|
HC W SCREW 4.0X35 HD
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
HC W SCREW 4.0X35 HD CANN
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.10 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$903.08
|
| Rate for Payer: Aetna Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.41
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Centivo All Commercial |
$545.70
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Humana Medicare |
$545.70
|
| Rate for Payer: Lucent All Commercial |
$545.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.30
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
| Rate for Payer: United Healthcare Medicare |
$353.10
|
|
|
HC W SCREW 4.0X35 HD CANN
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
HC W SCREW 4.0X35 PT CANC
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604962
|
|
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 4.0X35 PT CANC
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604962
|
|
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 4.0X36 HD
|
Facility
IP
|
$1,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.50 |
| Max. Negotiated Rate |
$1,181.10 |
| Rate for Payer: Aetna Commercial |
$1,097.28
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Cigna All Commercial |
$1,096.01
|
| Rate for Payer: CORVEL All Commercial |
$1,181.10
|
| Rate for Payer: Coventry All Commercial |
$1,117.60
|
| Rate for Payer: Encore All Commercial |
$1,169.04
|
| Rate for Payer: Frontpath All Commercial |
$1,168.40
|
| Rate for Payer: Humana ChoiceCare |
$1,096.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: PHCS All Commercial |
$952.50
|
| Rate for Payer: PHP All Commercial |
$963.17
|
| Rate for Payer: Sagamore Health Network All Products |
$980.44
|
| Rate for Payer: Signature Care EPO |
$1,054.10
|
| Rate for Payer: Signature Care PPO |
$1,117.60
|
| Rate for Payer: United Healthcare Commercial |
$1,000.76
|
|
|
HC W SCREW 4.0X36 HD
|
Facility
OP
|
$1,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.10 |
| Max. Negotiated Rate |
$1,181.10 |
| Rate for Payer: Aetna Commercial |
$1,071.88
|
| Rate for Payer: Aetna Medicare |
$419.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$729.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$793.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$481.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$461.01
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Centivo All Commercial |
$647.70
|
| Rate for Payer: Cigna All Commercial |
$1,096.01
|
| Rate for Payer: CORVEL All Commercial |
$1,181.10
|
| Rate for Payer: Coventry All Commercial |
$1,117.60
|
| Rate for Payer: Encore All Commercial |
$1,169.04
|
| Rate for Payer: Frontpath All Commercial |
$1,168.40
|
| Rate for Payer: Humana ChoiceCare |
$1,096.90
|
| Rate for Payer: Humana Medicare |
$647.70
|
| Rate for Payer: Lucent All Commercial |
$647.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$952.50
|
| Rate for Payer: PHP All Commercial |
$963.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$495.30
|
| Rate for Payer: Sagamore Health Network All Products |
$980.44
|
| Rate for Payer: Signature Care EPO |
$1,054.10
|
| Rate for Payer: Signature Care PPO |
$1,117.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,079.50
|
| Rate for Payer: United Healthcare Commercial |
$1,000.76
|
| Rate for Payer: United Healthcare Medicare |
$419.10
|
|
|
HC W SCREW 4.0X37.5 HD CANN
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.10 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$903.08
|
| Rate for Payer: Aetna Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.41
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Centivo All Commercial |
$545.70
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Humana Medicare |
$545.70
|
| Rate for Payer: Lucent All Commercial |
$545.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.30
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
| Rate for Payer: United Healthcare Medicare |
$353.10
|
|
|
HC W SCREW 4.0X37.5 HD CANN
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
HC W SCREW 4.0X38 HD
|
Facility
OP
|
$1,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.10 |
| Max. Negotiated Rate |
$1,181.10 |
| Rate for Payer: Aetna Commercial |
$1,071.88
|
| Rate for Payer: Aetna Medicare |
$419.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$729.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$793.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$481.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$461.01
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Centivo All Commercial |
$647.70
|
| Rate for Payer: Cigna All Commercial |
$1,096.01
|
| Rate for Payer: CORVEL All Commercial |
$1,181.10
|
| Rate for Payer: Coventry All Commercial |
$1,117.60
|
| Rate for Payer: Encore All Commercial |
$1,169.04
|
| Rate for Payer: Frontpath All Commercial |
$1,168.40
|
| Rate for Payer: Humana ChoiceCare |
$1,096.90
|
| Rate for Payer: Humana Medicare |
$647.70
|
| Rate for Payer: Lucent All Commercial |
$647.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$952.50
|
| Rate for Payer: PHP All Commercial |
$963.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$495.30
|
| Rate for Payer: Sagamore Health Network All Products |
$980.44
|
| Rate for Payer: Signature Care EPO |
$1,054.10
|
| Rate for Payer: Signature Care PPO |
$1,117.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,079.50
|
| Rate for Payer: United Healthcare Commercial |
$1,000.76
|
