|
HC DS SCREW 3.5X14 CRTX
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.72
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Centivo All Commercial |
$149.94
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Humana Medicare |
$149.94
|
| Rate for Payer: Lucent All Commercial |
$149.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.66
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
|
|
HC DS SCREW 3.5X14 CRTX
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
|
|
HC DS SCREW 3.5X14 LOCK
|
Facility
IP
|
$1,145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.75 |
| Max. Negotiated Rate |
$1,064.85 |
| Rate for Payer: Aetna Commercial |
$989.28
|
| Rate for Payer: Cash Price |
$709.90
|
| Rate for Payer: Cigna All Commercial |
$988.14
|
| Rate for Payer: CORVEL All Commercial |
$1,064.85
|
| Rate for Payer: Coventry All Commercial |
$1,007.60
|
| Rate for Payer: Encore All Commercial |
$1,053.97
|
| Rate for Payer: Frontpath All Commercial |
$1,053.40
|
| Rate for Payer: Humana ChoiceCare |
$988.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,030.50
|
| Rate for Payer: PHCS All Commercial |
$858.75
|
| Rate for Payer: PHP All Commercial |
$868.37
|
| Rate for Payer: Sagamore Health Network All Products |
$883.94
|
| Rate for Payer: Signature Care EPO |
$950.35
|
| Rate for Payer: Signature Care PPO |
$1,007.60
|
| Rate for Payer: United Healthcare Commercial |
$902.26
|
|
|
HC DS SCREW 3.5X14 LOCK
|
Facility
OP
|
$1,145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$377.85 |
| Max. Negotiated Rate |
$1,064.85 |
| Rate for Payer: Aetna Commercial |
$966.38
|
| Rate for Payer: Aetna Medicare |
$377.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$377.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$657.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$715.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$434.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$415.64
|
| Rate for Payer: Cash Price |
$709.90
|
| Rate for Payer: Cash Price |
$709.90
|
| Rate for Payer: Centivo All Commercial |
$583.95
|
| Rate for Payer: Cigna All Commercial |
$988.14
|
| Rate for Payer: CORVEL All Commercial |
$1,064.85
|
| Rate for Payer: Coventry All Commercial |
$1,007.60
|
| Rate for Payer: Encore All Commercial |
$1,053.97
|
| Rate for Payer: Frontpath All Commercial |
$1,053.40
|
| Rate for Payer: Humana ChoiceCare |
$988.94
|
| Rate for Payer: Humana Medicare |
$583.95
|
| Rate for Payer: Lucent All Commercial |
$583.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,030.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$858.75
|
| Rate for Payer: PHP All Commercial |
$868.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$446.55
|
| Rate for Payer: Sagamore Health Network All Products |
$883.94
|
| Rate for Payer: Signature Care EPO |
$950.35
|
| Rate for Payer: Signature Care PPO |
$1,007.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$973.25
|
| Rate for Payer: United Healthcare Commercial |
$902.26
|
| Rate for Payer: United Healthcare Medicare |
$377.85
|
|
|
HC DS SCREW 3.5X16 CRTX
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
|
|
HC DS SCREW 3.5X16 CRTX
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.72
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Centivo All Commercial |
$149.94
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Humana Medicare |
$149.94
|
| Rate for Payer: Lucent All Commercial |
$149.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.66
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
|
|
HC DS SCREW 3.5X16 STARDRIVE LOCK
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603974
|
|
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 3.5X16 STARDRIVE LOCK
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603974
|
|
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
|
|
|
HC DS SCREW 3.5X18 CRTX
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
|
|
HC DS SCREW 3.5X18 CRTX
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.72
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Centivo All Commercial |
$149.94
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Humana Medicare |
$149.94
|
| Rate for Payer: Lucent All Commercial |
