|
HC W SCREW 2.5X10 HD
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X10 HD
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X12
|
Facility
IP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,252.80
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
|
|
HC W SCREW 2.5X12
|
Facility
OP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,223.80
|
| Rate for Payer: Aetna Medicare |
$478.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$478.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$832.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$550.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$526.35
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Centivo All Commercial |
$739.50
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.36
|
| Rate for Payer: Humana Medicare |
$739.50
|
| Rate for Payer: Lucent All Commercial |
$739.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
| Rate for Payer: United Healthcare Medicare |
$478.50
|
|
|
HC W SCREW 2.5X12 HD
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X12 HD
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X14
|
Facility
OP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,223.80
|
| Rate for Payer: Aetna Medicare |
$478.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$478.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$832.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$550.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$526.35
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Centivo All Commercial |
$739.50
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.36
|
| Rate for Payer: Humana Medicare |
$739.50
|
| Rate for Payer: Lucent All Commercial |
$739.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
| Rate for Payer: United Healthcare Medicare |
$478.50
|
|
|
HC W SCREW 2.5X14
|
Facility
IP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,252.80
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
|
|
HC W SCREW 2.5X14 HD
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X14 HD
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X16 HD
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X16 HD
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X18 HD
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X18 HD
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X24 CANN
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X24 CANN
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X30 CANN
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.5X30 CANN
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X32 HD
|
Facility
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.10 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.11
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centivo All Commercial |
$494.70
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$494.70
|
| Rate for Payer: Lucent All Commercial |
$494.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
|
|
HC W SCREW 2.5X32 HD
|
Facility
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.7X10 CORT LP
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.13 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$726.68
|
| Rate for Payer: Aetna Medicare |
$284.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$284.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$494.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$538.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.54
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Centivo All Commercial |
$439.11
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Humana Medicare |
$439.11
|
| Rate for Payer: Lucent All Commercial |
$439.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.79
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
| Rate for Payer: United Healthcare Medicare |
$284.13
|
|
|
HC W SCREW 2.7X10 CORT LP
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.75 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$743.90
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
|
|
HC W SCREW 2.7X10 LOCK
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.30 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$399.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$399.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$459.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$439.23
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Centivo All Commercial |
$617.10
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.80
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$617.10
|
| Rate for Payer: Lucent All Commercial |
$617.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$399.30
|
|
|
HC W SCREW 2.7X10 LOCK
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.80
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC W SCREW 2.7X12 CORT LP
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.13 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$726.68
|
| Rate for Payer: Aetna Medicare |
$284.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$284.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$494.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$538.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.54
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Cash Price |
$533.82
|
| Rate for Payer: Centivo All Commercial |
$439.11
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Humana Medicare |
$439.11
|
| Rate for Payer: Lucent All Commercial |
$439.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.79
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
| Rate for Payer: United Healthcare Medicare |
$284.13
|
|
