|
HC ACU SCREW 3.5X30 NL LP HEX
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$531.72
|
| Rate for Payer: Aetna Medicare |
$207.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$361.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.69
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Centivo All Commercial |
$321.30
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.92
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Humana Medicare |
$321.30
|
| Rate for Payer: Lucent All Commercial |
$321.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.70
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$535.50
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
| Rate for Payer: United Healthcare Medicare |
$207.90
|
|
|
HC ACU SCREW 3.5X30 NL LP HEX
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$544.32
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.92
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
|
|
HC ACU SCREW 3.5X32 NL LP HEX
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$544.32
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.92
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
|
|
HC ACU SCREW 3.5X32 NL LP HEX
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$531.72
|
| Rate for Payer: Aetna Medicare |
$207.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$361.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.69
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Centivo All Commercial |
$321.30
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.92
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Humana Medicare |
$321.30
|
| Rate for Payer: Lucent All Commercial |
$321.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.70
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$535.50
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
| Rate for Payer: United Healthcare Medicare |
$207.90
|
|
|
HC ACU SCREW 3.5X36 NL LP HEX
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$531.72
|
| Rate for Payer: Aetna Medicare |
$207.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$361.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.69
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Centivo All Commercial |
$321.30
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.92
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Humana Medicare |
$321.30
|
| Rate for Payer: Lucent All Commercial |
$321.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.70
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$535.50
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
| Rate for Payer: United Healthcare Medicare |
$207.90
|
|
|
HC ACU SCREW 3.5X36 NL LP HEX
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$544.32
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.92
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
|
|
HC ACU SCREW 3.5X8 HEX NON-LOCK
|
Facility
OP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.97 |
| Max. Negotiated Rate |
$566.37 |
| Rate for Payer: Aetna Commercial |
$514.00
|
| Rate for Payer: Aetna Medicare |
$200.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$349.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.07
|
| Rate for Payer: Cash Price |
$377.58
|
| Rate for Payer: Cash Price |
$377.58
|
| Rate for Payer: Centivo All Commercial |
$310.59
|
| Rate for Payer: Cigna All Commercial |
$525.57
|
| Rate for Payer: CORVEL All Commercial |
$566.37
|
| Rate for Payer: Coventry All Commercial |
$535.92
|
| Rate for Payer: Encore All Commercial |
$560.58
|
| Rate for Payer: Frontpath All Commercial |
$560.28
|
| Rate for Payer: Humana ChoiceCare |
$525.99
|
| Rate for Payer: Humana Medicare |
$310.59
|
| Rate for Payer: Lucent All Commercial |
$310.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$548.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$456.75
|
| Rate for Payer: PHP All Commercial |
$461.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$237.51
|
| Rate for Payer: Sagamore Health Network All Products |
$470.15
|
| Rate for Payer: Signature Care EPO |
$505.47
|
| Rate for Payer: Signature Care PPO |
$535.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$517.65
|
| Rate for Payer: United Healthcare Commercial |
$479.89
|
| Rate for Payer: United Healthcare Medicare |
$200.97
|
|
|
HC ACU SCREW 3.5X8 HEX NON-LOCK
|
Facility
IP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$566.37 |
| Rate for Payer: Aetna Commercial |
$526.18
|
| Rate for Payer: Cash Price |
$377.58
|
| Rate for Payer: Cigna All Commercial |
$525.57
|
| Rate for Payer: CORVEL All Commercial |
$566.37
|
| Rate for Payer: Coventry All Commercial |
$535.92
|
| Rate for Payer: Encore All Commercial |
$560.58
|
| Rate for Payer: Frontpath All Commercial |
$560.28
|
| Rate for Payer: Humana ChoiceCare |
$525.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$548.10
|
| Rate for Payer: PHCS All Commercial |
$456.75
|
