|
HC Z SCREW 5.5 X 80 CANN LOCK
|
Facility
OP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$804.96 |
| Rate for Payer: Aetna Commercial |
$730.52
|
| Rate for Payer: Aetna Medicare |
$285.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$497.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.19
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Centivo All Commercial |
$441.43
|
| Rate for Payer: Cigna All Commercial |
$746.97
|
| Rate for Payer: CORVEL All Commercial |
$804.96
|
| Rate for Payer: Coventry All Commercial |
$761.68
|
| Rate for Payer: Encore All Commercial |
$796.74
|
| Rate for Payer: Frontpath All Commercial |
$796.31
|
| Rate for Payer: Humana ChoiceCare |
$747.58
|
| Rate for Payer: Humana Medicare |
$441.43
|
| Rate for Payer: Lucent All Commercial |
$441.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$649.16
|
| Rate for Payer: PHP All Commercial |
$656.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.56
|
| Rate for Payer: Sagamore Health Network All Products |
$668.20
|
| Rate for Payer: Signature Care EPO |
$718.41
|
| Rate for Payer: Signature Care PPO |
$761.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$735.72
|
| Rate for Payer: United Healthcare Commercial |
$682.05
|
| Rate for Payer: United Healthcare Medicare |
$285.63
|
|
|
HC Z SCREW 5.5 X 80 CANN LOCK
|
Facility
IP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.16 |
| Max. Negotiated Rate |
$804.96 |
| Rate for Payer: Aetna Commercial |
$747.84
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Cigna All Commercial |
$746.97
|
| Rate for Payer: CORVEL All Commercial |
$804.96
|
| Rate for Payer: Coventry All Commercial |
$761.68
|
| Rate for Payer: Encore All Commercial |
$796.74
|
| Rate for Payer: Frontpath All Commercial |
$796.31
|
| Rate for Payer: Humana ChoiceCare |
$747.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.00
|
| Rate for Payer: PHCS All Commercial |
$649.16
|
| Rate for Payer: PHP All Commercial |
$656.43
|
| Rate for Payer: Sagamore Health Network All Products |
$668.20
|
| Rate for Payer: Signature Care EPO |
$718.41
|
| Rate for Payer: Signature Care PPO |
$761.68
|
| Rate for Payer: United Healthcare Commercial |
$682.05
|
|
|
HC Z SCREW 5.5X80 CANN LOCK
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna All Commercial |
$1,035.60
|
| Rate for Payer: CORVEL All Commercial |
$1,116.00
|
| Rate for Payer: Coventry All Commercial |
$1,056.00
|
| Rate for Payer: Encore All Commercial |
$1,104.60
|
| Rate for Payer: Frontpath All Commercial |
$1,104.00
|
| Rate for Payer: Humana ChoiceCare |
$1,036.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,080.00
|
| Rate for Payer: PHCS All Commercial |
$900.00
|
| Rate for Payer: PHP All Commercial |
$910.08
|
| Rate for Payer: Sagamore Health Network All Products |
$926.40
|
| Rate for Payer: Signature Care EPO |
$996.00
|
| Rate for Payer: Signature Care PPO |
$1,056.00
|
| Rate for Payer: United Healthcare Commercial |
$945.60
|
|
|
HC Z SCREW 5.5X80 CANN LOCK
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$1,012.80
|
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$396.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$689.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.60
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Centivo All Commercial |
$612.00
|
| Rate for Payer: Cigna All Commercial |
$1,035.60
|
| Rate for Payer: CORVEL All Commercial |
$1,116.00
|
| Rate for Payer: Coventry All Commercial |
$1,056.00
|
| Rate for Payer: Encore All Commercial |
$1,104.60
|
| Rate for Payer: Frontpath All Commercial |
$1,104.00
|
| Rate for Payer: Humana ChoiceCare |
$1,036.44
|
| Rate for Payer: Humana Medicare |
$612.00
|
| Rate for Payer: Lucent All Commercial |
$612.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,080.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$900.00
|
| Rate for Payer: PHP All Commercial |
$910.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.00
|
| Rate for Payer: Sagamore Health Network All Products |
$926.40
|
| Rate for Payer: Signature Care EPO |
$996.00
|
| Rate for Payer: Signature Care PPO |
$1,056.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.00
|
| Rate for Payer: United Healthcare Commercial |
$945.60
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
|
|
HC Z SCREW 5.5 X 85 CANN LOCK
|
Facility
IP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.16 |
| Max. Negotiated Rate |
$804.96 |
| Rate for Payer: Aetna Commercial |
$747.84
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Cigna All Commercial |
$746.97
|
| Rate for Payer: CORVEL All Commercial |
$804.96
|
| Rate for Payer: Coventry All Commercial |
$761.68
|
| Rate for Payer: Encore All Commercial |
$796.74
|
| Rate for Payer: Frontpath All Commercial |
$796.31
|
| Rate for Payer: Humana ChoiceCare |
$747.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.00
|
| Rate for Payer: PHCS All Commercial |
$649.16
|
| Rate for Payer: PHP All Commercial |
$656.43
|
| Rate for Payer: Sagamore Health Network All Products |
$668.20
|
| Rate for Payer: Signature Care EPO |
$718.41
|
| Rate for Payer: Signature Care PPO |
$761.68
|
| Rate for Payer: United Healthcare Commercial |
$682.05
|
|
|
HC Z SCREW 5.5 X 85 CANN LOCK
|
Facility
OP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$804.96 |
