|
HC SCREW LP TI CANN PT 3.0 X 10 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 10 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 12 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 12 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 14 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 14 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 16 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 16 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 18 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 18 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 20 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 20 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 22 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 22 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 24 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 24 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 26 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 26 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 30 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 30 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 32 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 32 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 34 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
|
HC SCREW LP TI CANN PT 3.0 X 34 MM ACFS
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
41602200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$779.86
|
| Rate for Payer: Aetna Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.41
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Centivo All Commercial |
$471.24
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Humana Medicare |
$471.24
|
| Rate for Payer: Lucent All Commercial |
$471.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.36
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
| Rate for Payer: United Healthcare Medicare |
$304.92
|
|
|
HC SCREW LP TI CANN PT 3.0 X 36 MM ACFS
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
41602201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$859.32 |
| Rate for Payer: Aetna Commercial |
$798.34
|
| Rate for Payer: Cash Price |
$572.88
|
| Rate for Payer: Cigna All Commercial |
$797.41
|
| Rate for Payer: CORVEL All Commercial |
$859.32
|
| Rate for Payer: Coventry All Commercial |
$813.12
|
| Rate for Payer: Encore All Commercial |
$850.54
|
| Rate for Payer: Frontpath All Commercial |
$850.08
|
| Rate for Payer: Humana ChoiceCare |
$798.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.60
|
| Rate for Payer: PHCS All Commercial |
$693.00
|
| Rate for Payer: PHP All Commercial |
$700.76
|
| Rate for Payer: Sagamore Health Network All Products |
$713.33
|
| Rate for Payer: Signature Care EPO |
$766.92
|
| Rate for Payer: Signature Care PPO |
$813.12
|
| Rate for Payer: United Healthcare Commercial |
$728.11
|
|