$149.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.66
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
|
|
HC DS SCREW 3.5X18 STARDRIVE LOCK
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603981
|
|
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 3.5X18 STARDRIVE LOCK
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603981
|
|
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
|
|
|
HC DS SCREW 3.5X24 CORT ST
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$234.36 |
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
|
|
HC DS SCREW 3.5X24 CORT ST
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$212.69
|
| Rate for Payer: Aetna Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.48
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Centivo All Commercial |
$128.52
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Humana Medicare |
$128.52
|
| Rate for Payer: Lucent All Commercial |
$128.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.28
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
| Rate for Payer: United Healthcare Medicare |
$83.16
|
|
|
HC DS SCREW 3.5X24 STARDRIVE LOCK
|
Facility
IP
|
$1,485.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.75 |
| Max. Negotiated Rate |
$1,381.05 |
| Rate for Payer: Aetna Commercial |
$1,283.04
|
| Rate for Payer: Cash Price |
$920.70
|
| Rate for Payer: Cigna All Commercial |
$1,281.56
|
| Rate for Payer: CORVEL All Commercial |
$1,381.05
|
| Rate for Payer: Coventry All Commercial |
$1,306.80
|
| Rate for Payer: Encore All Commercial |
$1,366.94
|
| Rate for Payer: Frontpath All Commercial |
$1,366.20
|
| Rate for Payer: Humana ChoiceCare |
$1,282.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,336.50
|
| Rate for Payer: PHCS All Commercial |
$1,113.75
|
| Rate for Payer: PHP All Commercial |
$1,126.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,146.42
|
| Rate for Payer: Signature Care EPO |
$1,232.55
|
| Rate for Payer: Signature Care PPO |
$1,306.80
|
| Rate for Payer: United Healthcare Commercial |
$1,170.18
|
|
|
HC DS SCREW 3.5X24 STARDRIVE LOCK
|
Facility
OP
|
$1,485.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.05 |
| Max. Negotiated Rate |
$1,381.05 |
| Rate for Payer: Aetna Commercial |
$1,253.34
|
| Rate for Payer: Aetna Medicare |
$490.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$852.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$928.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$563.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$539.06
|
| Rate for Payer: Cash Price |
$920.70
|
| Rate for Payer: Cash Price |
$920.70
|
| Rate for Payer: Centivo All Commercial |
$757.35
|
| Rate for Payer: Cigna All Commercial |
$1,281.56
|
| Rate for Payer: CORVEL All Commercial |
$1,381.05
|
| Rate for Payer: Coventry All Commercial |
$1,306.80
|
| Rate for Payer: Encore All Commercial |
$1,366.94
|
| Rate for Payer: Frontpath All Commercial |
$1,366.20
|
| Rate for Payer: Humana ChoiceCare |
$1,282.59
|
| Rate for Payer: Humana Medicare |
$757.35
|
| Rate for Payer: Lucent All Commercial |
$757.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,336.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,113.75
|
| Rate for Payer: PHP All Commercial |
$1,126.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$579.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,146.42
|
| Rate for Payer: Signature Care EPO |
$1,232.55
|
| Rate for Payer: Signature Care PPO |
$1,306.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,262.25
|
| Rate for Payer: United Healthcare Commercial |
$1,170.18
|
| Rate for Payer: United Healthcare Medicare |
$490.05
|
|
|
HC DS SCREW 3.5X26 CORT ST
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$234.36 |
| Rate for Payer: Aetna Commercial |
$217.73
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
|
|
HC DS SCREW 3.5X26 CORT ST
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$212.69
|
| Rate for Payer: Aetna Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.48
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Centivo All Commercial |
$128.52
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Humana Medicare |
$128.52
|
| Rate for Payer: Lucent All Commercial |
$128.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.28