| Rate for Payer: United Healthcare Medicare |
$419.10
|
|
|
HC W SCREW 4.0X38 HD
|
Facility
IP
|
$1,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.50 |
| Max. Negotiated Rate |
$1,181.10 |
| Rate for Payer: Aetna Commercial |
$1,097.28
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Cigna All Commercial |
$1,096.01
|
| Rate for Payer: CORVEL All Commercial |
$1,181.10
|
| Rate for Payer: Coventry All Commercial |
$1,117.60
|
| Rate for Payer: Encore All Commercial |
$1,169.04
|
| Rate for Payer: Frontpath All Commercial |
$1,168.40
|
| Rate for Payer: Humana ChoiceCare |
$1,096.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: PHCS All Commercial |
$952.50
|
| Rate for Payer: PHP All Commercial |
$963.17
|
| Rate for Payer: Sagamore Health Network All Products |
$980.44
|
| Rate for Payer: Signature Care EPO |
$1,054.10
|
| Rate for Payer: Signature Care PPO |
$1,117.60
|
| Rate for Payer: United Healthcare Commercial |
$1,000.76
|
|
|
HC W SCREW 4.0X40 CANC
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604951
|
|
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 4.0X40 CANC
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604951
|
|
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 4.0X40 CORT
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604705
|
|
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 4.0X40 CORT
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604705
|
|
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 4.0X40 PT CANC
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604963
|
|
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 4.0X40 PT CANC
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604963
|
|
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 4.0X42.5 HD CANN
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
HC W SCREW 4.0X42.5 HD CANN
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.10 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$903.08
|
| Rate for Payer: Aetna Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$614.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.41
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Cash Price |
$663.40
|
| Rate for Payer: Centivo All Commercial |
$545.70
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.94
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Humana Medicare |
$545.70
|
| Rate for Payer: Lucent All Commercial |
$545.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.30
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
| Rate for Payer: United Healthcare Medicare |
$353.10
|
|
|
HC W SCREW 4.0X42 CORT
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604706
|
|
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 4.0X42 CORT
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604706
|
|
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 4.0X42 HD
|
Facility
IP
|
$1,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.50 |
| Max. Negotiated Rate |
$1,181.10 |
| Rate for Payer: Aetna Commercial |
$1,097.28
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Cigna All Commercial |
$1,096.01
|
| Rate for Payer: CORVEL All Commercial |
$1,181.10
|
| Rate for Payer: Coventry All Commercial |
$1,117.60
|
| Rate for Payer: Encore All Commercial |
$1,169.04
|
| Rate for Payer: Frontpath All Commercial |
$1,168.40
|
| Rate for Payer: Humana ChoiceCare |
$1,096.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: PHCS All Commercial |
$952.50
|
| Rate for Payer: PHP All Commercial |
$963.17
|
| Rate for Payer: Sagamore Health Network All Products |
$980.44
|
| Rate for Payer: Signature Care EPO |
$1,054.10
|
| Rate for Payer: Signature Care PPO |
$1,117.60
|
| Rate for Payer: United Healthcare Commercial |
$1,000.76
|
|
|
HC W SCREW 4.0X42 HD
|
Facility
OP
|
$1,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.10 |
| Max. Negotiated Rate |
$1,181.10 |
| Rate for Payer: Aetna Commercial |
$1,071.88
|
| Rate for Payer: Aetna Medicare |
$419.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$729.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$793.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$481.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$461.01
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Cash Price |
$787.40
|
| Rate for Payer: Centivo All Commercial |
$647.70
|
| Rate for Payer: Cigna All Commercial |
$1,096.01
|
| Rate for Payer: CORVEL All Commercial |
$1,181.10
|
| Rate for Payer: Coventry All Commercial |
$1,117.60
|
| Rate for Payer: Encore All Commercial |
$1,169.04
|
| Rate for Payer: Frontpath All Commercial |
$1,168.40
|
| Rate for Payer: Humana ChoiceCare |
$1,096.90
|
| Rate for Payer: Humana Medicare |
$647.70
|
| Rate for Payer: Lucent All Commercial |
$647.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$952.50
|
| Rate for Payer: PHP All Commercial |
$963.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$495.30
|
| Rate for Payer: Sagamore Health Network All Products |
$980.44
|
| Rate for Payer: Signature Care EPO |
$1,054.10
|
| Rate for Payer: Signature Care PPO |
$1,117.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,079.50
|
| Rate for Payer: United Healthcare Commercial |
$1,000.76
|
| Rate for Payer: United Healthcare Medicare |
$419.10
|
|
|
HC W SCREW 4.0X44 CORT
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604707
|
|
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 4.0X44 CORT
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604707
|
|
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
|
|
