|
HC SN PL SCREW 3.5X12 NON-LOCK
|
Facility
OP
|
$144.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601383
|
|
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 NON-LOCK
|
Facility
IP
|
$144.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601383
|
|
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 3.5X14 LOCK
|
Facility
OP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601744
|
|
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
|
|
|
HC SN PL SCREW 3.5X14 LOCK
|
Facility
IP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601744
|
|
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 3.5X14 NON-LOCK
|
Facility
OP
|
$144.69
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$122.12
|
| Rate for Payer: Aetna Medicare |
$47.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Centivo All Commercial |
$73.79
|
| Rate for Payer: Cigna All Commercial |
$124.87
|
| Rate for Payer: CORVEL All Commercial |
$134.56
|
| Rate for Payer: Coventry All Commercial |
$127.33
|
| Rate for Payer: Encore All Commercial |
$133.19
|
| Rate for Payer: Frontpath All Commercial |
$133.11
|
| Rate for Payer: Humana ChoiceCare |
$124.97
|
| Rate for Payer: Humana Medicare |
$73.79
|
| Rate for Payer: Lucent All Commercial |
$73.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.22
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$108.52
|
| Rate for Payer: PHP All Commercial |
$109.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.43
|
| Rate for Payer: Sagamore Health Network All Products |
$111.70
|
| Rate for Payer: Signature Care EPO |
$120.09
|
| Rate for Payer: Signature Care PPO |
$127.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.99
|
| Rate for Payer: United Healthcare Commercial |
$114.02
|
| Rate for Payer: United Healthcare Medicare |
$47.75
|
|
|
HC SN PL SCREW 3.5X14 NON-LOCK
|
Facility
IP
|
$144.69
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.52 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: Aetna Commercial |
$125.01
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cigna All Commercial |
$124.87
|
| Rate for Payer: CORVEL All Commercial |
$134.56
|
| Rate for Payer: Coventry All Commercial |
$127.33
|
| Rate for Payer: Encore All Commercial |
$133.19
|
| Rate for Payer: Frontpath All Commercial |
$133.11
|
| Rate for Payer: Humana ChoiceCare |
$124.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.22
|
| Rate for Payer: PHCS All Commercial |
$108.52
|
| Rate for Payer: PHP All Commercial |
$109.73
|
| Rate for Payer: Sagamore Health Network All Products |
$111.70
|
| Rate for Payer: Signature Care EPO |
$120.09
|
| Rate for Payer: Signature Care PPO |
$127.33
|
| Rate for Payer: United Healthcare Commercial |
$114.02
|
|
|
HC SN PL SCREW 3.5X16 LOCK
|
Facility
OP
|
$896.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.82 |
| Max. Negotiated Rate |
$833.67 |
| Rate for Payer: Aetna Commercial |
$756.58
|
| Rate for Payer: Aetna Medicare |
$295.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$295.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$514.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$560.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.40
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Centivo All Commercial |
$457.17
|
| Rate for Payer: Cigna All Commercial |
$773.61
|
| Rate for Payer: CORVEL All Commercial |
$833.67
|
| Rate for Payer: Coventry All Commercial |
$788.85
|
| Rate for Payer: Encore All Commercial |
$825.15
|
| Rate for Payer: Frontpath All Commercial |
$824.71
|
| Rate for Payer: Humana ChoiceCare |
$774.24
|
| Rate for Payer: Humana Medicare |
$457.17
|
| Rate for Payer: Lucent All Commercial |
$457.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$672.32
|
| Rate for Payer: PHP All Commercial |
$679.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$349.60
|
| Rate for Payer: Sagamore Health Network All Products |
$692.04
|
| Rate for Payer: Signature Care EPO |
$744.03
|
| Rate for Payer: Signature Care PPO |
$788.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$761.96
|
| Rate for Payer: United Healthcare Commercial |
$706.38
|
| Rate for Payer: United Healthcare Medicare |
$295.82
|
|
|
HC SN PL SCREW 3.5X16 LOCK
|
Facility
IP
|
