|
HC SN PL PLATE 3.5 8-H LOCK COMP
|
Facility
IP
|
$1,174.60
|
|
| Hospital Charge Code |
41601782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.95 |
| Max. Negotiated Rate |
$1,092.38 |
| Rate for Payer: Aetna Commercial |
$1,014.85
|
| Rate for Payer: Cash Price |
$728.25
|
| Rate for Payer: Cigna All Commercial |
$1,013.68
|
| Rate for Payer: CORVEL All Commercial |
$1,092.38
|
| Rate for Payer: Coventry All Commercial |
$1,033.65
|
| Rate for Payer: Encore All Commercial |
$1,081.22
|
| Rate for Payer: Frontpath All Commercial |
$1,080.63
|
| Rate for Payer: Humana ChoiceCare |
$1,014.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.14
|
| Rate for Payer: PHCS All Commercial |
$880.95
|
| Rate for Payer: PHP All Commercial |
$890.82
|
| Rate for Payer: Sagamore Health Network All Products |
$906.79
|
| Rate for Payer: Signature Care EPO |
$974.92
|
| Rate for Payer: Signature Care PPO |
$1,033.65
|
| Rate for Payer: United Healthcare Commercial |
$925.58
|
|
|
HC SN PL PLATE 3.5 8-H LOCK RECN
|
Facility
IP
|
$1,859.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,394.51 |
| Max. Negotiated Rate |
$1,729.20 |
| Rate for Payer: Aetna Commercial |
$1,606.48
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cigna All Commercial |
$1,604.62
|
| Rate for Payer: CORVEL All Commercial |
$1,729.20
|
| Rate for Payer: Coventry All Commercial |
$1,636.23
|
| Rate for Payer: Encore All Commercial |
$1,711.53
|
| Rate for Payer: Frontpath All Commercial |
$1,710.60
|
| Rate for Payer: Humana ChoiceCare |
$1,605.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,673.42
|
| Rate for Payer: PHCS All Commercial |
$1,394.51
|
| Rate for Payer: PHP All Commercial |
$1,410.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,435.42
|
| Rate for Payer: Signature Care EPO |
$1,543.26
|
| Rate for Payer: Signature Care PPO |
$1,636.23
|
| Rate for Payer: United Healthcare Commercial |
$1,465.17
|
|
|
HC SN PL PLATE 3.5 8-H LOCK RECN
|
Facility
OP
|
$1,859.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,729.20 |
| Rate for Payer: Aetna Commercial |
$1,569.29
|
| Rate for Payer: Aetna Medicare |
$613.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$613.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,067.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,162.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$705.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$674.94
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Centivo All Commercial |
$948.27
|
| Rate for Payer: Cigna All Commercial |
$1,604.62
|
| Rate for Payer: CORVEL All Commercial |
$1,729.20
|
| Rate for Payer: Coventry All Commercial |
$1,636.23
|
| Rate for Payer: Encore All Commercial |
$1,711.53
|
| Rate for Payer: Frontpath All Commercial |
$1,710.60
|
| Rate for Payer: Humana ChoiceCare |
$1,605.92
|
| Rate for Payer: Humana Medicare |
$948.27
|
| Rate for Payer: Lucent All Commercial |
$948.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,673.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,394.51
|
| Rate for Payer: PHP All Commercial |
$1,410.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$725.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,435.42
|
| Rate for Payer: Signature Care EPO |
$1,543.26
|
| Rate for Payer: Signature Care PPO |
$1,636.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,580.45
|
| Rate for Payer: United Healthcare Commercial |
$1,465.17
|
| Rate for Payer: United Healthcare Medicare |
$613.59
|
|
|
HC SN PL PLATE 3.5 8-H LOCK TUB
|
Facility
OP
|
$829.78
|
|
| Hospital Charge Code |
41601770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.83 |
| Max. Negotiated Rate |
$771.70 |
| Rate for Payer: Aetna Commercial |
$700.33
|
| Rate for Payer: Aetna Medicare |
$273.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$273.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$476.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$518.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.21