| Rate for Payer: PHP All Commercial |
$461.87
|
| Rate for Payer: Sagamore Health Network All Products |
$470.15
|
| Rate for Payer: Signature Care EPO |
$505.47
|
| Rate for Payer: Signature Care PPO |
$535.92
|
| Rate for Payer: United Healthcare Commercial |
$479.89
|
|
|
HC ACU SCREW 4.3X34 LP HEX
|
Facility
OP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC ACU SCREW 4.3X34 LP HEX
|
Facility
IP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC ACU SCREW 4.3X36 LP HEX
|
Facility
IP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC ACU SCREW 4.3X36 LP HEX
|
Facility
OP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC ACU SCREW 4.3X38 LP HEX
|
Facility
OP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC ACU SCREW 4.3X38 LP HEX
|
Facility
IP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC ACU SCREW 4.3X46 LP HEX
|
Facility
OP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$838.94
|
| Rate for Payer: Aetna Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$328.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$621.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Centivo All Commercial |
$506.94
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Humana Medicare |
$506.94
|
| Rate for Payer: Lucent All Commercial |
$506.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.66
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.90
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
| Rate for Payer: United Healthcare Medicare |
$328.02
|
|
|
HC ACU SCREW 4.3X46 LP HEX
|
Facility
IP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$924.42 |
| Rate for Payer: Aetna Commercial |
$858.82
|
| Rate for Payer: Cash Price |
$616.28
|
| Rate for Payer: Cigna All Commercial |
$857.82
|
| Rate for Payer: CORVEL All Commercial |
$924.42
|
| Rate for Payer: Coventry All Commercial |
$874.72
|
| Rate for Payer: Encore All Commercial |
$914.98
|
| Rate for Payer: Frontpath All Commercial |
$914.48
|
| Rate for Payer: Humana ChoiceCare |
$858.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$894.60
|
| Rate for Payer: PHCS All Commercial |
$745.50
|
| Rate for Payer: PHP All Commercial |
$753.85
|
| Rate for Payer: Sagamore Health Network All Products |
$767.37
|
| Rate for Payer: Signature Care EPO |
$825.02
|
| Rate for Payer: Signature Care PPO |
$874.72
|
| Rate for Payer: United Healthcare Commercial |
$783.27
|
|
|
HC ACUTE CARE ROOM
|
Facility
IP
|
$1,644.24
|
|
| Hospital Charge Code |
10010051
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,233.18 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$1,420.62
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,285.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,777.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,613.50
|
| Rate for Payer: Cash Price |
$1,019.43
|
| Rate for Payer: Cash Price |
$1,019.43
|
| Rate for Payer: Centivo All Commercial |
$3,613.50
|
| Rate for Payer: Cigna All Commercial |
$1,418.98
|
| Rate for Payer: CORVEL All Commercial |
$1,529.14
|
| Rate for Payer: Coventry All Commercial |
$1,446.93
|
| Rate for Payer: Encore All Commercial |
$1,513.52
|
| Rate for Payer: Frontpath All Commercial |
$1,512.70
|
| Rate for Payer: Humana ChoiceCare |
$1,420.13
|
| Rate for Payer: Humana Medicare |
$3,285.00
|
| Rate for Payer: Lucent All Commercial |
$5,584.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.82
|
| Rate for Payer: PHCS All Commercial |
$1,233.18
|
| Rate for Payer: PHP All Commercial |
$1,246.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,269.35
|
| Rate for Payer: Signature Care EPO |
$1,364.72
|
| Rate for Payer: Signature Care PPO |
$1,446.93
|
| Rate for Payer: United Healthcare Commercial |
$1,295.66
|
| Rate for Payer: United Healthcare Medicare |
$3,285.00
|
|
|
HC ACU T FRAG PLATE 2.7MM
|
Facility
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Aetna Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,350.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$819.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.08
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Centivo All Commercial |
$1,101.60
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Humana Medicare |
$1,101.60
|
| Rate for Payer: Lucent All Commercial |
$1,101.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare Medicare |
$712.80
|
|
|
HC ACU T FRAG PLATE 2.7MM
|
Facility
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,866.24
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
|
|
HC ACU VDR HEX EXT LINK SCREW
|
Facility
OP
|
$1,570.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.10 |
| Max. Negotiated Rate |
$1,460.10 |
| Rate for Payer: Aetna Commercial |
$1,325.08
|
| Rate for Payer: Aetna Medicare |
$518.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$518.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$901.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$981.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$595.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$569.91
