|
HC ACU 2.7X50 NON-LOCK HEX SCREW
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$827.70 |
| Rate for Payer: Aetna Commercial |
$768.96
|
| Rate for Payer: Cash Price |
$551.80
|
| Rate for Payer: Cigna All Commercial |
$768.07
|
| Rate for Payer: CORVEL All Commercial |
$827.70
|
| Rate for Payer: Coventry All Commercial |
$783.20
|
| Rate for Payer: Encore All Commercial |
$819.24
|
| Rate for Payer: Frontpath All Commercial |
$818.80
|
| Rate for Payer: Humana ChoiceCare |
$768.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.00
|
| Rate for Payer: PHCS All Commercial |
$667.50
|
| Rate for Payer: PHP All Commercial |
$674.98
|
| Rate for Payer: Sagamore Health Network All Products |
$687.08
|
| Rate for Payer: Signature Care EPO |
$738.70
|
| Rate for Payer: Signature Care PPO |
$783.20
|
| Rate for Payer: United Healthcare Commercial |
$701.32
|
|
|
HC ACU 2.7X55 LOCK HEX SCREW
|
Facility
OP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Aetna Commercial |
$1,164.72
|
| Rate for Payer: Aetna Medicare |
$455.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$455.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$792.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$862.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$523.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$500.94
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Centivo All Commercial |
$703.80
|
| Rate for Payer: Cigna All Commercial |
$1,190.94
|
| Rate for Payer: CORVEL All Commercial |
$1,283.40
|
| Rate for Payer: Coventry All Commercial |
$1,214.40
|
| Rate for Payer: Encore All Commercial |
$1,270.29
|
| Rate for Payer: Frontpath All Commercial |
$1,269.60
|
| Rate for Payer: Humana ChoiceCare |
$1,191.91
|
| Rate for Payer: Humana Medicare |
$703.80
|
| Rate for Payer: Lucent All Commercial |
$703.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,242.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,035.00
|
| Rate for Payer: PHP All Commercial |
$1,046.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$538.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,065.36
|
| Rate for Payer: Signature Care EPO |
$1,145.40
|
| Rate for Payer: Signature Care PPO |
$1,214.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,173.00
|
| Rate for Payer: United Healthcare Commercial |
$1,087.44
|
| Rate for Payer: United Healthcare Medicare |
$455.40
|
|
|
HC ACU 2.7X55 LOCK HEX SCREW
|
Facility
IP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Aetna Commercial |
$1,192.32
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cigna All Commercial |
$1,190.94
|
| Rate for Payer: CORVEL All Commercial |
$1,283.40
|
| Rate for Payer: Coventry All Commercial |
$1,214.40
|
| Rate for Payer: Encore All Commercial |
$1,270.29
|
| Rate for Payer: Frontpath All Commercial |
$1,269.60
|
| Rate for Payer: Humana ChoiceCare |
$1,191.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,242.00
|
| Rate for Payer: PHCS All Commercial |
$1,035.00
|
| Rate for Payer: PHP All Commercial |
$1,046.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,065.36
|
| Rate for Payer: Signature Care EPO |
$1,145.40
|
| Rate for Payer: Signature Care PPO |
$1,214.40
|
| Rate for Payer: United Healthcare Commercial |
$1,087.44
|
|
|
HC ACU 2.7X55 NON-LOCK HEX SCREW
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$827.70 |
| Rate for Payer: Aetna Commercial |
$768.96
|
| Rate for Payer: Cash Price |
$551.80
|
| Rate for Payer: Cigna All Commercial |
$768.07
|
| Rate for Payer: CORVEL All Commercial |
$827.70
|
| Rate for Payer: Coventry All Commercial |
$783.20
|
| Rate for Payer: Encore All Commercial |
$819.24
|
| Rate for Payer: Frontpath All Commercial |
$818.80
|
| Rate for Payer: Humana ChoiceCare |
$768.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.00
|
| Rate for Payer: PHCS All Commercial |
$667.50
|
| Rate for Payer: PHP All Commercial |
$674.98
|
| Rate for Payer: Sagamore Health Network All Products |
$687.08
|
| Rate for Payer: Signature Care EPO |
$738.70
|
| Rate for Payer: Signature Care PPO |
$783.20
|
| Rate for Payer: United Healthcare Commercial |
$701.32
|
|
|
HC ACU 2.7X55 NON-LOCK HEX SCREW
|
Facility
OP
|
$890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.70 |
| Max. Negotiated Rate |
$827.70 |
| Rate for Payer: Aetna Commercial |
$751.16
|
| Rate for Payer: Aetna Medicare |
$293.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$293.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$511.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$556.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$337.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.07
|
| Rate for Payer: Cash Price |
$551.80
|
| Rate for Payer: Cash Price |
$551.80
|
| Rate for Payer: Centivo All Commercial |
$453.90
|
| Rate for Payer: Cigna All Commercial |
$768.07
|
| Rate for Payer: CORVEL All Commercial |
$827.70
|
| Rate for Payer: Coventry All Commercial |
$783.20
|