|
| Rate for Payer: Cash Price |
$514.46
|
| Rate for Payer: Cash Price |
$514.46
|
| Rate for Payer: Centivo All Commercial |
$423.19
|
| Rate for Payer: Cigna All Commercial |
$716.10
|
| Rate for Payer: CORVEL All Commercial |
$771.70
|
| Rate for Payer: Coventry All Commercial |
$730.21
|
| Rate for Payer: Encore All Commercial |
$763.81
|
| Rate for Payer: Frontpath All Commercial |
$763.40
|
| Rate for Payer: Humana ChoiceCare |
$716.68
|
| Rate for Payer: Humana Medicare |
$423.19
|
| Rate for Payer: Lucent All Commercial |
$423.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$622.34
|
| Rate for Payer: PHP All Commercial |
$629.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$323.61
|
| Rate for Payer: Sagamore Health Network All Products |
$640.59
|
| Rate for Payer: Signature Care EPO |
$688.72
|
| Rate for Payer: Signature Care PPO |
$730.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$705.31
|
| Rate for Payer: United Healthcare Commercial |
$653.87
|
| Rate for Payer: United Healthcare Medicare |
$273.83
|
|
|
HC SN PL PLATE 3.5 8-H LOCK TUB
|
Facility
IP
|
$829.78
|
|
| Hospital Charge Code |
41601770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.34 |
| Max. Negotiated Rate |
$771.70 |
| Rate for Payer: Aetna Commercial |
$716.93
|
| Rate for Payer: Cash Price |
$514.46
|
| Rate for Payer: Cigna All Commercial |
$716.10
|
| Rate for Payer: CORVEL All Commercial |
$771.70
|
| Rate for Payer: Coventry All Commercial |
$730.21
|
| Rate for Payer: Encore All Commercial |
$763.81
|
| Rate for Payer: Frontpath All Commercial |
$763.40
|
| Rate for Payer: Humana ChoiceCare |
$716.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.80
|
| Rate for Payer: PHCS All Commercial |
$622.34
|
| Rate for Payer: PHP All Commercial |
$629.31
|
| Rate for Payer: Sagamore Health Network All Products |
$640.59
|
| Rate for Payer: Signature Care EPO |
$688.72
|
| Rate for Payer: Signature Care PPO |
$730.21
|
| Rate for Payer: United Healthcare Commercial |
$653.87
|
|
|
HC SN PL PLATE 3.5 9-H COMP
|
Facility
IP
|
$791.91
|
|
| Hospital Charge Code |
41601777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.93 |
| Max. Negotiated Rate |
$736.48 |
| Rate for Payer: Aetna Commercial |
$684.21
|
| Rate for Payer: Cash Price |
$490.98
|
| Rate for Payer: Cigna All Commercial |
$683.42
|
| Rate for Payer: CORVEL All Commercial |
$736.48
|
| Rate for Payer: Coventry All Commercial |
$696.88
|
| Rate for Payer: Encore All Commercial |
$728.95
|
| Rate for Payer: Frontpath All Commercial |
$728.56
|
| Rate for Payer: Humana ChoiceCare |
$683.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$712.72
|
| Rate for Payer: PHCS All Commercial |
$593.93
|
| Rate for Payer: PHP All Commercial |
$600.58
|
| Rate for Payer: Sagamore Health Network All Products |
$611.35
|
| Rate for Payer: Signature Care EPO |
$657.29
|
| Rate for Payer: Signature Care PPO |
$696.88
|
| Rate for Payer: United Healthcare Commercial |
$624.03
|
|
|
HC SN PL PLATE 3.5 9-H COMP
|
Facility
OP
|
$791.91
|
|
| Hospital Charge Code |
41601777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.33 |
| Max. Negotiated Rate |
$736.48 |
| Rate for Payer: Aetna Commercial |
$668.37
|
| Rate for Payer: Aetna Medicare |
$261.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$261.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$454.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$300.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$287.46
|
| Rate for Payer: Cash Price |
$490.98
|
| Rate for Payer: Cash Price |
$490.98
|
| Rate for Payer: Centivo All Commercial |
$403.87
|
| Rate for Payer: Cigna All Commercial |
$683.42
|
| Rate for Payer: CORVEL All Commercial |
$736.48
|
| Rate for Payer: Coventry All Commercial |
$696.88
|
| Rate for Payer: Encore All Commercial |
$728.95
|
| Rate for Payer: Frontpath All Commercial |
$728.56
|
| Rate for Payer: Humana ChoiceCare |
