|
HC DS PLATE PROX TIBIS SM 12H L
|
Facility
IP
|
$10,670.15
|
|
| Hospital Charge Code |
41606341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,002.61 |
| Max. Negotiated Rate |
$9,923.24 |
| Rate for Payer: Aetna Commercial |
$9,219.01
|
| Rate for Payer: Cash Price |
$6,615.49
|
| Rate for Payer: Cigna All Commercial |
$9,208.34
|
| Rate for Payer: CORVEL All Commercial |
$9,923.24
|
| Rate for Payer: Coventry All Commercial |
$9,389.73
|
| Rate for Payer: Encore All Commercial |
$9,821.87
|
| Rate for Payer: Frontpath All Commercial |
$9,816.54
|
| Rate for Payer: Humana ChoiceCare |
$9,215.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,603.14
|
| Rate for Payer: PHCS All Commercial |
$8,002.61
|
| Rate for Payer: PHP All Commercial |
$8,092.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8,237.36
|
| Rate for Payer: Signature Care EPO |
$8,856.22
|
| Rate for Payer: Signature Care PPO |
$9,389.73
|
| Rate for Payer: United Healthcare Commercial |
$8,408.08
|
|
|
HC DS PLATE SPR CLV 3.5 6-H L 85
|
Facility
IP
|
$6,490.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,868.10 |
| Max. Negotiated Rate |
$6,036.44 |
| Rate for Payer: Aetna Commercial |
$5,608.05
|
| Rate for Payer: Cash Price |
$4,024.30
|
| Rate for Payer: Cigna All Commercial |
$5,601.56
|
| Rate for Payer: CORVEL All Commercial |
$6,036.44
|
| Rate for Payer: Coventry All Commercial |
$5,711.90
|
| Rate for Payer: Encore All Commercial |
$5,974.78
|
| Rate for Payer: Frontpath All Commercial |
$5,971.54
|
| Rate for Payer: Humana ChoiceCare |
$5,606.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,841.72
|
| Rate for Payer: PHCS All Commercial |
$4,868.10
|
| Rate for Payer: PHP All Commercial |
$4,922.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,010.90
|
| Rate for Payer: Signature Care EPO |
$5,387.36
|
| Rate for Payer: Signature Care PPO |
$5,711.90
|
| Rate for Payer: United Healthcare Commercial |
$5,114.75
|
|
|
HC DS PLATE SPR CLV 3.5 6-H L 85
|
Facility
OP
|
$6,490.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,036.44 |
| Rate for Payer: Aetna Commercial |
$5,478.24
|
| Rate for Payer: Aetna Medicare |
$2,141.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,141.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,727.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,057.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,463.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,356.16
|
| Rate for Payer: Cash Price |
$4,024.30
|
| Rate for Payer: Cash Price |
$4,024.30
|
| Rate for Payer: Centivo All Commercial |
$3,310.31
|
| Rate for Payer: Cigna All Commercial |
$5,601.56
|
| Rate for Payer: CORVEL All Commercial |
$6,036.44
|
| Rate for Payer: Coventry All Commercial |
$5,711.90
|
| Rate for Payer: Encore All Commercial |
$5,974.78
|
| Rate for Payer: Frontpath All Commercial |
$5,971.54
|
| Rate for Payer: Humana ChoiceCare |
$5,606.10
|
| Rate for Payer: Humana Medicare |
$3,310.31
|
| Rate for Payer: Lucent All Commercial |
$3,310.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,841.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,868.10
|
| Rate for Payer: PHP All Commercial |
$4,922.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,531.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,010.90
|
| Rate for Payer: Signature Care EPO |
$5,387.36
|
| Rate for Payer: Signature Care PPO |
$5,711.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,517.18
|
| Rate for Payer: United Healthcare Commercial |
$5,114.75
|
| Rate for Payer: United Healthcare Medicare |
$2,141.96
|
|
|
HC DS PLATE SPR CLV 3.5 6-H R 85
|
Facility
IP
|
$5,644.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,233.60 |
| Max. Negotiated Rate |
$5,249.66 |
| Rate for Payer: Aetna Commercial |
$4,877.11
|
| Rate for Payer: Cash Price |
$3,499.78
|
| Rate for Payer: Cigna All Commercial |
$4,871.46
|
| Rate for Payer: CORVEL All Commercial |
$5,249.66
|
| Rate for Payer: Coventry All Commercial |
$4,967.42
|
| Rate for Payer: Encore All Commercial |
$5,196.04
|
| Rate for Payer: Frontpath All Commercial |
$5,193.22
|
| Rate for Payer: Humana ChoiceCare |
$4,875.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,080.32
