|
HC W SCREW 5.5X38 LOCK
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,084.32
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
|
|
HC W SCREW 5.5X38 LOCK
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.15 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,059.22
|
| Rate for Payer: Aetna Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.56
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Centivo All Commercial |
$640.05
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Humana Medicare |
$640.05
|
| Rate for Payer: Lucent All Commercial |
$640.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.45
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
| Rate for Payer: United Healthcare Medicare |
$414.15
|
|
|
HC W SCREW 5.5X40 CORT
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$641.09
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
|
|
HC W SCREW 5.5X40 CORT
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$626.25
|
| Rate for Payer: Aetna Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$426.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$463.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.35
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Centivo All Commercial |
$378.42
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Humana Medicare |
$378.42
|
| Rate for Payer: Lucent All Commercial |
$378.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.38
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
| Rate for Payer: United Healthcare Medicare |
$244.86
|
|
|
HC W SCREW 5.5X40 LOCK
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.15 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,059.22
|
| Rate for Payer: Aetna Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.56
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Centivo All Commercial |
$640.05
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Humana Medicare |
$640.05
|
| Rate for Payer: Lucent All Commercial |
$640.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.45
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
| Rate for Payer: United Healthcare Medicare |
$414.15
|
|
|
HC W SCREW 5.5X40 LOCK
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,084.32
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
|
|
HC W SCREW 5.5X45 CORT
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$641.09
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
|
|
HC W SCREW 5.5X45 CORT
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$626.25
|
| Rate for Payer: Aetna Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$426.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$463.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.35
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Centivo All Commercial |
$378.42
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Humana Medicare |
$378.42
|
| Rate for Payer: Lucent All Commercial |
$378.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.38
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
| Rate for Payer: United Healthcare Medicare |
$244.86
|
|
|
HC W SCREW 5.5X45 LOCK
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,084.32
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
|
|
HC W SCREW 5.5X45 LOCK
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.15 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,059.22
|
| Rate for Payer: Aetna Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.56
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Centivo All Commercial |
$640.05
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Humana Medicare |
$640.05
|
| Rate for Payer: Lucent All Commercial |
$640.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.45
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
| Rate for Payer: United Healthcare Medicare |
$414.15
|
|
|
HC W SCREW 5.5X50 CORT
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$626.25
|
| Rate for Payer: Aetna Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$426.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$463.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.35
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Centivo All Commercial |
$378.42
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Humana Medicare |
$378.42
|
| Rate for Payer: Lucent All Commercial |
$378.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.38
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
| Rate for Payer: United Healthcare Medicare |
$244.86
|
|
|
HC W SCREW 5.5X50 CORT
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$641.09
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
|
|
HC W SCREW 5.5X50 LOCK
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,084.32
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
|
|
HC W SCREW 5.5X50 LOCK
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.15 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,059.22
|
| Rate for Payer: Aetna Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.56
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Centivo All Commercial |
$640.05
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Humana Medicare |
$640.05
|
| Rate for Payer: Lucent All Commercial |
$640.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.45
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
| Rate for Payer: United Healthcare Medicare |
$414.15
|
|
|
HC W SCREW 5.5X55 CORT
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$641.09
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
|
|
HC W SCREW 5.5X55 CORT
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$626.25
|
| Rate for Payer: Aetna Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$426.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$463.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.35
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Centivo All Commercial |
$378.42
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Humana Medicare |
$378.42
|
| Rate for Payer: Lucent All Commercial |
$378.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.38
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
| Rate for Payer: United Healthcare Medicare |
$244.86
|
|
|
HC W SCREW 5.5X55 LOCK
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,084.32
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
|
|
HC W SCREW 5.5X55 LOCK
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.15 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,059.22
|
| Rate for Payer: Aetna Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.56
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Centivo All Commercial |
$640.05
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Humana Medicare |
