|
HC SCREW MINI MAGNA 4.0 PT 50
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 PT 50
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 PT 55
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 PT 55
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 PT 60
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 PT 60
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 PT 65
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 PT 65
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 PT 70
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 PT 70
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC S DRILL BIT 0.9MM
|
Facility
IP
|
$1,016.70
|
|
| Hospital Charge Code |
41607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.52 |
| Max. Negotiated Rate |
$945.53 |
| Rate for Payer: Aetna Commercial |
$878.43
|
| Rate for Payer: Cash Price |
$630.35
|
| Rate for Payer: Cigna All Commercial |
$877.41
|
| Rate for Payer: CORVEL All Commercial |
$945.53
|
| Rate for Payer: Coventry All Commercial |
$894.70
|
| Rate for Payer: Encore All Commercial |
$935.87
|
| Rate for Payer: Frontpath All Commercial |
$935.36
|
| Rate for Payer: Humana ChoiceCare |
$878.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$915.03
|
| Rate for Payer: PHCS All Commercial |
$762.52
|
| Rate for Payer: PHP All Commercial |
$771.07
|
| Rate for Payer: Sagamore Health Network All Products |
$784.89
|
| Rate for Payer: Signature Care EPO |
$843.86
|
| Rate for Payer: Signature Care PPO |
$894.70
|
| Rate for Payer: United Healthcare Commercial |
$801.16
|
|
|
HC S DRILL BIT 0.9MM
|
Facility
OP
|
$1,016.70
|
|
| Hospital Charge Code |
41607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$945.53 |
| Rate for Payer: Aetna Commercial |
$858.09
|
| Rate for Payer: Aetna Medicare |
$335.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$335.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$583.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$635.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$385.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.06
|
| Rate for Payer: Cash Price |
$630.35
|
| Rate for Payer: Cash Price |
$630.35
|
| Rate for Payer: Centivo All Commercial |
$518.52
|
| Rate for Payer: Cigna All Commercial |
$877.41
|
| Rate for Payer: CORVEL All Commercial |
$945.53
|
| Rate for Payer: Coventry All Commercial |
$894.70
|
| Rate for Payer: Encore All Commercial |
$935.87
|
| Rate for Payer: Frontpath All Commercial |
$935.36
|
| Rate for Payer: Humana ChoiceCare |
$878.12
|
| Rate for Payer: Humana Medicare |
$518.52
|
| Rate for Payer: Lucent All Commercial |
$518.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$915.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$762.52
|
| Rate for Payer: PHP All Commercial |
$771.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$396.51
|
| Rate for Payer: Sagamore Health Network All Products |
$784.89
|
| Rate for Payer: Signature Care EPO |
$843.86
|
| Rate for Payer: Signature Care PPO |
$894.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$864.20
|
| Rate for Payer: United Healthcare Commercial |
$801.16
|
| Rate for Payer: United Healthcare Medicare |
$335.51
|
|
|
HC S DRILL BIT 2.0X135 AO 703690
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41603938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.98
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Centivo All Commercial |
$744.60
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$744.60
|
| Rate for Payer: Lucent All Commercial |
$744.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
|
|
HC S DRILL BIT 2.0X135 AO 703690
|
Facility
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41603938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
|
HC S DRILL BIT 2.0X135 AO 703896
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41603942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.98
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Centivo All Commercial |
$744.60
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$744.60
|
| Rate for Payer: Lucent All Commercial |
$744.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
|
|
HC S DRILL BIT 2.0X135 AO 703896
|
Facility
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41603942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
|
HC S DRILL BIT 2.6X135 AO
|
Facility
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41603939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
|
HC S DRILL BIT 2.6X135 AO
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41603939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.98
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Centivo All Commercial |
$744.60
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$744.60
|
| Rate for Payer: Lucent All Commercial |
$744.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
|
|
HC S DRILL BIT 4.2X180
|
Facility
OP
|
$1,375.80
|
|
| Hospital Charge Code |
41607115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,279.49 |
| Rate for Payer: Aetna Commercial |
$1,161.18
|
| Rate for Payer: Aetna Medicare |
$454.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$454.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$790.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$860.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$522.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.42
