|
HC W SCREW 3.5X46 LOCK TM
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604863
|
|
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 3.5X46 NON LOCK TM
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$602.62
|
| Rate for Payer: Aetna Medicare |
$235.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$410.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$446.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.18
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Centivo All Commercial |
$364.14
|
| Rate for Payer: Cigna All Commercial |
$616.18
|
| Rate for Payer: CORVEL All Commercial |
$664.02
|
| Rate for Payer: Coventry All Commercial |
$628.32
|
| Rate for Payer: Encore All Commercial |
$657.24
|
| Rate for Payer: Frontpath All Commercial |
$656.88
|
| Rate for Payer: Humana ChoiceCare |
$616.68
|
| Rate for Payer: Humana Medicare |
$364.14
|
| Rate for Payer: Lucent All Commercial |
$364.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$535.50
|
| Rate for Payer: PHP All Commercial |
$541.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$278.46
|
| Rate for Payer: Sagamore Health Network All Products |
$551.21
|
| Rate for Payer: Signature Care EPO |
$592.62
|
| Rate for Payer: Signature Care PPO |
$628.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$606.90
|
| Rate for Payer: United Healthcare Commercial |
$562.63
|
| Rate for Payer: United Healthcare Medicare |
$235.62
|
|
|
HC W SCREW 3.5X46 NON LOCK TM
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$616.90
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cigna All Commercial |
$616.18
|
| Rate for Payer: CORVEL All Commercial |
$664.02
|
| Rate for Payer: Coventry All Commercial |
$628.32
|
| Rate for Payer: Encore All Commercial |
$657.24
|
| Rate for Payer: Frontpath All Commercial |
$656.88
|
| Rate for Payer: Humana ChoiceCare |
$616.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.60
|
| Rate for Payer: PHCS All Commercial |
$535.50
|
| Rate for Payer: PHP All Commercial |
$541.50
|
| Rate for Payer: Sagamore Health Network All Products |
$551.21
|
| Rate for Payer: Signature Care EPO |
$592.62
|
| Rate for Payer: Signature Care PPO |
$628.32
|
| Rate for Payer: United Healthcare Commercial |
$562.63
|
|
|
HC W SCREW 3.5X48 CORT
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604693
|
|
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 3.5X48 CORT
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604693
|
|
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 3.5X48 CORT LP
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604751
|
|
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 3.5X48 CORT LP
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604751
|
|
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 3.5X48 LOCK
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604732
|
|
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 3.5X48 LOCK
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604732
|
|
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 3.5X48 LOCK TM
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604864
|
|
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 3.5X48 LOCK TM
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604864
|
|
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 3.5X48 NON LOCK TM
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$602.62
|
| Rate for Payer: Aetna Medicare |
$235.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$410.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$446.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.18
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Centivo All Commercial |
$364.14
|
| Rate for Payer: Cigna All Commercial |
$616.18
|
| Rate for Payer: CORVEL All Commercial |
$664.02
|
| Rate for Payer: Coventry All Commercial |
$628.32
|
| Rate for Payer: Encore All Commercial |
$657.24
|
| Rate for Payer: Frontpath All Commercial |
$656.88
|
| Rate for Payer: Humana ChoiceCare |
$616.68
|
| Rate for Payer: Humana Medicare |
$364.14
|
| Rate for Payer: Lucent All Commercial |
$364.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$535.50
|
| Rate for Payer: PHP All Commercial |
$541.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$278.46
|
| Rate for Payer: Sagamore Health Network All Products |
$551.21
|
| Rate for Payer: Signature Care EPO |
$592.62
|
| Rate for Payer: Signature Care PPO |
$628.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$606.90
|
| Rate for Payer: United Healthcare Commercial |
$562.63
|
| Rate for Payer: United Healthcare Medicare |
$235.62
|
|
|
HC W SCREW 3.5X48 NON LOCK TM
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$616.90
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cigna All Commercial |
$616.18
|
| Rate for Payer: CORVEL All Commercial |
$664.02
|
| Rate for Payer: Coventry All Commercial |
$628.32
|
| Rate for Payer: Encore All Commercial |
$657.24
|
| Rate for Payer: Frontpath All Commercial |
$656.88
|
| Rate for Payer: Humana ChoiceCare |
$616.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.60
|
| Rate for Payer: PHCS All Commercial |
$535.50
|
| Rate for Payer: PHP All Commercial |
$541.50
|
| Rate for Payer: Sagamore Health Network All Products |
$551.21
|
| Rate for Payer: Signature Care EPO |
$592.62
|
| Rate for Payer: Signature Care PPO |
$628.32
|
| Rate for Payer: United Healthcare Commercial |
$562.63
|
|
|
HC W SCREW 3.5X50 CORT
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604694
|
|
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 3.5X50 CORT
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604694
|
|
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 3.5X50 CORT LP
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604752
|
|
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 3.5X50 CORT LP
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604752
|
|
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 3.5X50 LOCK
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604733
|
|
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 3.5X50 LOCK
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604733
|
|
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 3.5X50 LOCK TM
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604865
|
|
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 3.5X50 LOCK TM
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604865
|
|
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 3.5X50 NON LOCK TM
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$616.90
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cigna All Commercial |
$616.18
|
| Rate for Payer: CORVEL All Commercial |
$664.02
|
| Rate for Payer: Coventry All Commercial |
$628.32
|
| Rate for Payer: Encore All Commercial |
$657.24
|
| Rate for Payer: Frontpath All Commercial |
$656.88
|
| Rate for Payer: Humana ChoiceCare |
$616.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.60
|
| Rate for Payer: PHCS All Commercial |
$535.50
|
| Rate for Payer: PHP All Commercial |
$541.50
|
| Rate for Payer: Sagamore Health Network All Products |
$551.21
|
| Rate for Payer: Signature Care EPO |
$592.62
|
| Rate for Payer: Signature Care PPO |
$628.32
|
| Rate for Payer: United Healthcare Commercial |
$562.63
|
|
|
HC W SCREW 3.5X50 NON LOCK TM
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$602.62
|
| Rate for Payer: Aetna Medicare |
$235.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$410.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$446.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.18
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Centivo All Commercial |
$364.14
|
| Rate for Payer: Cigna All Commercial |
$616.18
|
| Rate for Payer: CORVEL All Commercial |
$664.02
|
| Rate for Payer: Coventry All Commercial |
$628.32
|
| Rate for Payer: Encore All Commercial |
$657.24
|
| Rate for Payer: Frontpath All Commercial |
$656.88
|
| Rate for Payer: Humana ChoiceCare |
$616.68
|
| Rate for Payer: Humana Medicare |
$364.14
|
| Rate for Payer: Lucent All Commercial |
$364.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$535.50
|
| Rate for Payer: PHP All Commercial |
$541.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$278.46
|
| Rate for Payer: Sagamore Health Network All Products |
$551.21
|
| Rate for Payer: Signature Care EPO |
$592.62
|
| Rate for Payer: Signature Care PPO |
$628.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$606.90
|
| Rate for Payer: United Healthcare Commercial |
$562.63
|
| Rate for Payer: United Healthcare Medicare |
$235.62
|
|
|
HC W SCREW 3.5X52 CORT
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604695
|
|
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 3.5X52 CORT
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604695
|
|
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
|
|