| Rate for Payer: Encore All Commercial |
$819.24
|
| Rate for Payer: Frontpath All Commercial |
$818.80
|
| Rate for Payer: Humana ChoiceCare |
$768.69
|
| Rate for Payer: Humana Medicare |
$453.90
|
| Rate for Payer: Lucent All Commercial |
$453.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$667.50
|
| Rate for Payer: PHP All Commercial |
$674.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$347.10
|
| Rate for Payer: Sagamore Health Network All Products |
$687.08
|
| Rate for Payer: Signature Care EPO |
$738.70
|
| Rate for Payer: Signature Care PPO |
$783.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$756.50
|
| Rate for Payer: United Healthcare Commercial |
$701.32
|
| Rate for Payer: United Healthcare Medicare |
$293.70
|
|
|
HC ACU 2.7X60 LOCK HEX SCREW
|
Facility
OP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Aetna Commercial |
$1,164.72
|
| Rate for Payer: Aetna Medicare |
$455.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$455.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$792.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$862.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$523.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$500.94
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Centivo All Commercial |
$703.80
|
| Rate for Payer: Cigna All Commercial |
$1,190.94
|
| Rate for Payer: CORVEL All Commercial |
$1,283.40
|
| Rate for Payer: Coventry All Commercial |
$1,214.40
|
| Rate for Payer: Encore All Commercial |
$1,270.29
|
| Rate for Payer: Frontpath All Commercial |
$1,269.60
|
| Rate for Payer: Humana ChoiceCare |
$1,191.91
|
| Rate for Payer: Humana Medicare |
$703.80
|
| Rate for Payer: Lucent All Commercial |
$703.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,242.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,035.00
|
| Rate for Payer: PHP All Commercial |
$1,046.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$538.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,065.36
|
| Rate for Payer: Signature Care EPO |
$1,145.40
|
| Rate for Payer: Signature Care PPO |
$1,214.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,173.00
|
| Rate for Payer: United Healthcare Commercial |
$1,087.44
|
| Rate for Payer: United Healthcare Medicare |
$455.40
|
|
|
HC ACU 2.7X60 LOCK HEX SCREW
|
Facility
IP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Aetna Commercial |
$1,192.32
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cigna All Commercial |
$1,190.94
|
| Rate for Payer: CORVEL All Commercial |
$1,283.40
|
| Rate for Payer: Coventry All Commercial |
$1,214.40
|
| Rate for Payer: Encore All Commercial |
$1,270.29
|
| Rate for Payer: Frontpath All Commercial |
$1,269.60
|
| Rate for Payer: Humana ChoiceCare |
$1,191.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,242.00
|
| Rate for Payer: PHCS All Commercial |
$1,035.00
|
| Rate for Payer: PHP All Commercial |
$1,046.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,065.36
|
| Rate for Payer: Signature Care EPO |
$1,145.40
|
| Rate for Payer: Signature Care PPO |
$1,214.40
|
| Rate for Payer: United Healthcare Commercial |
$1,087.44
|
|
|
HC ACU 2.7X60 NON-LOCK HEX SCREW
|
Facility
IP
|
$798.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.50 |
| Max. Negotiated Rate |
$742.14 |
| Rate for Payer: Aetna Commercial |
$689.47
|
| Rate for Payer: Cash Price |
$494.76
|
| Rate for Payer: Cigna All Commercial |
$688.67
|
| Rate for Payer: CORVEL All Commercial |
$742.14
|
| Rate for Payer: Coventry All Commercial |
$702.24
|
| Rate for Payer: Encore All Commercial |
$734.56
|
| Rate for Payer: Frontpath All Commercial |
$734.16
|
| Rate for Payer: Humana ChoiceCare |
$689.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$718.20
|
| Rate for Payer: PHCS All Commercial |
$598.50
|
| Rate for Payer: PHP All Commercial |
$605.20
|
| Rate for Payer: Sagamore Health Network All Products |
$616.06
|
| Rate for Payer: Signature Care EPO |
$662.34
|
| Rate for Payer: Signature Care PPO |
$702.24
|
| Rate for Payer: United Healthcare Commercial |
$628.82
|
|
|
HC ACU 2.7X60 NON-LOCK HEX SCREW
|
Facility
OP
|
$798.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$742.14 |
| Rate for Payer: Aetna Commercial |
$673.51
|
| Rate for Payer: Aetna Medicare |
$263.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$458.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$498.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$302.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$494.76
|
| Rate for Payer: Cash Price |
$494.76
|
| Rate for Payer: Centivo All Commercial |
$406.98
|
| Rate for Payer: Cigna All Commercial |
$688.67
|
| Rate for Payer: CORVEL All Commercial |
$742.14
|
| Rate for Payer: Coventry All Commercial |
$702.24
|
| Rate for Payer: Encore All Commercial |
$734.56
|
| Rate for Payer: Frontpath All Commercial |
$734.16
|
| Rate for Payer: Humana ChoiceCare |
$689.23
|
| Rate for Payer: Humana Medicare |
$406.98
|
| Rate for Payer: Lucent All Commercial |