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Centivo All Commercial |
$701.66
|
| Rate for Payer: Cigna All Commercial |
$1,187.32
|
| Rate for Payer: CORVEL All Commercial |
$1,279.49
|
| Rate for Payer: Coventry All Commercial |
$1,210.70
|
| Rate for Payer: Encore All Commercial |
$1,266.42
|
| Rate for Payer: Frontpath All Commercial |
$1,265.74
|
| Rate for Payer: Humana ChoiceCare |
$1,188.28
|
| Rate for Payer: Humana Medicare |
$701.66
|
| Rate for Payer: Lucent All Commercial |
$701.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,238.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,031.85
|
| Rate for Payer: PHP All Commercial |
$1,043.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,062.12
|
| Rate for Payer: Signature Care EPO |
$1,141.91
|
| Rate for Payer: Signature Care PPO |
$1,210.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,169.43
|
| Rate for Payer: United Healthcare Commercial |
$1,084.13
|
| Rate for Payer: United Healthcare Medicare |
$454.01
|
|
|
HC S DRILL BIT 4.2X180
|
Facility
IP
|
$1,375.80
|
|
| Hospital Charge Code |
41607115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.85 |
| Max. Negotiated Rate |
$1,279.49 |
| Rate for Payer: Aetna Commercial |
$1,188.69
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna All Commercial |
$1,187.32
|
| Rate for Payer: CORVEL All Commercial |
$1,279.49
|
| Rate for Payer: Coventry All Commercial |
$1,210.70
|
| Rate for Payer: Encore All Commercial |
$1,266.42
|
| Rate for Payer: Frontpath All Commercial |
$1,265.74
|
| Rate for Payer: Humana ChoiceCare |
$1,188.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,238.22
|
| Rate for Payer: PHCS All Commercial |
$1,031.85
|
| Rate for Payer: PHP All Commercial |
$1,043.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,062.12
|
| Rate for Payer: Signature Care EPO |
$1,141.91
|
| Rate for Payer: Signature Care PPO |
$1,210.70
|
| Rate for Payer: United Healthcare Commercial |
$1,084.13
|
|
|
HC S DRILL BIT 4.2X340
|
Facility
OP
|
$1,283.55
|
|
| Hospital Charge Code |
41607114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,193.70 |
| Rate for Payer: Aetna Commercial |
$1,083.32
|
| Rate for Payer: Aetna Medicare |
$423.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$423.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$737.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$802.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$487.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$465.93
|
| Rate for Payer: Cash Price |
$795.80
|
| Rate for Payer: Cash Price |
$795.80
|
| Rate for Payer: Centivo All Commercial |
$654.61
|
| Rate for Payer: Cigna All Commercial |
$1,107.70
|
| Rate for Payer: CORVEL All Commercial |
$1,193.70
|
| Rate for Payer: Coventry All Commercial |
$1,129.52
|
| Rate for Payer: Encore All Commercial |
$1,181.51
|
| Rate for Payer: Frontpath All Commercial |
$1,180.87
|
| Rate for Payer: Humana ChoiceCare |
$1,108.60
|
| Rate for Payer: Humana Medicare |
$654.61
|
| Rate for Payer: Lucent All Commercial |
$654.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,155.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$962.66
|
| Rate for Payer: PHP All Commercial |
$973.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$500.58
|
| Rate for Payer: Sagamore Health Network All Products |
$990.90
|
| Rate for Payer: Signature Care EPO |
$1,065.35
|
| Rate for Payer: Signature Care PPO |
$1,129.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,091.02
|
| Rate for Payer: United Healthcare Commercial |
$1,011.44
|
| Rate for Payer: United Healthcare Medicare |
$423.57
|
|
|
HC S DRILL BIT 4.2X340
|
Facility
IP
|
$1,283.55
|
|
| Hospital Charge Code |
41607114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$962.66 |
| Max. Negotiated Rate |
$1,193.70 |
| Rate for Payer: Aetna Commercial |
$1,108.99
|
| Rate for Payer: Cash Price |
$795.80
|
| Rate for Payer: Cigna All Commercial |
$1,107.70
|
| Rate for Payer: CORVEL All Commercial |
$1,193.70
|
| Rate for Payer: Coventry All Commercial |
$1,129.52
|
| Rate for Payer: Encore All Commercial |
$1,181.51
|
| Rate for Payer: Frontpath All Commercial |
$1,180.87
|
| Rate for Payer: Humana ChoiceCare |
$1,108.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,155.20
|
| Rate for Payer: PHCS All Commercial |
$962.66
|
| Rate for Payer: PHP All Commercial |
$973.44
|
| Rate for Payer: Sagamore Health Network All Products |
$990.90
|
| Rate for Payer: Signature Care EPO |
$1,065.35
|
| Rate for Payer: Signature Care PPO |
$1,129.52
|
| Rate for Payer: United Healthcare Commercial |
$1,011.44
|
|
|
HC S DRILL BIT OVER 2.7X122 AO
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41603943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$481.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.98
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Centivo All Commercial |
$744.60
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$744.60
|
| Rate for Payer: Lucent All Commercial |
$744.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
|
|
HC S DRILL BIT OVER 2.7X122 AO
|
Facility
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41603943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
|
HC S DRILL BIT OVER 3.5X122 AO
|
Facility
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41603940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$905.20
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