|
| Rate for Payer: PHCS All Commercial |
$4,233.60
|
| Rate for Payer: PHP All Commercial |
$4,281.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,357.79
|
| Rate for Payer: Signature Care EPO |
$4,685.18
|
| Rate for Payer: Signature Care PPO |
$4,967.42
|
| Rate for Payer: United Healthcare Commercial |
$4,448.10
|
|
|
HC DS PLATE SPR CLV 3.5 6-H R 85
|
Facility
OP
|
$5,644.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,249.66 |
| Rate for Payer: Aetna Commercial |
$4,764.21
|
| Rate for Payer: Aetna Medicare |
$1,862.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,862.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,241.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,528.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,142.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,049.06
|
| Rate for Payer: Cash Price |
$3,499.78
|
| Rate for Payer: Cash Price |
$3,499.78
|
| Rate for Payer: Centivo All Commercial |
$2,878.85
|
| Rate for Payer: Cigna All Commercial |
$4,871.46
|
| Rate for Payer: CORVEL All Commercial |
$5,249.66
|
| Rate for Payer: Coventry All Commercial |
$4,967.42
|
| Rate for Payer: Encore All Commercial |
$5,196.04
|
| Rate for Payer: Frontpath All Commercial |
$5,193.22
|
| Rate for Payer: Humana ChoiceCare |
$4,875.41
|
| Rate for Payer: Humana Medicare |
$2,878.85
|
| Rate for Payer: Lucent All Commercial |
$2,878.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,080.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,233.60
|
| Rate for Payer: PHP All Commercial |
$4,281.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,201.47
|
| Rate for Payer: Sagamore Health Network All Products |
$4,357.79
|
| Rate for Payer: Signature Care EPO |
$4,685.18
|
| Rate for Payer: Signature Care PPO |
$4,967.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,798.08
|
| Rate for Payer: United Healthcare Commercial |
$4,448.10
|
| Rate for Payer: United Healthcare Medicare |
$1,862.78
|
|
|
HC DS PLATE SPR CLV 3.5 7-H R 100
|
Facility
OP
|
$5,788.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,383.58 |
| Rate for Payer: Aetna Commercial |
$4,885.75
|
| Rate for Payer: Aetna Medicare |
$1,910.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,910.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,324.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,618.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,196.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,101.33
|
| Rate for Payer: Cash Price |
$3,589.06
|
| Rate for Payer: Cash Price |
$3,589.06
|
| Rate for Payer: Centivo All Commercial |
$2,952.29
|
| Rate for Payer: Cigna All Commercial |
$4,995.73
|
| Rate for Payer: CORVEL All Commercial |
$5,383.58
|
| Rate for Payer: Coventry All Commercial |
$5,094.14
|
| Rate for Payer: Encore All Commercial |
$5,328.59
|
| Rate for Payer: Frontpath All Commercial |
$5,325.70
|
| Rate for Payer: Humana ChoiceCare |
$4,999.79
|
| Rate for Payer: Humana Medicare |
$2,952.29
|
| Rate for Payer: Lucent All Commercial |
$2,952.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,209.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,341.60
|
| Rate for Payer: PHP All Commercial |
$4,390.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,257.63
|
| Rate for Payer: Sagamore Health Network All Products |
$4,468.95
|
| Rate for Payer: Signature Care EPO |
$4,804.70
|
| Rate for Payer: Signature Care PPO |
$5,094.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,920.48
|
| Rate for Payer: United Healthcare Commercial |
$4,561.57
|
| Rate for Payer: United Healthcare Medicare |
$1,910.30
|
|
|
HC DS PLATE SPR CLV 3.5 7-H R 100
|
Facility
IP
|
$5,788.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,341.60 |
| Max. Negotiated Rate |
$5,383.58 |
| Rate for Payer: Aetna Commercial |
$5,001.52
|
| Rate for Payer: Cash Price |
$3,589.06
|
| Rate for Payer: Cigna All Commercial |
$4,995.73
|
| Rate for Payer: CORVEL All Commercial |
$5,383.58
|
| Rate for Payer: Coventry All Commercial |
$5,094.14
|
| Rate for Payer: Encore All Commercial |
$5,328.59
|
| Rate for Payer: Frontpath All Commercial |
$5,325.70
|
| Rate for Payer: Humana ChoiceCare |