$896.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.32 |
| Max. Negotiated Rate |
$833.67 |
| Rate for Payer: Aetna Commercial |
$774.51
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Cigna All Commercial |
$773.61
|
| Rate for Payer: CORVEL All Commercial |
$833.67
|
| Rate for Payer: Coventry All Commercial |
$788.85
|
| Rate for Payer: Encore All Commercial |
$825.15
|
| Rate for Payer: Frontpath All Commercial |
$824.71
|
| Rate for Payer: Humana ChoiceCare |
$774.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.78
|
| Rate for Payer: PHCS All Commercial |
$672.32
|
| Rate for Payer: PHP All Commercial |
$679.84
|
| Rate for Payer: Sagamore Health Network All Products |
$692.04
|
| Rate for Payer: Signature Care EPO |
$744.03
|
| Rate for Payer: Signature Care PPO |
$788.85
|
| Rate for Payer: United Healthcare Commercial |
$706.38
|
|
|
HC SN PL SCREW 3.5X16 NON-LOCK
|
Facility
OP
|
$151.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$128.20
|
| Rate for Payer: Aetna Medicare |
$50.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.14
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Centivo All Commercial |
$77.47
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Humana Medicare |
$77.47
|
| Rate for Payer: Lucent All Commercial |
$77.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.24
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.12
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare |
$50.13
|
|
|
HC SN PL SCREW 3.5X16 NON-LOCK
|
Facility
IP
|
$151.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
HC SN PL SCREW 3.5X18 LOCK
|
Facility
OP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601746
|
|
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
|
|
|
HC SN PL SCREW 3.5X18 LOCK
|
Facility
IP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601746
|
|
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 3.5X18 NON-LOCK
|
Facility
IP
|
$151.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$141.27 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
HC SN PL SCREW 3.5X18 NON-LOCK
|
Facility
OP
|
$151.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$128.20
|
| Rate for Payer: Aetna Medicare |
$50.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.14
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Cash Price |
$94.18
|
| Rate for Payer: Centivo All Commercial |
$77.47
|
| Rate for Payer: Cigna All Commercial |
$131.09
|
| Rate for Payer: CORVEL All Commercial |
$141.27
|
| Rate for Payer: Coventry All Commercial |
$133.67
|
| Rate for Payer: Encore All Commercial |
$139.82
|
| Rate for Payer: Frontpath All Commercial |
$139.75
|
| Rate for Payer: Humana ChoiceCare |
$131.20
|
| Rate for Payer: Humana Medicare |
$77.47
|
| Rate for Payer: Lucent All Commercial |
$77.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.71
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$113.92
|
| Rate for Payer: PHP All Commercial |
$115.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.24
|
| Rate for Payer: Sagamore Health Network All Products |
$117.27
|
| Rate for Payer: Signature Care EPO |
$126.08
|
| Rate for Payer: Signature Care PPO |
$133.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.12
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare |
$50.13
|
|
|
HC SN PL SCREW 3.5X20 CRTX VLP
|
Facility
IP
|
$214.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602514
|
|
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 3.5X20 CRTX VLP
|
Facility
OP
|
$214.34
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602514
|
|
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 3.5X20 LOCK
|
Facility
IP
|
$896.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.32 |
| Max. Negotiated Rate |
$833.67 |
| Rate for Payer: Aetna Commercial |
$774.51
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Cigna All Commercial |
$773.61
|
| Rate for Payer: CORVEL All Commercial |
$833.67
|
| Rate for Payer: Coventry All Commercial |
$788.85
|
| Rate for Payer: Encore All Commercial |
$825.15
|
| Rate for Payer: Frontpath All Commercial |
$824.71
|
| Rate for Payer: Humana ChoiceCare |
$774.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.78
|
| Rate for Payer: PHCS All Commercial |
$672.32
|
| Rate for Payer: PHP All Commercial |