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
| Rate for Payer: United Healthcare Medicare |
$83.16
|
|
|
HC DS SCREW 3.5X26 STARDRIVE LOCK
|
Facility
IP
|
$916.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.00 |
| Max. Negotiated Rate |
$851.88 |
| Rate for Payer: Aetna Commercial |
$791.42
|
| Rate for Payer: Cash Price |
$567.92
|
| Rate for Payer: Cigna All Commercial |
$790.51
|
| Rate for Payer: CORVEL All Commercial |
$851.88
|
| Rate for Payer: Coventry All Commercial |
$806.08
|
| Rate for Payer: Encore All Commercial |
$843.18
|
| Rate for Payer: Frontpath All Commercial |
$842.72
|
| Rate for Payer: Humana ChoiceCare |
$791.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$824.40
|
| Rate for Payer: PHCS All Commercial |
$687.00
|
| Rate for Payer: PHP All Commercial |
$694.69
|
| Rate for Payer: Sagamore Health Network All Products |
$707.15
|
| Rate for Payer: Signature Care EPO |
$760.28
|
| Rate for Payer: Signature Care PPO |
$806.08
|
| Rate for Payer: United Healthcare Commercial |
$721.81
|
|
|
HC DS SCREW 3.5X26 STARDRIVE LOCK
|
Facility
OP
|
$916.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$302.28 |
| Max. Negotiated Rate |
$851.88 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Medicare |
$302.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$526.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$572.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$347.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$332.51
|
| Rate for Payer: Cash Price |
$567.92
|
| Rate for Payer: Cash Price |
$567.92
|
| Rate for Payer: Centivo All Commercial |
$467.16
|
| Rate for Payer: Cigna All Commercial |
$790.51
|
| Rate for Payer: CORVEL All Commercial |
$851.88
|
| Rate for Payer: Coventry All Commercial |
$806.08
|
| Rate for Payer: Encore All Commercial |
$843.18
|
| Rate for Payer: Frontpath All Commercial |
$842.72
|
| Rate for Payer: Humana ChoiceCare |
$791.15
|
| Rate for Payer: Humana Medicare |
$467.16
|
| Rate for Payer: Lucent All Commercial |
$467.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$824.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$687.00
|
| Rate for Payer: PHP All Commercial |
$694.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$357.24
|
| Rate for Payer: Sagamore Health Network All Products |
$707.15
|
| Rate for Payer: Signature Care EPO |
$760.28
|
| Rate for Payer: Signature Care PPO |
$806.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$778.60
|
| Rate for Payer: United Healthcare Commercial |
$721.81
|
| Rate for Payer: United Healthcare Medicare |
$302.28
|
|
|
HC DS SCREW 3.5X28 CORT ST
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$425.38
|
| Rate for Payer: Aetna Medicare |
$166.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$166.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$289.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$315.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.95
|
| Rate for Payer: Cash Price |
$312.48
|
| Rate for Payer: Cash Price |
$312.48
|
| Rate for Payer: Centivo All Commercial |
$257.04
|
| Rate for Payer: Cigna All Commercial |
$434.95
|
| Rate for Payer: CORVEL All Commercial |
$468.72
|
| Rate for Payer: Coventry All Commercial |
$443.52
|
| Rate for Payer: Encore All Commercial |
$463.93
|
| Rate for Payer: Frontpath All Commercial |
$463.68
|
| Rate for Payer: Humana ChoiceCare |
$435.30
|
| Rate for Payer: Humana Medicare |
$257.04
|
| Rate for Payer: Lucent All Commercial |
$257.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$378.00
|
| Rate for Payer: PHP All Commercial |
$382.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.56
|
| Rate for Payer: Sagamore Health Network All Products |
$389.09
|
| Rate for Payer: Signature Care EPO |
$418.32
|
| Rate for Payer: Signature Care PPO |
$443.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$428.40
|
| Rate for Payer: United Healthcare Commercial |
$397.15
|
| Rate for Payer: United Healthcare Medicare |
$166.32
|
|
|
HC DS SCREW 3.5X28 CORT ST
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$468.72 |
| Rate for Payer: Aetna Commercial |
$435.46
|
| Rate for Payer: Cash Price |
$312.48
|
| Rate for Payer: Cigna All Commercial |