$4,999.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,209.92
|
| Rate for Payer: PHCS All Commercial |
$4,341.60
|
| Rate for Payer: PHP All Commercial |
$4,390.23
|
| Rate for Payer: Sagamore Health Network All Products |
$4,468.95
|
| Rate for Payer: Signature Care EPO |
$4,804.70
|
| Rate for Payer: Signature Care PPO |
$5,094.14
|
| Rate for Payer: United Healthcare Commercial |
$4,561.57
|
|
|
HC DS PLATE SPR CLV 3.5 8-H R 115
|
Facility
IP
|
$6,534.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,900.50 |
| Max. Negotiated Rate |
$6,076.62 |
| Rate for Payer: Aetna Commercial |
$5,645.38
|
| Rate for Payer: Cash Price |
$4,051.08
|
| Rate for Payer: Cigna All Commercial |
$5,638.84
|
| Rate for Payer: CORVEL All Commercial |
$6,076.62
|
| Rate for Payer: Coventry All Commercial |
$5,749.92
|
| Rate for Payer: Encore All Commercial |
$6,014.55
|
| Rate for Payer: Frontpath All Commercial |
$6,011.28
|
| Rate for Payer: Humana ChoiceCare |
$5,643.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,880.60
|
| Rate for Payer: PHCS All Commercial |
$4,900.50
|
| Rate for Payer: PHP All Commercial |
$4,955.39
|
| Rate for Payer: Sagamore Health Network All Products |
$5,044.25
|
| Rate for Payer: Signature Care EPO |
$5,423.22
|
| Rate for Payer: Signature Care PPO |
$5,749.92
|
| Rate for Payer: United Healthcare Commercial |
$5,148.79
|
|
|
HC DS PLATE SPR CLV 3.5 8-H R 115
|
Facility
OP
|
$6,534.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,076.62 |
| Rate for Payer: Aetna Commercial |
$5,514.70
|
| Rate for Payer: Aetna Medicare |
$2,156.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,156.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,752.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,084.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,479.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,371.84
|
| Rate for Payer: Cash Price |
$4,051.08
|
| Rate for Payer: Cash Price |
$4,051.08
|
| Rate for Payer: Centivo All Commercial |
$3,332.34
|
| Rate for Payer: Cigna All Commercial |
$5,638.84
|
| Rate for Payer: CORVEL All Commercial |
$6,076.62
|
| Rate for Payer: Coventry All Commercial |
$5,749.92
|
| Rate for Payer: Encore All Commercial |
$6,014.55
|
| Rate for Payer: Frontpath All Commercial |
$6,011.28
|
| Rate for Payer: Humana ChoiceCare |
$5,643.42
|
| Rate for Payer: Humana Medicare |
$3,332.34
|
| Rate for Payer: Lucent All Commercial |
$3,332.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,880.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,900.50
|
| Rate for Payer: PHP All Commercial |
$4,955.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,548.26
|
| Rate for Payer: Sagamore Health Network All Products |
$5,044.25
|
| Rate for Payer: Signature Care EPO |
$5,423.22
|
| Rate for Payer: Signature Care PPO |
$5,749.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,553.90
|
| Rate for Payer: United Healthcare Commercial |
$5,148.79
|
| Rate for Payer: United Healthcare Medicare |
$2,156.22
|
|
|
HC DS REAMING ROD 3X950
|
Facility
OP
|
$1,392.00
|
|
| Hospital Charge Code |
41607105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,294.56 |
| Rate for Payer: Aetna Commercial |
$1,174.85
|
| Rate for Payer: Aetna Medicare |
$459.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$459.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$799.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$870.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$528.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$505.30
|
| Rate for Payer: Cash Price |
$863.04
|
| Rate for Payer: Cash Price |
$863.04
|
| Rate for Payer: Centivo All Commercial |
$709.92
|
| Rate for Payer: Cigna All Commercial |
$1,201.30
|
| Rate for Payer: CORVEL All Commercial |
$1,294.56
|
| Rate for Payer: Coventry All Commercial |
$1,224.96
|
| Rate for Payer: Encore All Commercial |
$1,281.34
|
| Rate for Payer: Frontpath All Commercial |
$1,280.64
|
| Rate for Payer: Humana ChoiceCare |
$1,202.27
|
| Rate for Payer: Humana Medicare |
$709.92
|
| Rate for Payer: Lucent All Commercial |
$709.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,252.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,044.00
|