|
| Rate for Payer: Cash Price |
$973.40
|
| Rate for Payer: Cash Price |
$973.40
|
| Rate for Payer: Centivo All Commercial |
$800.70
|
| Rate for Payer: Cigna All Commercial |
$1,354.91
|
| Rate for Payer: CORVEL All Commercial |
$1,460.10
|
| Rate for Payer: Coventry All Commercial |
$1,381.60
|
| Rate for Payer: Encore All Commercial |
$1,445.18
|
| Rate for Payer: Frontpath All Commercial |
$1,444.40
|
| Rate for Payer: Humana ChoiceCare |
$1,356.01
|
| Rate for Payer: Humana Medicare |
$800.70
|
| Rate for Payer: Lucent All Commercial |
$800.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,413.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,177.50
|
| Rate for Payer: PHP All Commercial |
$1,190.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,212.04
|
| Rate for Payer: Signature Care EPO |
$1,303.10
|
| Rate for Payer: Signature Care PPO |
$1,381.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,334.50
|
| Rate for Payer: United Healthcare Commercial |
$1,237.16
|
| Rate for Payer: United Healthcare Medicare |
$518.10
|
|
|
HC ACU VDR HEX EXT LINK SCREW
|
Facility
IP
|
$1,570.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.50 |
| Max. Negotiated Rate |
$1,460.10 |
| Rate for Payer: Aetna Commercial |
$1,356.48
|
| Rate for Payer: Cash Price |
$973.40
|
| Rate for Payer: Cigna All Commercial |
$1,354.91
|
| Rate for Payer: CORVEL All Commercial |
$1,460.10
|
| Rate for Payer: Coventry All Commercial |
$1,381.60
|
| Rate for Payer: Encore All Commercial |
$1,445.18
|
| Rate for Payer: Frontpath All Commercial |
$1,444.40
|
| Rate for Payer: Humana ChoiceCare |
$1,356.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,413.00
|
| Rate for Payer: PHCS All Commercial |
$1,177.50
|
| Rate for Payer: PHP All Commercial |
$1,190.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,212.04
|
| Rate for Payer: Signature Care EPO |
$1,303.10
|
| Rate for Payer: Signature Care PPO |
$1,381.60
|
| Rate for Payer: United Healthcare Commercial |
$1,237.16
|
|
|
HC ACU VDU PLATE LEFT LONG
|
Facility
OP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,679.14
|
| Rate for Payer: Aetna Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,183.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,465.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,103.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,012.47
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Centivo All Commercial |
$2,827.44
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Humana Medicare |
$2,827.44
|
| Rate for Payer: Lucent All Commercial |
$2,827.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,162.16
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,712.40
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
| Rate for Payer: United Healthcare Medicare |
$1,829.52
|
|
|
HC ACU VDU PLATE LEFT LONG
|
Facility
IP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,158.00 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,790.02
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
|
|
HC ACU VDU PLATE LEFT STD
|
Facility
IP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,158.00 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,790.02
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
|
|
HC ACU VDU PLATE LEFT STD
|
Facility
OP
|
$5,544.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,155.92 |
| Rate for Payer: Aetna Commercial |
$4,679.14
|
| Rate for Payer: Aetna Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,829.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,183.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,465.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,103.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,012.47
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Cash Price |
$3,437.28
|
| Rate for Payer: Centivo All Commercial |
$2,827.44
|
| Rate for Payer: Cigna All Commercial |
$4,784.47
|
| Rate for Payer: CORVEL All Commercial |
$5,155.92
|
| Rate for Payer: Coventry All Commercial |
$4,878.72
|
| Rate for Payer: Encore All Commercial |
$5,103.25
|
| Rate for Payer: Frontpath All Commercial |
$5,100.48
|
| Rate for Payer: Humana ChoiceCare |
$4,788.35
|
| Rate for Payer: Humana Medicare |
$2,827.44
|
| Rate for Payer: Lucent All Commercial |
$2,827.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,989.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,158.00
|
| Rate for Payer: PHP All Commercial |
$4,204.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,162.16
|
| Rate for Payer: Sagamore Health Network All Products |
$4,279.97
|
| Rate for Payer: Signature Care EPO |
$4,601.52
|
| Rate for Payer: Signature Care PPO |
$4,878.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,712.40
|
| Rate for Payer: United Healthcare Commercial |
$4,368.67
|
| Rate for Payer: United Healthcare Medicare |
$1,829.52
|
|
