|
HC Z MF PLATE 1/4TUB 7-H
|
Facility
IP
|
$605.92
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.44 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$523.51
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
|
|
HC Z MF PLATE 1/4TUB 7-H
|
Facility
OP
|
$605.92
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.95 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$511.40
|
| Rate for Payer: Aetna Medicare |
$199.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.95
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Centivo All Commercial |
$309.02
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Humana Medicare |
$309.02
|
| Rate for Payer: Lucent All Commercial |
$309.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.31
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$515.03
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
| Rate for Payer: United Healthcare Medicare |
$199.95
|
|
|
HC Z MF PLATE 1/4TUB 8-H
|
Facility
OP
|
$629.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.65 |
| Max. Negotiated Rate |
$585.18 |
| Rate for Payer: Aetna Commercial |
$531.07
|
| Rate for Payer: Aetna Medicare |
$207.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$361.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$238.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.41
|
| Rate for Payer: Cash Price |
$390.12
|
| Rate for Payer: Cash Price |
$390.12
|
| Rate for Payer: Centivo All Commercial |
$320.91
|
| Rate for Payer: Cigna All Commercial |
$543.03
|
| Rate for Payer: CORVEL All Commercial |
$585.18
|
| Rate for Payer: Coventry All Commercial |
$553.72
|
| Rate for Payer: Encore All Commercial |
$579.21
|
| Rate for Payer: Frontpath All Commercial |
$578.89
|
| Rate for Payer: Humana ChoiceCare |
$543.47
|
| Rate for Payer: Humana Medicare |
$320.91
|
| Rate for Payer: Lucent All Commercial |
$320.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.31
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$471.92
|
| Rate for Payer: PHP All Commercial |
$477.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.40
|
| Rate for Payer: Sagamore Health Network All Products |
$485.77
|
| Rate for Payer: Signature Care EPO |
$522.26
|
| Rate for Payer: Signature Care PPO |
$553.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$534.85
|
| Rate for Payer: United Healthcare Commercial |
$495.83
|
| Rate for Payer: United Healthcare Medicare |
$207.65
|
|
|
HC Z MF PLATE 1/4TUB 8-H
|
Facility
IP
|
$629.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.92 |
| Max. Negotiated Rate |
$585.18 |
| Rate for Payer: Aetna Commercial |
$543.65
|
| Rate for Payer: Cash Price |
$390.12
|
| Rate for Payer: Cigna All Commercial |
$543.03
|
| Rate for Payer: CORVEL All Commercial |
$585.18
|
| Rate for Payer: Coventry All Commercial |
$553.72
|
| Rate for Payer: Encore All Commercial |
$579.21
|
| Rate for Payer: Frontpath All Commercial |
$578.89
|
| Rate for Payer: Humana ChoiceCare |
$543.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.31
|
| Rate for Payer: PHCS All Commercial |
$471.92
|
| Rate for Payer: PHP All Commercial |
$477.21
|
| Rate for Payer: Sagamore Health Network All Products |
$485.77
|
| Rate for Payer: Signature Care EPO |
$522.26
|
| Rate for Payer: Signature Care PPO |
$553.72
|
| Rate for Payer: United Healthcare Commercial |
$495.83
|
|
|
HC Z MF PLATE ST 2.0 3-H
|
Facility
OP
|
$382.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$322.58
|
| Rate for Payer: Aetna Medicare |
$126.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$219.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.74
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Centivo All Commercial |
$194.92
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$355.45
|
| Rate for Payer: Coventry All Commercial |
$336.34
|
| Rate for Payer: Encore All Commercial |
$351.82
|
| Rate for Payer: Frontpath All Commercial |
$351.62
|
| Rate for Payer: Humana ChoiceCare |
$330.11
|