$683.97
|
| Rate for Payer: Humana Medicare |
$403.87
|
| Rate for Payer: Lucent All Commercial |
$403.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$712.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$593.93
|
| Rate for Payer: PHP All Commercial |
$600.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$308.84
|
| Rate for Payer: Sagamore Health Network All Products |
$611.35
|
| Rate for Payer: Signature Care EPO |
$657.29
|
| Rate for Payer: Signature Care PPO |
$696.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$673.12
|
| Rate for Payer: United Healthcare Commercial |
$624.03
|
| Rate for Payer: United Healthcare Medicare |
$261.33
|
|
|
HC SN PL SCREW 2.7X10 NON-LOCK
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SN PL SCREW 2.7X10 NON-LOCK
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SN PL SCREW 2.7X12 NON-LOCK
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SN PL SCREW 2.7X12 NON-LOCK
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SN PL SCREW 2.7X14 NON-LOCK
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SN PL SCREW 2.7X14 NON-LOCK
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SN PL SCREW 2.7X16 NON-LOCK
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SN PL SCREW 2.7X16 NON-LOCK
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SN PL SCREW 2.7X18 NON-LOCK
|
Facility
IP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$101.17 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
|
|
HC SN PL SCREW 2.7X18 NON-LOCK
|
Facility
OP
|
$108.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.49
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Centivo All Commercial |
$55.48
|
| Rate for Payer: Cigna All Commercial |
$93.88
|
| Rate for Payer: CORVEL All Commercial |
$101.17
|
| Rate for Payer: Coventry All Commercial |
$95.73
|
| Rate for Payer: Encore All Commercial |
$100.13
|
| Rate for Payer: Frontpath All Commercial |
$100.08
|
| Rate for Payer: Humana ChoiceCare |
$93.95
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Lucent All Commercial |
$55.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$81.58
|
| Rate for Payer: PHP All Commercial |
$82.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.42
|
| Rate for Payer: Sagamore Health Network All Products |
$83.98
|
| Rate for Payer: Signature Care EPO |
$90.29
|
| Rate for Payer: Signature Care PPO |
$95.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.46
|
| Rate for Payer: United Healthcare Commercial |
$85.72
|
| Rate for Payer: United Healthcare Medicare |
$35.90
|
|
|
HC SN PL SCREW 3.5X10 LOCK
|
Facility
OP
|
$748.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.89 |
| Max. Negotiated Rate |
$695.79 |
| Rate for Payer: Aetna Commercial |
$631.45
|
| Rate for Payer: Aetna Medicare |
$246.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$246.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$429.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$467.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.58
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Centivo All Commercial |
$381.56
|
| Rate for Payer: Cigna All Commercial |
$645.66
|
| Rate for Payer: CORVEL All Commercial |
$695.79
|
| Rate for Payer: Coventry All Commercial |
$658.38
|
| Rate for Payer: Encore All Commercial |
$688.68
|
| Rate for Payer: Frontpath All Commercial |
$688.31
|
| Rate for Payer: Humana ChoiceCare |
$646.19
|
| Rate for Payer: Humana Medicare |
$381.56
|
| Rate for Payer: Lucent All Commercial |
$381.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$673.34
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$561.12
|
| Rate for Payer: PHP All Commercial |
$567.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$291.78
|
| Rate for Payer: Sagamore Health Network All Products |
$577.58
|
| Rate for Payer: Signature Care EPO |
$620.97
|
| Rate for Payer: Signature Care PPO |
$658.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$635.94