| Rate for Payer: PHP All Commercial |
$1,055.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$542.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,074.62
|
| Rate for Payer: Signature Care EPO |
$1,155.36
|
| Rate for Payer: Signature Care PPO |
$1,224.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,183.20
|
| Rate for Payer: United Healthcare Commercial |
$1,096.90
|
| Rate for Payer: United Healthcare Medicare |
$459.36
|
|
|
HC DS REAMING ROD 3X950
|
Facility
IP
|
$1,392.00
|
|
| Hospital Charge Code |
41607105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,044.00 |
| Max. Negotiated Rate |
$1,294.56 |
| Rate for Payer: Aetna Commercial |
$1,202.69
|
| Rate for Payer: Cash Price |
$863.04
|
| Rate for Payer: Cigna All Commercial |
$1,201.30
|
| Rate for Payer: CORVEL All Commercial |
$1,294.56
|
| Rate for Payer: Coventry All Commercial |
$1,224.96
|
| Rate for Payer: Encore All Commercial |
$1,281.34
|
| Rate for Payer: Frontpath All Commercial |
$1,280.64
|
| Rate for Payer: Humana ChoiceCare |
$1,202.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,252.80
|
| Rate for Payer: PHCS All Commercial |
$1,044.00
|
| Rate for Payer: PHP All Commercial |
$1,055.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,074.62
|
| Rate for Payer: Signature Care EPO |
$1,155.36
|
| Rate for Payer: Signature Care PPO |
$1,224.96
|
| Rate for Payer: United Healthcare Commercial |
$1,096.90
|
|
|
HC DS SCREW 2.7X14 CRTX
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
|
|
HC DS SCREW 2.7X14 CRTX
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Aetna Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$281.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$306.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.87
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Centivo All Commercial |
$249.90
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Humana Medicare |
$249.90
|
| Rate for Payer: Lucent All Commercial |
$249.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.10
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$416.50
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
|
|
HC DS SCREW 2.7X20 LOCK ST
|
Facility
OP
|
$1,070.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.33 |
| Max. Negotiated Rate |
$995.75 |
| Rate for Payer: Aetna Commercial |
$903.67
|
| Rate for Payer: Aetna Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.66
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Centivo All Commercial |
$546.06
|
| Rate for Payer: Cigna All Commercial |
$924.01
|
| Rate for Payer: CORVEL All Commercial |
$995.75
|
| Rate for Payer: Coventry All Commercial |
$942.22
|
| Rate for Payer: Encore All Commercial |
$985.58
|
| Rate for Payer: Frontpath All Commercial |
$985.04
|
| Rate for Payer: Humana ChoiceCare |
$924.76
|
| Rate for Payer: Humana Medicare |
$546.06
|
| Rate for Payer: Lucent All Commercial |
$546.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.63
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$803.02
|
| Rate for Payer: PHP All Commercial |
$812.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.57
|
| Rate for Payer: Sagamore Health Network All Products |
$826.58
|
| Rate for Payer: Signature Care EPO |
$888.68
|
| Rate for Payer: Signature Care PPO |
$942.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$910.10
|
| Rate for Payer: United Healthcare Commercial |
$843.71
|
| Rate for Payer: United Healthcare Medicare |
$353.33
|
|
|
HC DS SCREW 2.7X20 LOCK ST
|
Facility
IP
|
$1,070.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.02 |
| Max. Negotiated Rate |
$995.75 |
| Rate for Payer: Aetna Commercial |
$925.08
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Cigna All Commercial |
$924.01
|
| Rate for Payer: CORVEL All Commercial |
$995.75
|
| Rate for Payer: Coventry All Commercial |
$942.22
|
| Rate for Payer: Encore All Commercial |
$985.58
|
| Rate for Payer: Frontpath All Commercial |
$985.04
|
| Rate for Payer: Humana ChoiceCare |
$924.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.63
|
| Rate for Payer: PHCS All Commercial |
$803.02
|
| Rate for Payer: PHP All Commercial |
$812.02
|
| Rate for Payer: Sagamore Health Network All Products |