| Rate for Payer: Humana Medicare |
$194.92
|
| Rate for Payer: Lucent All Commercial |
$194.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$286.65
|
| Rate for Payer: PHP All Commercial |
$289.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.06
|
| Rate for Payer: Sagamore Health Network All Products |
$295.06
|
| Rate for Payer: Signature Care EPO |
$317.23
|
| Rate for Payer: Signature Care PPO |
$336.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.87
|
| Rate for Payer: United Healthcare Commercial |
$301.17
|
| Rate for Payer: United Healthcare Medicare |
$126.13
|
|
|
HC Z MF PLATE ST 2.0 3-H
|
Facility
IP
|
$382.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$355.45 |
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$355.45
|
| Rate for Payer: Coventry All Commercial |
$336.34
|
| Rate for Payer: Encore All Commercial |
$351.82
|
| Rate for Payer: Frontpath All Commercial |
$351.62
|
| Rate for Payer: Humana ChoiceCare |
$330.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.98
|
| Rate for Payer: PHCS All Commercial |
$286.65
|
| Rate for Payer: PHP All Commercial |
$289.86
|
| Rate for Payer: Sagamore Health Network All Products |
$295.06
|
| Rate for Payer: Signature Care EPO |
$317.23
|
| Rate for Payer: Signature Care PPO |
$336.34
|
| Rate for Payer: United Healthcare Commercial |
$301.17
|
|
|
HC Z MF PLATE ST 2.0 4-H
|
Facility
OP
|
$419.44
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.42 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$354.01
|
| Rate for Payer: Aetna Medicare |
$138.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$240.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.26
|
| Rate for Payer: Cash Price |
$260.05
|
| Rate for Payer: Cash Price |
$260.05
|
| Rate for Payer: Centivo All Commercial |
$213.91
|
| Rate for Payer: Cigna All Commercial |
$361.98
|
| Rate for Payer: CORVEL All Commercial |
$390.08
|
| Rate for Payer: Coventry All Commercial |
$369.11
|
| Rate for Payer: Encore All Commercial |
$386.09
|
| Rate for Payer: Frontpath All Commercial |
$385.88
|
| Rate for Payer: Humana ChoiceCare |
$362.27
|
| Rate for Payer: Humana Medicare |
$213.91
|
| Rate for Payer: Lucent All Commercial |
$213.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$377.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$314.58
|
| Rate for Payer: PHP All Commercial |
$318.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.58
|
| Rate for Payer: Sagamore Health Network All Products |
$323.81
|
| Rate for Payer: Signature Care EPO |
$348.14
|
| Rate for Payer: Signature Care PPO |
$369.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$356.52
|
| Rate for Payer: United Healthcare Commercial |
$330.52
|
| Rate for Payer: United Healthcare Medicare |
$138.42
|
|
|
HC Z MF PLATE ST 2.0 4-H
|
Facility
IP
|
$419.44
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$390.08 |
| Rate for Payer: Aetna Commercial |
$362.40
|
| Rate for Payer: Cash Price |
$260.05
|
| Rate for Payer: Cigna All Commercial |
$361.98
|
| Rate for Payer: CORVEL All Commercial |
$390.08
|
| Rate for Payer: Coventry All Commercial |
$369.11
|
| Rate for Payer: Encore All Commercial |
$386.09
|
| Rate for Payer: Frontpath All Commercial |
$385.88
|
| Rate for Payer: Humana ChoiceCare |
$362.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$377.50
|
| Rate for Payer: PHCS All Commercial |
$314.58
|
| Rate for Payer: PHP All Commercial |
$318.10
|
| Rate for Payer: Sagamore Health Network All Products |
$323.81
|
| Rate for Payer: Signature Care EPO |
$348.14
|
| Rate for Payer: Signature Care PPO |
$369.11
|
| Rate for Payer: United Healthcare Commercial |
$330.52
|
|
|
HC Z MF PLATE ST 2.0 5-H
|
Facility
IP
|
$438.13
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$407.46 |
| Rate for Payer: Aetna Commercial |
$378.54
|
| Rate for Payer: Cash Price |
$271.64
|
| Rate for Payer: Cigna All Commercial |
$378.11
|
| Rate for Payer: CORVEL All Commercial |
$407.46
|