$434.95
|
| Rate for Payer: CORVEL All Commercial |
$468.72
|
| Rate for Payer: Coventry All Commercial |
$443.52
|
| Rate for Payer: Encore All Commercial |
$463.93
|
| Rate for Payer: Frontpath All Commercial |
$463.68
|
| Rate for Payer: Humana ChoiceCare |
$435.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.60
|
| Rate for Payer: PHCS All Commercial |
$378.00
|
| Rate for Payer: PHP All Commercial |
$382.23
|
| Rate for Payer: Sagamore Health Network All Products |
$389.09
|
| Rate for Payer: Signature Care EPO |
$418.32
|
| Rate for Payer: Signature Care PPO |
$443.52
|
| Rate for Payer: United Healthcare Commercial |
$397.15
|
|
|
HC DS SCREW 3.5X30 STARDRIVE LOCK
|
Facility
OP
|
$916.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$302.28 |
| Max. Negotiated Rate |
$851.88 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Medicare |
$302.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$526.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$572.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$347.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$332.51
|
| Rate for Payer: Cash Price |
$567.92
|
| Rate for Payer: Cash Price |
$567.92
|
| Rate for Payer: Centivo All Commercial |
$467.16
|
| Rate for Payer: Cigna All Commercial |
$790.51
|
| Rate for Payer: CORVEL All Commercial |
$851.88
|
| Rate for Payer: Coventry All Commercial |
$806.08
|
| Rate for Payer: Encore All Commercial |
$843.18
|
| Rate for Payer: Frontpath All Commercial |
$842.72
|
| Rate for Payer: Humana ChoiceCare |
$791.15
|
| Rate for Payer: Humana Medicare |
$467.16
|
| Rate for Payer: Lucent All Commercial |
$467.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$824.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$687.00
|
| Rate for Payer: PHP All Commercial |
$694.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$357.24
|
| Rate for Payer: Sagamore Health Network All Products |
$707.15
|
| Rate for Payer: Signature Care EPO |
$760.28
|
| Rate for Payer: Signature Care PPO |
$806.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$778.60
|
| Rate for Payer: United Healthcare Commercial |
$721.81
|
| Rate for Payer: United Healthcare Medicare |
$302.28
|
|
|
HC DS SCREW 3.5X30 STARDRIVE LOCK
|
Facility
IP
|
$916.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.00 |
| Max. Negotiated Rate |
$851.88 |
| Rate for Payer: Aetna Commercial |
$791.42
|
| Rate for Payer: Cash Price |
$567.92
|
| Rate for Payer: Cigna All Commercial |
$790.51
|
| Rate for Payer: CORVEL All Commercial |
$851.88
|
| Rate for Payer: Coventry All Commercial |
$806.08
|
| Rate for Payer: Encore All Commercial |
$843.18
|
| Rate for Payer: Frontpath All Commercial |
$842.72
|
| Rate for Payer: Humana ChoiceCare |
$791.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$824.40
|
| Rate for Payer: PHCS All Commercial |
$687.00
|
| Rate for Payer: PHP All Commercial |
$694.69
|
| Rate for Payer: Sagamore Health Network All Products |
$707.15
|
| Rate for Payer: Signature Care EPO |
$760.28
|
| Rate for Payer: Signature Care PPO |
$806.08
|
| Rate for Payer: United Healthcare Commercial |
$721.81
|
|
|
HC DS SCREW 3.5X32 CORTEX ST
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$212.69
|
| Rate for Payer: Aetna Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.48
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Centivo All Commercial |
$128.52
|
| Rate for Payer: Cigna All Commercial |
$217.48
|
| Rate for Payer: CORVEL All Commercial |
$234.36
|
| Rate for Payer: Coventry All Commercial |
$221.76
|
| Rate for Payer: Encore All Commercial |
$231.97
|
| Rate for Payer: Frontpath All Commercial |
$231.84
|
| Rate for Payer: Humana ChoiceCare |
$217.65
|
| Rate for Payer: Humana Medicare |
$128.52
|
| Rate for Payer: Lucent All Commercial |
$128.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$189.00
|
| Rate for Payer: PHP All Commercial |
$191.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.28
|
| Rate for Payer: Sagamore Health Network All Products |
$194.54
|
| Rate for Payer: Signature Care EPO |
$209.16
|
| Rate for Payer: Signature Care PPO |
$221.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$198.58
|
| Rate for Payer: United Healthcare Medicare |
$83.16
|
|