$826.58
|
| Rate for Payer: Signature Care EPO |
$888.68
|
| Rate for Payer: Signature Care PPO |
$942.22
|
| Rate for Payer: United Healthcare Commercial |
$843.71
|
|
|
HC DS SCREW 2.7X22 META ST
|
Facility
OP
|
$482.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.14 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.00
|
| Rate for Payer: Aetna Medicare |
$159.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$276.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.05
|
| Rate for Payer: Cash Price |
$298.98
|
| Rate for Payer: Cash Price |
$298.98
|
| Rate for Payer: Centivo All Commercial |
$245.94
|
| Rate for Payer: Cigna All Commercial |
$416.16
|
| Rate for Payer: CORVEL All Commercial |
$448.47
|
| Rate for Payer: Coventry All Commercial |
$424.36
|
| Rate for Payer: Encore All Commercial |
$443.89
|
| Rate for Payer: Frontpath All Commercial |
$443.65
|
| Rate for Payer: Humana ChoiceCare |
$416.50
|
| Rate for Payer: Humana Medicare |
$245.94
|
| Rate for Payer: Lucent All Commercial |
$245.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.01
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$361.67
|
| Rate for Payer: PHP All Commercial |
$365.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.07
|
| Rate for Payer: Sagamore Health Network All Products |
$372.28
|
| Rate for Payer: Signature Care EPO |
$400.25
|
| Rate for Payer: Signature Care PPO |
$424.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$409.90
|
| Rate for Payer: United Healthcare Commercial |
$380.00
|
| Rate for Payer: United Healthcare Medicare |
$159.14
|
|
|
HC DS SCREW 2.7X22 META ST
|
Facility
IP
|
$482.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$448.47 |
| Rate for Payer: Aetna Commercial |
$416.65
|
| Rate for Payer: Cash Price |
$298.98
|
| Rate for Payer: Cigna All Commercial |
$416.16
|
| Rate for Payer: CORVEL All Commercial |
$448.47
|
| Rate for Payer: Coventry All Commercial |
$424.36
|
| Rate for Payer: Encore All Commercial |
$443.89
|
| Rate for Payer: Frontpath All Commercial |
$443.65
|
| Rate for Payer: Humana ChoiceCare |
$416.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.01
|
| Rate for Payer: PHCS All Commercial |
$361.67
|
| Rate for Payer: PHP All Commercial |
$365.72
|
| Rate for Payer: Sagamore Health Network All Products |
$372.28
|
| Rate for Payer: Signature Care EPO |
$400.25
|
| Rate for Payer: Signature Care PPO |
$424.36
|
| Rate for Payer: United Healthcare Commercial |
$380.00
|
|
|
HC DS SCREW 2.7X26 CRTX
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$413.56
|
| Rate for Payer: Aetna Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$281.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$306.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.87
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Centivo All Commercial |
$249.90
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Humana Medicare |
$249.90
|
| Rate for Payer: Lucent All Commercial |
$249.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.10
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$416.50
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
|
|
HC DS SCREW 2.7X26 CRTX
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
|
|
HC DS SCREW 2.7X30 LOCK ST
|
Facility
OP
|
$1,070.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.33 |
| Max. Negotiated Rate |
$995.75 |
| Rate for Payer: Aetna Commercial |
$903.67
|
| Rate for Payer: Aetna Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.66
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Centivo All Commercial |
$546.06
|
| Rate for Payer: Cigna All Commercial |
$924.01
|
| Rate for Payer: CORVEL All Commercial |
$995.75
|
| Rate for Payer: Coventry All Commercial |
$942.22
|
| Rate for Payer: Encore All Commercial |
$985.58
|
| Rate for Payer: Frontpath All Commercial |
$985.04
|
| Rate for Payer: Humana ChoiceCare |
$924.76
|
| Rate for Payer: Humana Medicare |
$546.06
|
| Rate for Payer: Lucent All Commercial |
$546.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.63
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$803.02
|
| Rate for Payer: PHP All Commercial |
$812.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.57
