|
HC ACU 4.0X50 PT CAN HXLB SCREW
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC ACU 4.0X50 PT CAN HXLB SCREW
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU 4.0X55 CAN HEX SCREW
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC ACU 4.0X55 CAN HEX SCREW
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU 4.0X55 PT CAN HXLB SCREW
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU 4.0X55 PT CAN HXLB SCREW
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC ACU 4.0X60 CAN HEX SCREW
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC ACU 4.0X60 CAN HEX SCREW
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU 4.0X60 PT CAN HXLB SCREW
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU 4.0X60 PT CAN HXLB SCREW
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC ACU 70 TENSION BAND PIN
|
Facility
OP
|
$637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$592.41 |
| Rate for Payer: Aetna Commercial |
$537.63
|
| Rate for Payer: Aetna Medicare |
$210.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$365.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$398.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.23
|
| Rate for Payer: Cash Price |
$394.94
|
| Rate for Payer: Cash Price |
$394.94
|
| Rate for Payer: Centivo All Commercial |
$324.87
|
| Rate for Payer: Cigna All Commercial |
$549.73
|
| Rate for Payer: CORVEL All Commercial |
$592.41
|
| Rate for Payer: Coventry All Commercial |
$560.56
|
| Rate for Payer: Encore All Commercial |
$586.36
|
| Rate for Payer: Frontpath All Commercial |
$586.04
|
| Rate for Payer: Humana ChoiceCare |
$550.18
|
| Rate for Payer: Humana Medicare |
$324.87
|
| Rate for Payer: Lucent All Commercial |
$324.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$573.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$477.75
|
| Rate for Payer: PHP All Commercial |
$483.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$248.43
|
| Rate for Payer: Sagamore Health Network All Products |
$491.76
|
| Rate for Payer: Signature Care EPO |
$528.71
|
| Rate for Payer: Signature Care PPO |
$560.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$541.45
|
| Rate for Payer: United Healthcare Commercial |
$501.96
|
| Rate for Payer: United Healthcare Medicare |
$210.21
|
|
|
HC ACU 70 TENSION BAND PIN
|
Facility
IP
|
$637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$592.41 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Cash Price |
$394.94
|
| Rate for Payer: Cigna All Commercial |
$549.73
|
| Rate for Payer: CORVEL All Commercial |
$592.41
|
| Rate for Payer: Coventry All Commercial |
$560.56
|
| Rate for Payer: Encore All Commercial |
$586.36
|
| Rate for Payer: Frontpath All Commercial |
$586.04
|
| Rate for Payer: Humana ChoiceCare |
$550.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$573.30
|
| Rate for Payer: PHCS All Commercial |
$477.75
|
| Rate for Payer: PHP All Commercial |
$483.10
|
| Rate for Payer: Sagamore Health Network All Products |
$491.76
|
| Rate for Payer: Signature Care EPO |
$528.71
|
| Rate for Payer: Signature Care PPO |
$560.56
|
| Rate for Payer: United Healthcare Commercial |
$501.96
|
|
|
HC ACU 90 TENSION BAND PIN
|
Facility
IP
|
$637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$592.41 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Cash Price |
$394.94
|
| Rate for Payer: Cigna All Commercial |
$549.73
|
| Rate for Payer: CORVEL All Commercial |
$592.41
|
| Rate for Payer: Coventry All Commercial |
$560.56
|
| Rate for Payer: Encore All Commercial |
$586.36
|
| Rate for Payer: Frontpath All Commercial |
$586.04
|
| Rate for Payer: Humana ChoiceCare |
$550.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$573.30
|
| Rate for Payer: PHCS All Commercial |
$477.75
|
| Rate for Payer: PHP All Commercial |
$483.10
|
| Rate for Payer: Sagamore Health Network All Products |
$491.76
|
| Rate for Payer: Signature Care EPO |
$528.71
|
| Rate for Payer: Signature Care PPO |
$560.56
|
| Rate for Payer: United Healthcare Commercial |
$501.96
|
|
|
HC ACU 90 TENSION BAND PIN
|
Facility
OP
|
$637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$592.41 |
| Rate for Payer: Aetna Commercial |
$537.63
|
| Rate for Payer: Aetna Medicare |
$210.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$210.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$365.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$398.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.23
|
| Rate for Payer: Cash Price |
$394.94
|
| Rate for Payer: Cash Price |
$394.94
|
| Rate for Payer: Centivo All Commercial |
$324.87
|
| Rate for Payer: Cigna All Commercial |
$549.73
|
| Rate for Payer: CORVEL All Commercial |
$592.41
|
| Rate for Payer: Coventry All Commercial |
$560.56
|
| Rate for Payer: Encore All Commercial |
$586.36
|
| Rate for Payer: Frontpath All Commercial |
$586.04
|
| Rate for Payer: Humana ChoiceCare |
$550.18
|
| Rate for Payer: Humana Medicare |
$324.87
|
| Rate for Payer: Lucent All Commercial |
$324.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$573.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$477.75
