|
| Rate for Payer: Aetna Medicare |
$260.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$260.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$453.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$493.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$299.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$286.77
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Centivo All Commercial |
$402.90
|
| Rate for Payer: Cigna All Commercial |
$681.77
|
| Rate for Payer: CORVEL All Commercial |
$734.70
|
| Rate for Payer: Coventry All Commercial |
$695.20
|
| Rate for Payer: Encore All Commercial |
$727.20
|
| Rate for Payer: Frontpath All Commercial |
$726.80
|
| Rate for Payer: Humana ChoiceCare |
$682.32
|
| Rate for Payer: Humana Medicare |
$402.90
|
| Rate for Payer: Lucent All Commercial |
$402.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$711.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$592.50
|
| Rate for Payer: PHP All Commercial |
$599.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$308.10
|
| Rate for Payer: Sagamore Health Network All Products |
$609.88
|
| Rate for Payer: Signature Care EPO |
$655.70
|
| Rate for Payer: Signature Care PPO |
$695.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$671.50
|
| Rate for Payer: United Healthcare Commercial |
$622.52
|
| Rate for Payer: United Healthcare Medicare |
$260.70
|
|
|
HC ACU 20 TWIST-TRAK COMP SCREW
|
Facility
OP
|
$1,635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,520.55 |
| Rate for Payer: Aetna Commercial |
$1,379.94
|
| Rate for Payer: Aetna Medicare |
$539.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$539.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$938.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,022.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$620.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$593.50
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Centivo All Commercial |
$833.85
|
| Rate for Payer: Cigna All Commercial |
$1,411.00
|
| Rate for Payer: CORVEL All Commercial |
$1,520.55
|
| Rate for Payer: Coventry All Commercial |
$1,438.80
|
| Rate for Payer: Encore All Commercial |
$1,505.02
|
| Rate for Payer: Frontpath All Commercial |
$1,504.20
|
| Rate for Payer: Humana ChoiceCare |
$1,412.15
|
| Rate for Payer: Humana Medicare |
$833.85
|
| Rate for Payer: Lucent All Commercial |
$833.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,471.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,226.25
|
| Rate for Payer: PHP All Commercial |
$1,239.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$637.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,262.22
|
| Rate for Payer: Signature Care EPO |
$1,357.05
|
| Rate for Payer: Signature Care PPO |
$1,438.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,389.75
|
| Rate for Payer: United Healthcare Commercial |
$1,288.38
|
| Rate for Payer: United Healthcare Medicare |
$539.55
|
|
|
HC ACU 20 TWIST-TRAK COMP SCREW
|
Facility
IP
|
$1,635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$1,520.55 |
| Rate for Payer: Aetna Commercial |
$1,412.64
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna All Commercial |
$1,411.00
|
| Rate for Payer: CORVEL All Commercial |
$1,520.55
|
| Rate for Payer: Coventry All Commercial |
$1,438.80
|
| Rate for Payer: Encore All Commercial |
$1,505.02
|
| Rate for Payer: Frontpath All Commercial |
$1,504.20
|
| Rate for Payer: Humana ChoiceCare |
$1,412.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,471.50
|
| Rate for Payer: PHCS All Commercial |
$1,226.25
|
| Rate for Payer: PHP All Commercial |
$1,239.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,262.22
|
| Rate for Payer: Signature Care EPO |
$1,357.05
|
| Rate for Payer: Signature Care PPO |
$1,438.80
|
| Rate for Payer: United Healthcare Commercial |
$1,288.38
|
|
|
HC ACU 2.0 X 6" ST GUIDE WIRE
|
Facility
IP
|
$147.00
|
|
| Hospital Charge Code |
41602812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$127.01
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cigna All Commercial |
$126.86
|
| Rate for Payer: CORVEL All Commercial |
$136.71
|
| Rate for Payer: Coventry All Commercial |
$129.36
|
| Rate for Payer: Encore All Commercial |
$135.31
|
| Rate for Payer: Frontpath All Commercial |
$135.24
|
| Rate for Payer: Humana ChoiceCare |
$126.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.30
|
| Rate for Payer: PHCS All Commercial |
$110.25
|
| Rate for Payer: PHP All Commercial |
$111.48
|
| Rate for Payer: Sagamore Health Network All Products |
$113.48
|
| Rate for Payer: Signature Care EPO |
$122.01
|
| Rate for Payer: Signature Care PPO |
$129.36
|
| Rate for Payer: United Healthcare Commercial |
$115.84
|
|
|
HC ACU 2.0 X 6" ST GUIDE WIRE
|
Facility
OP
|
$147.00
|
|
| Hospital Charge Code |
41602812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$124.07
|
| Rate for Payer: Aetna Medicare |
$48.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.36
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Centivo All Commercial |
$74.97
|
| Rate for Payer: Cigna All Commercial |
$126.86
|
| Rate for Payer: CORVEL All Commercial |
$136.71
|
| Rate for Payer: Coventry All Commercial |
$129.36
|
| Rate for Payer: Encore All Commercial |
$135.31
|
| Rate for Payer: Frontpath All Commercial |
$135.24
|
| Rate for Payer: Humana ChoiceCare |
$126.96
|
| Rate for Payer: Humana Medicare |
$74.97
|
| Rate for Payer: Lucent All Commercial |
$74.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$110.25
|
| Rate for Payer: PHP All Commercial |
$111.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.33
|
| Rate for Payer: Sagamore Health Network All Products |
$113.48
|
| Rate for Payer: Signature Care EPO |
$122.01
|
| Rate for Payer: Signature Care PPO |
$129.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.95
|
| Rate for Payer: United Healthcare Commercial |
$115.84
|
| Rate for Payer: United Healthcare Medicare |
$48.51
|
|
|
HC ACU 2.3MM X 10MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 10MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 10MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 10MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 11MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 11MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 11MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 11MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 12MM HEX LAG SCREW
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$635.04
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
|
|
HC ACU 2.3MM X 12MM HEX LAG SCREW
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.55 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$620.34
|
| Rate for Payer: Aetna Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.80
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Centivo All Commercial |
$374.85
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Humana Medicare |
$374.85
|
| Rate for Payer: Lucent All Commercial |
$374.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.65
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$624.75
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
| Rate for Payer: United Healthcare Medicare |
$242.55
|
|
|
HC ACU 2.3MM X 12MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 12MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 13MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 13MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 13MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 13MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 14MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 2.3MM X 14MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 2.3MM X 14MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