$679.84
|
| Rate for Payer: Sagamore Health Network All Products |
$692.04
|
| Rate for Payer: Signature Care EPO |
$744.03
|
| Rate for Payer: Signature Care PPO |
$788.85
|
| Rate for Payer: United Healthcare Commercial |
$706.38
|
|
|
HC SN PL SCREW 3.5X20 LOCK
|
Facility
OP
|
$896.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.82 |
| Max. Negotiated Rate |
$833.67 |
| Rate for Payer: Aetna Commercial |
$756.58
|
| Rate for Payer: Aetna Medicare |
$295.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$295.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$514.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$560.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.40
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Centivo All Commercial |
$457.17
|
| Rate for Payer: Cigna All Commercial |
$773.61
|
| Rate for Payer: CORVEL All Commercial |
$833.67
|
| Rate for Payer: Coventry All Commercial |
$788.85
|
| Rate for Payer: Encore All Commercial |
$825.15
|
| Rate for Payer: Frontpath All Commercial |
$824.71
|
| Rate for Payer: Humana ChoiceCare |
$774.24
|
| Rate for Payer: Humana Medicare |
$457.17
|
| Rate for Payer: Lucent All Commercial |
$457.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$672.32
|
| Rate for Payer: PHP All Commercial |
$679.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$349.60
|
| Rate for Payer: Sagamore Health Network All Products |
$692.04
|
| Rate for Payer: Signature Care EPO |
$744.03
|
| Rate for Payer: Signature Care PPO |
$788.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$761.96
|
| Rate for Payer: United Healthcare Commercial |
$706.38
|
| Rate for Payer: United Healthcare Medicare |
$295.82
|
|
|
HC SN PL SCREW 3.5X20 NON-LOCK
|
Facility
IP
|
$173.18
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.88 |
| Max. Negotiated Rate |
$161.06 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cigna All Commercial |
$149.45
|
| Rate for Payer: CORVEL All Commercial |
$161.06
|
| Rate for Payer: Coventry All Commercial |
$152.40
|
| Rate for Payer: Encore All Commercial |
$159.41
|
| Rate for Payer: Frontpath All Commercial |
$159.33
|
| Rate for Payer: Humana ChoiceCare |
$149.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.86
|
| Rate for Payer: PHCS All Commercial |
$129.88
|
| Rate for Payer: PHP All Commercial |
$131.34
|
| Rate for Payer: Sagamore Health Network All Products |
$133.69
|
| Rate for Payer: Signature Care EPO |
$143.74
|
| Rate for Payer: Signature Care PPO |
$152.40
|
| Rate for Payer: United Healthcare Commercial |
$136.47
|
|
|
HC SN PL SCREW 3.5X20 NON-LOCK
|
Facility
OP
|
$173.18
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$146.16
|
| Rate for Payer: Aetna Medicare |
$57.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.86
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Centivo All Commercial |
$88.32
|
| Rate for Payer: Cigna All Commercial |
$149.45
|
| Rate for Payer: CORVEL All Commercial |
$161.06
|
| Rate for Payer: Coventry All Commercial |
$152.40
|
| Rate for Payer: Encore All Commercial |
$159.41
|
| Rate for Payer: Frontpath All Commercial |
$159.33
|
| Rate for Payer: Humana ChoiceCare |
$149.58
|
| Rate for Payer: Humana Medicare |
$88.32
|
| Rate for Payer: Lucent All Commercial |
$88.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.86
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$129.88
|
| Rate for Payer: PHP All Commercial |
$131.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.54
|
| Rate for Payer: Sagamore Health Network All Products |
$133.69
|
| Rate for Payer: Signature Care EPO |
$143.74
|
| Rate for Payer: Signature Care PPO |
$152.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.20
|
| Rate for Payer: United Healthcare Commercial |
$136.47
|
| Rate for Payer: United Healthcare Medicare |
$57.15
|
|
|
HC SN PL SCREW 3.5X22 LOCK
|
Facility
OP
|
$896.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.82 |
| Max. Negotiated Rate |
$833.67 |
| Rate for Payer: Aetna Commercial |
$756.58
|
| Rate for Payer: Aetna Medicare |
$295.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$295.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$514.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$560.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.40