| Rate for Payer: Coventry All Commercial |
$385.55
|
| Rate for Payer: Encore All Commercial |
$403.30
|
| Rate for Payer: Frontpath All Commercial |
$403.08
|
| Rate for Payer: Humana ChoiceCare |
$378.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.32
|
| Rate for Payer: PHCS All Commercial |
$328.60
|
| Rate for Payer: PHP All Commercial |
$332.28
|
| Rate for Payer: Sagamore Health Network All Products |
$338.24
|
| Rate for Payer: Signature Care EPO |
$363.65
|
| Rate for Payer: Signature Care PPO |
$385.55
|
| Rate for Payer: United Healthcare Commercial |
$345.25
|
|
|
HC Z MF PLATE ST 2.0 5-H
|
Facility
OP
|
$438.13
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.58 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$369.78
|
| Rate for Payer: Aetna Medicare |
$144.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$273.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.04
|
| Rate for Payer: Cash Price |
$271.64
|
| Rate for Payer: Cash Price |
$271.64
|
| Rate for Payer: Centivo All Commercial |
$223.45
|
| Rate for Payer: Cigna All Commercial |
$378.11
|
| Rate for Payer: CORVEL All Commercial |
$407.46
|
| Rate for Payer: Coventry All Commercial |
$385.55
|
| Rate for Payer: Encore All Commercial |
$403.30
|
| Rate for Payer: Frontpath All Commercial |
$403.08
|
| Rate for Payer: Humana ChoiceCare |
$378.41
|
| Rate for Payer: Humana Medicare |
$223.45
|
| Rate for Payer: Lucent All Commercial |
$223.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$328.60
|
| Rate for Payer: PHP All Commercial |
$332.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.87
|
| Rate for Payer: Sagamore Health Network All Products |
$338.24
|
| Rate for Payer: Signature Care EPO |
$363.65
|
| Rate for Payer: Signature Care PPO |
$385.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.41
|
| Rate for Payer: United Healthcare Commercial |
$345.25
|
| Rate for Payer: United Healthcare Medicare |
$144.58
|
|
|
HC Z MF PLATE ST 2.0 6-H
|
Facility
IP
|
$489.37
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.03 |
| Max. Negotiated Rate |
$455.11 |
| Rate for Payer: Aetna Commercial |
$422.82
|
| Rate for Payer: Cash Price |
$303.41
|
| Rate for Payer: Cigna All Commercial |
$422.33
|
| Rate for Payer: CORVEL All Commercial |
$455.11
|
| Rate for Payer: Coventry All Commercial |
$430.65
|
| Rate for Payer: Encore All Commercial |
$450.47
|
| Rate for Payer: Frontpath All Commercial |
$450.22
|
| Rate for Payer: Humana ChoiceCare |
$422.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$440.43
|
| Rate for Payer: PHCS All Commercial |
$367.03
|
| Rate for Payer: PHP All Commercial |
$371.14
|
| Rate for Payer: Sagamore Health Network All Products |
$377.79
|
| Rate for Payer: Signature Care EPO |
$406.18
|
| Rate for Payer: Signature Care PPO |
$430.65
|
| Rate for Payer: United Healthcare Commercial |
$385.62
|
|
|
HC Z MF PLATE ST 2.0 6-H
|
Facility
OP
|
$489.37
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$413.03
|
| Rate for Payer: Aetna Medicare |
$161.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$281.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$305.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.64
|
| Rate for Payer: Cash Price |
$303.41
|
| Rate for Payer: Cash Price |
$303.41
|
| Rate for Payer: Centivo All Commercial |
$249.58
|
| Rate for Payer: Cigna All Commercial |
$422.33
|
| Rate for Payer: CORVEL All Commercial |
$455.11
|
| Rate for Payer: Coventry All Commercial |
$430.65
|
| Rate for Payer: Encore All Commercial |
$450.47
|
| Rate for Payer: Frontpath All Commercial |
$450.22
|
| Rate for Payer: Humana ChoiceCare |
$422.67
|
| Rate for Payer: Humana Medicare |
$249.58
|
| Rate for Payer: Lucent All Commercial |
$249.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$440.43
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$367.03
|
| Rate for Payer: PHP All Commercial |
$371.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$190.85
|