$406.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$718.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$598.50
|
| Rate for Payer: PHP All Commercial |
$605.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$311.22
|
| Rate for Payer: Sagamore Health Network All Products |
$616.06
|
| Rate for Payer: Signature Care EPO |
$662.34
|
| Rate for Payer: Signature Care PPO |
$702.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$678.30
|
| Rate for Payer: United Healthcare Commercial |
$628.82
|
| Rate for Payer: United Healthcare Medicare |
$263.34
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL DM
|
Facility
IP
|
$790.00
|
|
| Hospital Charge Code |
41603279
|
|
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 2.8 QR SURGIBIT DRILL DM
|
Facility
OP
|
$790.00
|
|
| Hospital Charge Code |
41603279
|
|
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 2 VDR EXT PLATE NEUT
|
Facility
OP
|
$4,435.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,124.74 |
| Rate for Payer: Aetna Commercial |
$3,743.31
|
| Rate for Payer: Aetna Medicare |
$1,463.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,463.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,547.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,772.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,683.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,609.98
|
| Rate for Payer: Cash Price |
$2,749.82
|
| Rate for Payer: Cash Price |
$2,749.82
|
| Rate for Payer: Centivo All Commercial |
$2,261.95
|
| Rate for Payer: Cigna All Commercial |
$3,827.58
|
| Rate for Payer: CORVEL All Commercial |
$4,124.74
|
| Rate for Payer: Coventry All Commercial |
$3,902.98
|
| Rate for Payer: Encore All Commercial |
$4,082.60
|
| Rate for Payer: Frontpath All Commercial |
$4,080.38
|
| Rate for Payer: Humana ChoiceCare |
$3,830.68
|
| Rate for Payer: Humana Medicare |
$2,261.95
|
| Rate for Payer: Lucent All Commercial |
$2,261.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,991.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,326.40
|
| Rate for Payer: PHP All Commercial |
$3,363.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,729.73
|
| Rate for Payer: Sagamore Health Network All Products |
$3,423.97
|
| Rate for Payer: Signature Care EPO |
$3,681.22
|
| Rate for Payer: Signature Care PPO |
$3,902.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,769.92
|
| Rate for Payer: United Healthcare Commercial |
$3,494.94
|
| Rate for Payer: United Healthcare Medicare |
$1,463.62
|
|
|
HC ACU 2 VDR EXT PLATE NEUT
|
Facility
IP
|
$4,435.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.40 |
| Max. Negotiated Rate |
$4,124.74 |
| Rate for Payer: Aetna Commercial |
$3,832.01
|
| Rate for Payer: Cash Price |
$2,749.82
|
| Rate for Payer: Cigna All Commercial |
$3,827.58
|
| Rate for Payer: CORVEL All Commercial |
$4,124.74
|
| Rate for Payer: Coventry All Commercial |
$3,902.98
|
| Rate for Payer: Encore All Commercial |
$4,082.60
|
| Rate for Payer: Frontpath All Commercial |
$4,080.38
|
| Rate for Payer: Humana ChoiceCare |
$3,830.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,991.68
|
| Rate for Payer: PHCS All Commercial |
$3,326.40
|
| Rate for Payer: PHP All Commercial |
$3,363.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3,423.97
|
| Rate for Payer: Signature Care EPO |
$3,681.22
|
| Rate for Payer: Signature Care PPO |
$3,902.98
|
| Rate for Payer: United Healthcare Commercial |
$3,494.94
|
|
|
HC ACU 2 VDR PLT NARR L
|
Facility
IP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.00 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,825.79
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
|
|
HC ACU 2 VDR PLT NARR L
|
Facility
OP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,737.23
|
| Rate for Payer: Aetna Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,543.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,767.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,680.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,607.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Centivo All Commercial |
$2,258.28
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Humana Medicare |
$2,258.28
|
| Rate for Payer: Lucent All Commercial |
$2,258.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,726.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
| Rate for Payer: United Healthcare Medicare |
$1,461.24
|
|
|
HC ACU 2 VDR PLT NARR LONG L
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PLT NARR LONG L
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT NARR LONG R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PLT NARR LONG R
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT NARR R
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT NARR R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PLT STD L
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT STD L
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
