|
HC ACU 1.5MM X 12MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 12MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 12MM HEX MLT SCREW
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.55 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$620.34
|
| Rate for Payer: Aetna Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.80
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Centivo All Commercial |
$374.85
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Humana Medicare |
$374.85
|
| Rate for Payer: Lucent All Commercial |
$374.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.65
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$624.75
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
| Rate for Payer: United Healthcare Medicare |
$242.55
|
|
|
HC ACU 1.5MM X 12MM HEX MLT SCREW
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$635.04
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
|
|
HC ACU 1.5MM X 13MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 13MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 13MM HEX MLT SCREW
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$635.04
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
|
|
HC ACU 1.5MM X 13MM HEX MLT SCREW
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.55 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$620.34
|
| Rate for Payer: Aetna Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.80
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Centivo All Commercial |
$374.85
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Humana Medicare |
$374.85
|
| Rate for Payer: Lucent All Commercial |
$374.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.65
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$624.75
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
| Rate for Payer: United Healthcare Medicare |
$242.55
|
|
|
HC ACU 1.5MM X 14MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 14MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 14MM HEX MLT SCREW
|
Facility
OP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.55 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$620.34
|
| Rate for Payer: Aetna Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.80
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Centivo All Commercial |
$374.85
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Humana Medicare |
$374.85
|
| Rate for Payer: Lucent All Commercial |
$374.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.65
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$624.75
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
| Rate for Payer: United Healthcare Medicare |
$242.55
|
|
|
HC ACU 1.5MM X 14MM HEX MLT SCREW
|
Facility
IP
|
$735.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$635.04
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
|
|
HC ACU 1.5MM X 16MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 16MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 16MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 16MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 18MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 18MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 18MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 18MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 20MM HEX LAG SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 20MM HEX LAG SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 20MM HEX MLT SCREW
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 1.5MM X 20MM HEX MLT SCREW
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 1.5MM X 4 STT GUIDE WIRE
|
Facility
IP
|
$490.00
|
|
| Hospital Charge Code |
41603243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cigna All Commercial |
$422.87
|
| Rate for Payer: CORVEL All Commercial |
$455.70
|
| Rate for Payer: Coventry All Commercial |
$431.20
|
| Rate for Payer: Encore All Commercial |
$451.04
|
| Rate for Payer: Frontpath All Commercial |
$450.80
|
| Rate for Payer: Humana ChoiceCare |
$423.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$441.00
|
| Rate for Payer: PHCS All Commercial |
$367.50
|
| Rate for Payer: PHP All Commercial |
$371.62
|
| Rate for Payer: Sagamore Health Network All Products |
$378.28
|
| Rate for Payer: Signature Care EPO |
$406.70
|
| Rate for Payer: Signature Care PPO |
$431.20
|
| Rate for Payer: United Healthcare Commercial |
$386.12
|
|