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Centivo All Commercial |
$457.17
|
| Rate for Payer: Cigna All Commercial |
$773.61
|
| Rate for Payer: CORVEL All Commercial |
$833.67
|
| Rate for Payer: Coventry All Commercial |
$788.85
|
| Rate for Payer: Encore All Commercial |
$825.15
|
| Rate for Payer: Frontpath All Commercial |
$824.71
|
| Rate for Payer: Humana ChoiceCare |
$774.24
|
| Rate for Payer: Humana Medicare |
$457.17
|
| Rate for Payer: Lucent All Commercial |
$457.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$672.32
|
| Rate for Payer: PHP All Commercial |
$679.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$349.60
|
| Rate for Payer: Sagamore Health Network All Products |
$692.04
|
| Rate for Payer: Signature Care EPO |
$744.03
|
| Rate for Payer: Signature Care PPO |
$788.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$761.96
|
| Rate for Payer: United Healthcare Commercial |
$706.38
|
| Rate for Payer: United Healthcare Medicare |
$295.82
|
|
|
HC SN PL SCREW 3.5X22 LOCK
|
Facility
IP
|
$896.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.32 |
| Max. Negotiated Rate |
$833.67 |
| Rate for Payer: Aetna Commercial |
$774.51
|
| Rate for Payer: Cash Price |
$555.78
|
| Rate for Payer: Cigna All Commercial |
$773.61
|
| Rate for Payer: CORVEL All Commercial |
$833.67
|
| Rate for Payer: Coventry All Commercial |
$788.85
|
| Rate for Payer: Encore All Commercial |
$825.15
|
| Rate for Payer: Frontpath All Commercial |
$824.71
|
| Rate for Payer: Humana ChoiceCare |
$774.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.78
|
| Rate for Payer: PHCS All Commercial |
$672.32
|
| Rate for Payer: PHP All Commercial |
$679.84
|
| Rate for Payer: Sagamore Health Network All Products |
$692.04
|
| Rate for Payer: Signature Care EPO |
$744.03
|
| Rate for Payer: Signature Care PPO |
$788.85
|
| Rate for Payer: United Healthcare Commercial |
$706.38
|
|
|
HC SN PL SCREW 3.5X22 NON-LOCK
|
Facility
IP
|
$173.18
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.88 |
| Max. Negotiated Rate |
$161.06 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cigna All Commercial |
$149.45
|
| Rate for Payer: CORVEL All Commercial |
$161.06
|
| Rate for Payer: Coventry All Commercial |
$152.40
|
| Rate for Payer: Encore All Commercial |
$159.41
|
| Rate for Payer: Frontpath All Commercial |
$159.33
|
| Rate for Payer: Humana ChoiceCare |
$149.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.86
|
| Rate for Payer: PHCS All Commercial |
$129.88
|
| Rate for Payer: PHP All Commercial |
$131.34
|
| Rate for Payer: Sagamore Health Network All Products |
$133.69
|
| Rate for Payer: Signature Care EPO |
$143.74
|
| Rate for Payer: Signature Care PPO |
$152.40
|
| Rate for Payer: United Healthcare Commercial |
$136.47
|
|
|
HC SN PL SCREW 3.5X22 NON-LOCK
|
Facility
OP
|
$173.18
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$146.16
|
| Rate for Payer: Aetna Medicare |
$57.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.86
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Centivo All Commercial |
$88.32
|
| Rate for Payer: Cigna All Commercial |
$149.45
|
| Rate for Payer: CORVEL All Commercial |
$161.06
|
| Rate for Payer: Coventry All Commercial |
$152.40
|
| Rate for Payer: Encore All Commercial |
$159.41
|
| Rate for Payer: Frontpath All Commercial |
$159.33
|
| Rate for Payer: Humana ChoiceCare |
$149.58
|
| Rate for Payer: Humana Medicare |
$88.32
|
| Rate for Payer: Lucent All Commercial |
$88.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.86
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$129.88
|
| Rate for Payer: PHP All Commercial |
$131.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.54
|
| Rate for Payer: Sagamore Health Network All Products |
$133.69
|
| Rate for Payer: Signature Care EPO |
$143.74
|
| Rate for Payer: Signature Care PPO |
$152.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.20
|
| Rate for Payer: United Healthcare Commercial |
$136.47
|
| Rate for Payer: United Healthcare Medicare |
$57.15
|
|
|
HC SN PL SCREW 3.5X24 LOCK
|
Facility
IP
|
$785.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601749
|
|
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
|
|