|
| Rate for Payer: United Healthcare Commercial |
$589.55
|
| Rate for Payer: United Healthcare Medicare |
$246.89
|
|
|
HC SN PL SCREW 3.5X10 LOCK
|
Facility
IP
|
$748.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.12 |
| Max. Negotiated Rate |
$695.79 |
| Rate for Payer: Aetna Commercial |
$646.41
|
| Rate for Payer: Cash Price |
$463.86
|
| Rate for Payer: Cigna All Commercial |
$645.66
|
| Rate for Payer: CORVEL All Commercial |
$695.79
|
| Rate for Payer: Coventry All Commercial |
$658.38
|
| Rate for Payer: Encore All Commercial |
$688.68
|
| Rate for Payer: Frontpath All Commercial |
$688.31
|
| Rate for Payer: Humana ChoiceCare |
$646.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$673.34
|
| Rate for Payer: PHCS All Commercial |
$561.12
|
| Rate for Payer: PHP All Commercial |
$567.40
|
| Rate for Payer: Sagamore Health Network All Products |
$577.58
|
| Rate for Payer: Signature Care EPO |
$620.97
|
| Rate for Payer: Signature Care PPO |
$658.38
|
| Rate for Payer: United Healthcare Commercial |
$589.55
|
|
|
HC SN PL SCREW 3.5X10 NON-LOCK
|
Facility
IP
|
$144.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.26 |
| Max. Negotiated Rate |
$134.24 |
| Rate for Payer: Aetna Commercial |
$124.71
|
| Rate for Payer: Cash Price |
$89.49
|
| Rate for Payer: Cigna All Commercial |
$124.57
|
| Rate for Payer: CORVEL All Commercial |
$134.24
|
| Rate for Payer: Coventry All Commercial |
$127.02
|
| Rate for Payer: Encore All Commercial |
$132.86
|
| Rate for Payer: Frontpath All Commercial |
$132.79
|
| Rate for Payer: Humana ChoiceCare |
$124.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.91
|
| Rate for Payer: PHCS All Commercial |
$108.26
|
| Rate for Payer: PHP All Commercial |
$109.47
|
| Rate for Payer: Sagamore Health Network All Products |
$111.43
|
| Rate for Payer: Signature Care EPO |
$119.80
|
| Rate for Payer: Signature Care PPO |
$127.02
|
| Rate for Payer: United Healthcare Commercial |
$113.74
|
|
|
HC SN PL SCREW 3.5X10 NON-LOCK
|
Facility
OP
|
$144.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.82
|
| Rate for Payer: Aetna Medicare |
$47.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.40
|
| Rate for Payer: Cash Price |
$89.49
|
| Rate for Payer: Cash Price |
$89.49
|
| Rate for Payer: Centivo All Commercial |
$73.61
|
| Rate for Payer: Cigna All Commercial |
$124.57
|
| Rate for Payer: CORVEL All Commercial |
$134.24
|
| Rate for Payer: Coventry All Commercial |
$127.02
|
| Rate for Payer: Encore All Commercial |
$132.86
|
| Rate for Payer: Frontpath All Commercial |
$132.79
|
| Rate for Payer: Humana ChoiceCare |
$124.67
|
| Rate for Payer: Humana Medicare |
$73.61
|
| Rate for Payer: Lucent All Commercial |
$73.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$108.26
|
| Rate for Payer: PHP All Commercial |
$109.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.29
|
| Rate for Payer: Sagamore Health Network All Products |
$111.43
|
| Rate for Payer: Signature Care EPO |
$119.80
|
| Rate for Payer: Signature Care PPO |
$127.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.69
|
| Rate for Payer: United Healthcare Commercial |
$113.74
|
| Rate for Payer: United Healthcare Medicare |
$47.63
|
|
|
HC SN PL SCREW 3.5X12 CRTX VLP
|
Facility
OP
|
$214.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Medicare |
$70.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.81
|
| Rate for Payer: Cash Price |
$132.89
|
| Rate for Payer: Cash Price |
$132.89
|
| Rate for Payer: Centivo All Commercial |
$109.31
|
| Rate for Payer: Cigna All Commercial |
$184.98
|
| Rate for Payer: CORVEL All Commercial |
$199.34
|
| Rate for Payer: Coventry All Commercial |
$188.62
|
| Rate for Payer: Encore All Commercial |
$197.30
|
| Rate for Payer: Frontpath All Commercial |
$197.19
|
| Rate for Payer: Humana ChoiceCare |
$185.13
|
| Rate for Payer: Humana Medicare |
$109.31
|
| Rate for Payer: Lucent All Commercial |