|
| Rate for Payer: PHP All Commercial |
$483.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$248.43
|
| Rate for Payer: Sagamore Health Network All Products |
$491.76
|
| Rate for Payer: Signature Care EPO |
$528.71
|
| Rate for Payer: Signature Care PPO |
$560.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$541.45
|
| Rate for Payer: United Healthcare Commercial |
$501.96
|
| Rate for Payer: United Healthcare Medicare |
$210.21
|
|
|
HC ACU ANK SCREW 2.7X8 HEX LOCK
|
Facility
IP
|
$1,022.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$766.50 |
| Max. Negotiated Rate |
$950.46 |
| Rate for Payer: Aetna Commercial |
$883.01
|
| Rate for Payer: Cash Price |
$633.64
|
| Rate for Payer: Cigna All Commercial |
$881.99
|
| Rate for Payer: CORVEL All Commercial |
$950.46
|
| Rate for Payer: Coventry All Commercial |
$899.36
|
| Rate for Payer: Encore All Commercial |
$940.75
|
| Rate for Payer: Frontpath All Commercial |
$940.24
|
| Rate for Payer: Humana ChoiceCare |
$882.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$919.80
|
| Rate for Payer: PHCS All Commercial |
$766.50
|
| Rate for Payer: PHP All Commercial |
$775.08
|
| Rate for Payer: Sagamore Health Network All Products |
$788.98
|
| Rate for Payer: Signature Care EPO |
$848.26
|
| Rate for Payer: Signature Care PPO |
$899.36
|
| Rate for Payer: United Healthcare Commercial |
$805.34
|
|
|
HC ACU ANK SCREW 2.7X8 HEX LOCK
|
Facility
OP
|
$1,022.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.26 |
| Max. Negotiated Rate |
$950.46 |
| Rate for Payer: Aetna Commercial |
$862.57
|
| Rate for Payer: Aetna Medicare |
$337.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$337.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$586.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$638.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$387.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$370.99
|
| Rate for Payer: Cash Price |
$633.64
|
| Rate for Payer: Cash Price |
$633.64
|
| Rate for Payer: Centivo All Commercial |
$521.22
|
| Rate for Payer: Cigna All Commercial |
$881.99
|
| Rate for Payer: CORVEL All Commercial |
$950.46
|
| Rate for Payer: Coventry All Commercial |
$899.36
|
| Rate for Payer: Encore All Commercial |
$940.75
|
| Rate for Payer: Frontpath All Commercial |
$940.24
|
| Rate for Payer: Humana ChoiceCare |
$882.70
|
| Rate for Payer: Humana Medicare |
$521.22
|
| Rate for Payer: Lucent All Commercial |
$521.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$919.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$766.50
|
| Rate for Payer: PHP All Commercial |
$775.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$398.58
|
| Rate for Payer: Sagamore Health Network All Products |
$788.98
|
| Rate for Payer: Signature Care EPO |
$848.26
|
| Rate for Payer: Signature Care PPO |
$899.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$868.70
|
| Rate for Payer: United Healthcare Commercial |
$805.34
|
| Rate for Payer: United Healthcare Medicare |
$337.26
|
|
|
HC ACU CANN SC WASHER 7ODX3.6ID
|
Facility
OP
|
$651.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.83 |
| Max. Negotiated Rate |
$605.43 |
| Rate for Payer: Aetna Commercial |
$549.44
|
| Rate for Payer: Aetna Medicare |
$214.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$247.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$236.31
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Centivo All Commercial |
$332.01
|
| Rate for Payer: Cigna All Commercial |
$561.81
|
| Rate for Payer: CORVEL All Commercial |
$605.43
|
| Rate for Payer: Coventry All Commercial |
$572.88
|
| Rate for Payer: Encore All Commercial |
$599.25
|
| Rate for Payer: Frontpath All Commercial |
$598.92
|
| Rate for Payer: Humana ChoiceCare |
$562.27
|
| Rate for Payer: Humana Medicare |
$332.01
|
| Rate for Payer: Lucent All Commercial |
$332.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$585.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$488.25
|
| Rate for Payer: PHP All Commercial |
$493.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.89
|
| Rate for Payer: Sagamore Health Network All Products |
$502.57
|
| Rate for Payer: Signature Care EPO |
$540.33
|
| Rate for Payer: Signature Care PPO |
$572.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$553.35
|
| Rate for Payer: United Healthcare Commercial |
$512.99
|
| Rate for Payer: United Healthcare Medicare |
$214.83
|
|
|
HC ACU CANN SC WASHER 7ODX3.6ID
|
Facility
IP
|
$651.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$605.43 |
| Rate for Payer: Aetna Commercial |
$562.46
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Cigna All Commercial |
$561.81
|
| Rate for Payer: CORVEL All Commercial |
$605.43
|
| Rate for Payer: Coventry All Commercial |
$572.88
|
| Rate for Payer: Encore All Commercial |
$599.25
|
| Rate for Payer: Frontpath All Commercial |
$598.92
|
| Rate for Payer: Humana ChoiceCare |
$562.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$585.90
|