$640.05
|
| Rate for Payer: Lucent All Commercial |
$640.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.45
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
| Rate for Payer: United Healthcare Medicare |
$414.15
|
|
|
HC W SCREW 5.5X60 CORT
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$626.25
|
| Rate for Payer: Aetna Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$426.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$463.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.35
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Centivo All Commercial |
$378.42
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Humana Medicare |
$378.42
|
| Rate for Payer: Lucent All Commercial |
$378.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.38
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
| Rate for Payer: United Healthcare Medicare |
$244.86
|
|
|
HC W SCREW 5.5X60 CORT
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$690.06 |
| Rate for Payer: Aetna Commercial |
$641.09
|
| Rate for Payer: Cash Price |
$460.04
|
| Rate for Payer: Cigna All Commercial |
$640.35
|
| Rate for Payer: CORVEL All Commercial |
$690.06
|
| Rate for Payer: Coventry All Commercial |
$652.96
|
| Rate for Payer: Encore All Commercial |
$683.01
|
| Rate for Payer: Frontpath All Commercial |
$682.64
|
| Rate for Payer: Humana ChoiceCare |
$640.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$667.80
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$562.73
|
| Rate for Payer: Sagamore Health Network All Products |
$572.82
|
| Rate for Payer: Signature Care EPO |
$615.86
|
| Rate for Payer: Signature Care PPO |
$652.96
|
| Rate for Payer: United Healthcare Commercial |
$584.70
|
|
|
HC W SCREW 5.5X60 LOCK
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.25 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,084.32
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
|
|
HC W SCREW 5.5X60 LOCK
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.15 |
| Max. Negotiated Rate |
$1,167.15 |
| Rate for Payer: Aetna Commercial |
$1,059.22
|
| Rate for Payer: Aetna Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.56
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Cash Price |
$778.10
|
| Rate for Payer: Centivo All Commercial |
$640.05
|
| Rate for Payer: Cigna All Commercial |
$1,083.06
|
| Rate for Payer: CORVEL All Commercial |
$1,167.15
|
| Rate for Payer: Coventry All Commercial |
$1,104.40
|
| Rate for Payer: Encore All Commercial |
$1,155.23
|
| Rate for Payer: Frontpath All Commercial |
$1,154.60
|
| Rate for Payer: Humana ChoiceCare |
$1,083.94
|
| Rate for Payer: Humana Medicare |
$640.05
|
| Rate for Payer: Lucent All Commercial |
$640.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,129.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$941.25
|
| Rate for Payer: PHP All Commercial |
$951.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.45
|
| Rate for Payer: Sagamore Health Network All Products |
$968.86
|
| Rate for Payer: Signature Care EPO |
$1,041.65
|
| Rate for Payer: Signature Care PPO |
$1,104.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$988.94
|
| Rate for Payer: United Healthcare Medicare |
$414.15
|
|
|
HC W SCREW 5.5X60 PT
|
Facility
OP
|
$1,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.60 |
| Max. Negotiated Rate |
$1,320.60 |
| Rate for Payer: Aetna Commercial |
$1,198.48
|
| Rate for Payer: Aetna Medicare |
$468.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$468.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$815.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$887.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$538.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$515.46
|
| Rate for Payer: Cash Price |
$880.40
|
| Rate for Payer: Cash Price |
$880.40
|
| Rate for Payer: Centivo All Commercial |
$724.20
|
| Rate for Payer: Cigna All Commercial |
$1,225.46
|
| Rate for Payer: CORVEL All Commercial |
$1,320.60
|
| Rate for Payer: Coventry All Commercial |
$1,249.60
|
| Rate for Payer: Encore All Commercial |
$1,307.11
|
| Rate for Payer: Frontpath All Commercial |
$1,306.40
|
| Rate for Payer: Humana ChoiceCare |
$1,226.45
|
| Rate for Payer: Humana Medicare |
$724.20
|
| Rate for Payer: Lucent All Commercial |
$724.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,278.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,065.00
|
| Rate for Payer: PHP All Commercial |
$1,076.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$553.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,096.24
|
| Rate for Payer: Signature Care EPO |
$1,178.60
|
| Rate for Payer: Signature Care PPO |
$1,249.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,207.00
|
| Rate for Payer: United Healthcare Commercial |
$1,118.96
|
| Rate for Payer: United Healthcare Medicare |
$468.60
|
|
|
HC W SCREW 5.5X60 PT
|
Facility
IP
|
$1,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.00 |
| Max. Negotiated Rate |
$1,320.60 |
| Rate for Payer: Aetna Commercial |
$1,226.88
|
| Rate for Payer: Cash Price |
$880.40
|
| Rate for Payer: Cigna All Commercial |
$1,225.46
|
| Rate for Payer: CORVEL All Commercial |
$1,320.60
|
| Rate for Payer: Coventry All Commercial |
$1,249.60
|
| Rate for Payer: Encore All Commercial |
$1,307.11
|
| Rate for Payer: Frontpath All Commercial |
$1,306.40
|
| Rate for Payer: Humana ChoiceCare |
$1,226.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,278.00
|
| Rate for Payer: PHCS All Commercial |
$1,065.00
|
| Rate for Payer: PHP All Commercial |
$1,076.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,096.24
|
| Rate for Payer: Signature Care EPO |
$1,178.60
|
| Rate for Payer: Signature Care PPO |
$1,249.60
|
| Rate for Payer: United Healthcare Commercial |
$1,118.96
|
|
|
HC W SCREW 5.5X65 PT
|
Facility
IP
|
$1,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.00 |
| Max. Negotiated Rate |
$1,320.60 |
| Rate for Payer: Aetna Commercial |
$1,226.88
|
| Rate for Payer: Cash Price |
$880.40
|
| Rate for Payer: Cigna All Commercial |
$1,225.46
|
| Rate for Payer: CORVEL All Commercial |
$1,320.60
|
| Rate for Payer: Coventry All Commercial |
$1,249.60
|
| Rate for Payer: Encore All Commercial |
$1,307.11
|
| Rate for Payer: Frontpath All Commercial |
$1,306.40
|
| Rate for Payer: Humana ChoiceCare |
$1,226.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,278.00
|
| Rate for Payer: PHCS All Commercial |
$1,065.00
|
| Rate for Payer: PHP All Commercial |
$1,076.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,096.24
|
| Rate for Payer: Signature Care EPO |
$1,178.60
|
| Rate for Payer: Signature Care PPO |
$1,249.60
|
| Rate for Payer: United Healthcare Commercial |
$1,118.96
|
|