$109.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$160.76
|
| Rate for Payer: PHP All Commercial |
$162.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.59
|
| Rate for Payer: Sagamore Health Network All Products |
$165.47
|
| Rate for Payer: Signature Care EPO |
$177.90
|
| Rate for Payer: Signature Care PPO |
$188.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.19
|
| Rate for Payer: United Healthcare Commercial |
$168.90
|
| Rate for Payer: United Healthcare Medicare |
$70.73
|
|
|
HC SN PL SCREW 3.5X12 CRTX VLP
|
Facility
IP
|
$214.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.76 |
| Max. Negotiated Rate |
$199.34 |
| Rate for Payer: Aetna Commercial |
$185.19
|
| Rate for Payer: Cash Price |
$132.89
|
| Rate for Payer: Cigna All Commercial |
$184.98
|
| Rate for Payer: CORVEL All Commercial |
$199.34
|
| Rate for Payer: Coventry All Commercial |
$188.62
|
| Rate for Payer: Encore All Commercial |
$197.30
|
| Rate for Payer: Frontpath All Commercial |
$197.19
|
| Rate for Payer: Humana ChoiceCare |
$185.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.91
|
| Rate for Payer: PHCS All Commercial |
$160.76
|
| Rate for Payer: PHP All Commercial |
$162.56
|
| Rate for Payer: Sagamore Health Network All Products |
$165.47
|
| Rate for Payer: Signature Care EPO |
$177.90
|
| Rate for Payer: Signature Care PPO |
$188.62
|
| Rate for Payer: United Healthcare Commercial |
$168.90
|
|
|
HC SN PL SCREW 3.5X12 LOCK
|
Facility
IP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.16 |
| Max. Negotiated Rate |
$730.55 |
| Rate for Payer: Aetna Commercial |
$678.71
|
| Rate for Payer: Cash Price |
$487.04
|
| Rate for Payer: Cigna All Commercial |
$677.92
|
| Rate for Payer: CORVEL All Commercial |
$730.55
|
| Rate for Payer: Coventry All Commercial |
$691.28
|
| Rate for Payer: Encore All Commercial |
$723.09
|
| Rate for Payer: Frontpath All Commercial |
$722.70
|
| Rate for Payer: Humana ChoiceCare |
$678.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$706.99
|
| Rate for Payer: PHCS All Commercial |
$589.16
|
| Rate for Payer: PHP All Commercial |
$595.75
|
| Rate for Payer: Sagamore Health Network All Products |
$606.44
|
| Rate for Payer: Signature Care EPO |
$652.00
|
| Rate for Payer: Signature Care PPO |
$691.28
|
| Rate for Payer: United Healthcare Commercial |
$619.01
|
|
|
HC SN PL SCREW 3.5X12 LOCK
|
Facility
OP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.23 |
| Max. Negotiated Rate |
$730.55 |
| Rate for Payer: Aetna Commercial |
$663.00
|
| Rate for Payer: Aetna Medicare |
$259.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$259.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$451.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$491.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$298.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$285.15
|
| Rate for Payer: Cash Price |
$487.04
|
| Rate for Payer: Cash Price |
$487.04
|
| Rate for Payer: Centivo All Commercial |
$400.63
|
| Rate for Payer: Cigna All Commercial |
$677.92
|
| Rate for Payer: CORVEL All Commercial |
$730.55
|
| Rate for Payer: Coventry All Commercial |
$691.28
|
| Rate for Payer: Encore All Commercial |
$723.09
|
| Rate for Payer: Frontpath All Commercial |
$722.70
|
| Rate for Payer: Humana ChoiceCare |
$678.47
|
| Rate for Payer: Humana Medicare |
$400.63
|
| Rate for Payer: Lucent All Commercial |
$400.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$706.99
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$589.16
|
| Rate for Payer: PHP All Commercial |
$595.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.36
|
| Rate for Payer: Sagamore Health Network All Products |
$606.44
|
| Rate for Payer: Signature Care EPO |
$652.00
|
| Rate for Payer: Signature Care PPO |
$691.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$667.71
|
| Rate for Payer: United Healthcare Commercial |
$619.01
|
| Rate for Payer: United Healthcare Medicare |
$259.23
|
|