|
| Rate for Payer: Sagamore Health Network All Products |
$826.58
|
| Rate for Payer: Signature Care EPO |
$888.68
|
| Rate for Payer: Signature Care PPO |
$942.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$910.10
|
| Rate for Payer: United Healthcare Commercial |
$843.71
|
| Rate for Payer: United Healthcare Medicare |
$353.33
|
|
|
HC DS SCREW 2.7X30 LOCK ST
|
Facility
IP
|
$1,070.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.02 |
| Max. Negotiated Rate |
$995.75 |
| Rate for Payer: Aetna Commercial |
$925.08
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Cigna All Commercial |
$924.01
|
| Rate for Payer: CORVEL All Commercial |
$995.75
|
| Rate for Payer: Coventry All Commercial |
$942.22
|
| Rate for Payer: Encore All Commercial |
$985.58
|
| Rate for Payer: Frontpath All Commercial |
$985.04
|
| Rate for Payer: Humana ChoiceCare |
$924.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.63
|
| Rate for Payer: PHCS All Commercial |
$803.02
|
| Rate for Payer: PHP All Commercial |
$812.02
|
| Rate for Payer: Sagamore Health Network All Products |
$826.58
|
| Rate for Payer: Signature Care EPO |
$888.68
|
| Rate for Payer: Signature Care PPO |
$942.22
|
| Rate for Payer: United Healthcare Commercial |
$843.71
|
|
|
HC DS SCREW 2.7X32 LOCK ST
|
Facility
OP
|
$1,070.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.33 |
| Max. Negotiated Rate |
$995.75 |
| Rate for Payer: Aetna Commercial |
$903.67
|
| Rate for Payer: Aetna Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.66
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Centivo All Commercial |
$546.06
|
| Rate for Payer: Cigna All Commercial |
$924.01
|
| Rate for Payer: CORVEL All Commercial |
$995.75
|
| Rate for Payer: Coventry All Commercial |
$942.22
|
| Rate for Payer: Encore All Commercial |
$985.58
|
| Rate for Payer: Frontpath All Commercial |
$985.04
|
| Rate for Payer: Humana ChoiceCare |
$924.76
|
| Rate for Payer: Humana Medicare |
$546.06
|
| Rate for Payer: Lucent All Commercial |
$546.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.63
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$803.02
|
| Rate for Payer: PHP All Commercial |
$812.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.57
|
| Rate for Payer: Sagamore Health Network All Products |
$826.58
|
| Rate for Payer: Signature Care EPO |
$888.68
|
| Rate for Payer: Signature Care PPO |
$942.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$910.10
|
| Rate for Payer: United Healthcare Commercial |
$843.71
|
| Rate for Payer: United Healthcare Medicare |
$353.33
|
|
|
HC DS SCREW 2.7X32 LOCK ST
|
Facility
IP
|
$1,070.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.02 |
| Max. Negotiated Rate |
$995.75 |
| Rate for Payer: Aetna Commercial |
$925.08
|
| Rate for Payer: Cash Price |
$663.83
|
| Rate for Payer: Cigna All Commercial |
$924.01
|
| Rate for Payer: CORVEL All Commercial |
$995.75
|
| Rate for Payer: Coventry All Commercial |
$942.22
|
| Rate for Payer: Encore All Commercial |
$985.58
|
| Rate for Payer: Frontpath All Commercial |
$985.04
|
| Rate for Payer: Humana ChoiceCare |
$924.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.63
|
| Rate for Payer: PHCS All Commercial |
$803.02
|
| Rate for Payer: PHP All Commercial |
$812.02
|
| Rate for Payer: Sagamore Health Network All Products |
$826.58
|
| Rate for Payer: Signature Care EPO |
$888.68
|
| Rate for Payer: Signature Care PPO |
$942.22
|
| Rate for Payer: United Healthcare Commercial |
$843.71
|
|
|
HC DS SCREW 3.5X10 STARDRIVE LOCK
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
HC DS SCREW 3.5X10 STARDRIVE LOCK
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.10 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$903.08
|
| Rate for Payer: Aetna Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.41
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Centivo All Commercial |
$545.70
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Humana Medicare |
$545.70
|
| Rate for Payer: Lucent All Commercial |
$545.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.30
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
| Rate for Payer: United Healthcare Medicare |
$353.10
|
|
