|
HC SCREW LP CORTEX 2.4 X 16 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 16 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 18 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 18 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 20 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 20 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 22 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 22 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 24 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP CORTEX 2.4 X 24 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 26 MM ACFS
|
Facility
IP
|
$847.00
|
|
| Hospital Charge Code |
41601300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP CORTEX 2.4 X 26 MM ACFS
|
Facility
OP
|
$847.00
|
|
| Hospital Charge Code |
41601300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.46
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Cash Price |
$525.14
|
| Rate for Payer: Centivo All Commercial |
$431.97
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$431.97
|
| Rate for Payer: Lucent All Commercial |
$431.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$279.51
|
|
|
HC SCREW LP LOCK 2.4 X 10 MM ACFS
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41601301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC SCREW LP LOCK 2.4 X 10 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC SCREW LP LOCK 2.4 X 12 MM ACFS
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41601302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC SCREW LP LOCK 2.4 X 12 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC SCREW LP LOCK 2.4 X 14 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC SCREW LP LOCK 2.4 X 14 MM ACFS
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41601303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC SCREW LP LOCK 2.4 X 16 MM ACFS
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41601304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC SCREW LP LOCK 2.4 X 16 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC SCREW LP LOCK 2.4 X 18 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC SCREW LP LOCK 2.4 X 18 MM ACFS
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41601305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC SCREW LP LOCK 2.4 X 20 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
|
HC SCREW LP LOCK 2.4 X 20 MM ACFS
|
Facility
IP
|
$770.00
|
|
| Hospital Charge Code |
41601306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
|
|
HC SCREW LP LOCK 2.4 X 22 MM ACFS
|
Facility
OP
|
$770.00
|
|
| Hospital Charge Code |
41601307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$716.10 |
| Rate for Payer: Aetna Commercial |
$649.88
|
| Rate for Payer: Aetna Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.51
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Centivo All Commercial |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$664.51
|
| Rate for Payer: CORVEL All Commercial |
$716.10
|
| Rate for Payer: Coventry All Commercial |
$677.60
|
| Rate for Payer: Encore All Commercial |
$708.78
|
| Rate for Payer: Frontpath All Commercial |
$708.40
|
| Rate for Payer: Humana ChoiceCare |
$665.05
|
| Rate for Payer: Humana Medicare |
$392.70
|
| Rate for Payer: Lucent All Commercial |
$392.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$577.50
|
| Rate for Payer: PHP All Commercial |
$583.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.30
|
| Rate for Payer: Sagamore Health Network All Products |
$594.44
|
| Rate for Payer: Signature Care EPO |
$639.10
|
| Rate for Payer: Signature Care PPO |
$677.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.50
|
| Rate for Payer: United Healthcare Commercial |
$606.76
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
|