| Rate for Payer: Sagamore Health Network All Products |
$377.79
|
| Rate for Payer: Signature Care EPO |
$406.18
|
| Rate for Payer: Signature Care PPO |
$430.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$415.96
|
| Rate for Payer: United Healthcare Commercial |
$385.62
|
| Rate for Payer: United Healthcare Medicare |
$161.49
|
|
|
HC Z MF SCREW 1.5X18 CORT
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z MF SCREW 1.5X18 CORT
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z MF SCREW 1.5X20 CORT
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z MF SCREW 1.5X20 CORT
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z MF SCREW 1.5X22 CORT
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z MF SCREW 1.5X22 CORT
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z MF SCREW 1.5X24 CORT
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z MF SCREW 1.5X24 CORT
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z MF SCREW 2.0X22 CORT
|
Facility
IP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$151.75 |
| Rate for Payer: Aetna Commercial |
$140.98
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
|
|
HC Z MF SCREW 2.0X22 CORT
|
Facility
OP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$137.72
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Centivo All Commercial |
$83.22
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Humana Medicare |
$83.22
|
| Rate for Payer: Lucent All Commercial |
$83.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.64
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.69
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
| Rate for Payer: United Healthcare Medicare |
$53.85
|
|
|
HC Z MF SCREW 2.0X24 CORT
|
Facility
IP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$151.75 |
| Rate for Payer: Aetna Commercial |
$140.98
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
|
|
HC Z MF SCREW 2.0X24 CORT
|
Facility
OP
|
$163.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$137.72
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Cash Price |
$101.17
|
| Rate for Payer: Centivo All Commercial |
$83.22
|
| Rate for Payer: Cigna All Commercial |
$140.82
|
| Rate for Payer: CORVEL All Commercial |
$151.75
|
| Rate for Payer: Coventry All Commercial |
$143.59
|
| Rate for Payer: Encore All Commercial |
$150.20
|
| Rate for Payer: Frontpath All Commercial |
$150.12
|
| Rate for Payer: Humana ChoiceCare |
$140.93
|
| Rate for Payer: Humana Medicare |
$83.22
|
| Rate for Payer: Lucent All Commercial |
$83.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.85
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$122.38
|
| Rate for Payer: PHP All Commercial |
$123.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.64
|
| Rate for Payer: Sagamore Health Network All Products |
$125.97
|
| Rate for Payer: Signature Care EPO |
$135.43
|
| Rate for Payer: Signature Care PPO |
$143.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.69
|
| Rate for Payer: United Healthcare Commercial |
$128.58
|
| Rate for Payer: United Healthcare Medicare |
$53.85
|
|
|
HC Z MF T-PLATE 2.0 18
|
Facility
IP
|
$391.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.63 |
| Max. Negotiated Rate |
$364.10 |
| Rate for Payer: Aetna Commercial |
$338.26
|
| Rate for Payer: Cash Price |
$242.74
|
| Rate for Payer: Cigna All Commercial |
$337.87
|
| Rate for Payer: CORVEL All Commercial |
$364.10
|
| Rate for Payer: Coventry All Commercial |
$344.53
|
| Rate for Payer: Encore All Commercial |
$360.38
|
| Rate for Payer: Frontpath All Commercial |
$360.19
|
| Rate for Payer: Humana ChoiceCare |
$338.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$352.36
|
| Rate for Payer: PHCS All Commercial |
$293.63
|
| Rate for Payer: PHP All Commercial |
$296.92
|
| Rate for Payer: Sagamore Health Network All Products |
$302.25
|
| Rate for Payer: Signature Care EPO |
$324.95
|
| Rate for Payer: Signature Care PPO |
$344.53
|
| Rate for Payer: United Healthcare Commercial |
$308.51
|
|