| Rate for Payer: PHCS All Commercial |
$488.25
|
| Rate for Payer: PHP All Commercial |
$493.72
|
| Rate for Payer: Sagamore Health Network All Products |
$502.57
|
| Rate for Payer: Signature Care EPO |
$540.33
|
| Rate for Payer: Signature Care PPO |
$572.88
|
| Rate for Payer: United Healthcare Commercial |
$512.99
|
|
|
HC ACU DIV RAD STYLOID PLATE
|
Facility
IP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.50 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,276.80
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
HC ACU DIV RAD STYLOID PLATE
|
Facility
OP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,177.80
|
| Rate for Payer: Aetna Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,842.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,094.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,878.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,796.85
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Centivo All Commercial |
$2,524.50
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Humana Medicare |
$2,524.50
|
| Rate for Payer: Lucent All Commercial |
$2,524.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,930.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,207.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Medicare |
$1,633.50
|
|
|
HC ACU DORSAL LUNATE PLATE LT
|
Facility
IP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.50 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,276.80
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
HC ACU DORSAL LUNATE PLATE LT
|
Facility
OP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,177.80
|
| Rate for Payer: Aetna Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,842.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,094.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,878.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,796.85
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Centivo All Commercial |
$2,524.50
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Humana Medicare |
$2,524.50
|
| Rate for Payer: Lucent All Commercial |
$2,524.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,930.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,207.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Medicare |
$1,633.50
|
|
|
HC ACU DORSAL LUNATE PLATE RT
|
Facility
IP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.50 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,276.80
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
|
|
HC ACU DORSAL LUNATE PLATE RT
|
Facility
OP
|
$4,950.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,603.50 |
| Rate for Payer: Aetna Commercial |
$4,177.80
|
| Rate for Payer: Aetna Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,633.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,842.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,094.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,878.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,796.85
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Cash Price |
$3,069.00
|
| Rate for Payer: Centivo All Commercial |
$2,524.50
|
| Rate for Payer: Cigna All Commercial |
$4,271.85
|
| Rate for Payer: CORVEL All Commercial |
$4,603.50
|
| Rate for Payer: Coventry All Commercial |
$4,356.00
|
| Rate for Payer: Encore All Commercial |
$4,556.48
|
| Rate for Payer: Frontpath All Commercial |
$4,554.00
|
| Rate for Payer: Humana ChoiceCare |
$4,275.32
|
| Rate for Payer: Humana Medicare |
$2,524.50
|
| Rate for Payer: Lucent All Commercial |
$2,524.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,455.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,712.50
|
| Rate for Payer: PHP All Commercial |
$3,754.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,930.50
|
| Rate for Payer: Sagamore Health Network All Products |
$3,821.40
|
| Rate for Payer: Signature Care EPO |
$4,108.50
|
| Rate for Payer: Signature Care PPO |
$4,356.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,207.50
|
| Rate for Payer: United Healthcare Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare Medicare |
$1,633.50
|
|
|
HC ACU DORSAL PLATE NARR LT
|
Facility
IP
|
$5,382.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,036.50 |
| Max. Negotiated Rate |
$5,005.26 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Cash Price |
$3,336.84
|
| Rate for Payer: Cigna All Commercial |
$4,644.67
|
| Rate for Payer: CORVEL All Commercial |
$5,005.26
|
| Rate for Payer: Coventry All Commercial |
$4,736.16
|
| Rate for Payer: Encore All Commercial |
$4,954.13
|
| Rate for Payer: Frontpath All Commercial |
$4,951.44
|
| Rate for Payer: Humana ChoiceCare |
$4,648.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,843.80
|
| Rate for Payer: PHCS All Commercial |
$4,036.50
|
| Rate for Payer: PHP All Commercial |
$4,081.71
|
| Rate for Payer: Sagamore Health Network All Products |
$4,154.90
|
| Rate for Payer: Signature Care EPO |
$4,467.06
|
| Rate for Payer: Signature Care PPO |
$4,736.16
|
| Rate for Payer: United Healthcare Commercial |
$4,241.02
|
|