| Rate for Payer: Aetna Commercial |
$730.52
|
| Rate for Payer: Aetna Medicare |
$285.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$497.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.19
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Centivo All Commercial |
$441.43
|
| Rate for Payer: Cigna All Commercial |
$746.97
|
| Rate for Payer: CORVEL All Commercial |
$804.96
|
| Rate for Payer: Coventry All Commercial |
$761.68
|
| Rate for Payer: Encore All Commercial |
$796.74
|
| Rate for Payer: Frontpath All Commercial |
$796.31
|
| Rate for Payer: Humana ChoiceCare |
$747.58
|
| Rate for Payer: Humana Medicare |
$441.43
|
| Rate for Payer: Lucent All Commercial |
$441.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$649.16
|
| Rate for Payer: PHP All Commercial |
$656.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.56
|
| Rate for Payer: Sagamore Health Network All Products |
$668.20
|
| Rate for Payer: Signature Care EPO |
$718.41
|
| Rate for Payer: Signature Care PPO |
$761.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$735.72
|
| Rate for Payer: United Healthcare Commercial |
$682.05
|
| Rate for Payer: United Healthcare Medicare |
$285.63
|
|
|
HC Z SCREW 5.5 X 90 CANN CONICAL
|
Facility
OP
|
$848.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.14 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Aetna Commercial |
$716.47
|
| Rate for Payer: Aetna Medicare |
$280.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.15
|
| Rate for Payer: Cash Price |
$526.32
|
| Rate for Payer: Cash Price |
$526.32
|
| Rate for Payer: Centivo All Commercial |
$432.94
|
| Rate for Payer: Cigna All Commercial |
$732.60
|
| Rate for Payer: CORVEL All Commercial |
$789.48
|
| Rate for Payer: Coventry All Commercial |
$747.03
|
| Rate for Payer: Encore All Commercial |
$781.41
|
| Rate for Payer: Frontpath All Commercial |
$780.99
|
| Rate for Payer: Humana ChoiceCare |
$733.19
|
| Rate for Payer: Humana Medicare |
$432.94
|
| Rate for Payer: Lucent All Commercial |
$432.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.01
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$636.68
|
| Rate for Payer: PHP All Commercial |
$643.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.07
|
| Rate for Payer: Sagamore Health Network All Products |
$655.35
|
| Rate for Payer: Signature Care EPO |
$704.59
|
| Rate for Payer: Signature Care PPO |
$747.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.56
|
| Rate for Payer: United Healthcare Commercial |
$668.93
|
| Rate for Payer: United Healthcare Medicare |
$280.14
|
|
|
HC Z SCREW 5.5 X 90 CANN CONICAL
|
Facility
IP
|
$848.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.68 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Aetna Commercial |
$733.45
|
| Rate for Payer: Cash Price |
$526.32
|
| Rate for Payer: Cigna All Commercial |
$732.60
|
| Rate for Payer: CORVEL All Commercial |
$789.48
|
| Rate for Payer: Coventry All Commercial |
$747.03
|
| Rate for Payer: Encore All Commercial |
$781.41
|
| Rate for Payer: Frontpath All Commercial |
$780.99
|
| Rate for Payer: Humana ChoiceCare |
$733.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.01
|
| Rate for Payer: PHCS All Commercial |
$636.68
|
| Rate for Payer: PHP All Commercial |
$643.81
|
| Rate for Payer: Sagamore Health Network All Products |
$655.35
|
| Rate for Payer: Signature Care EPO |
$704.59
|
| Rate for Payer: Signature Care PPO |
$747.03
|
| Rate for Payer: United Healthcare Commercial |
$668.93
|
|
|
HC Z SCREW 5X10 NCB UNICORT
|
Facility
IP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.54 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$865.77
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
|
|
HC Z SCREW 5X10 NCB UNICORT
|
Facility
OP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.68 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$845.73
|
| Rate for Payer: Aetna Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$575.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$626.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.74
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Centivo All Commercial |
$511.05
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Humana Medicare |
$511.05
|
| Rate for Payer: Lucent All Commercial |
$511.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.80
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$851.74
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
| Rate for Payer: United Healthcare Medicare |
$330.68
|
|
|
HC Z SCREW 5X12 NCB UNICORT
|
Facility
OP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.68 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$845.73
|
| Rate for Payer: Aetna Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$575.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$626.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.74
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Centivo All Commercial |
$511.05
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Humana Medicare |
$511.05
|
| Rate for Payer: Lucent All Commercial |
$511.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.80
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$851.74
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
| Rate for Payer: United Healthcare Medicare |
$330.68
|
|
|
HC Z SCREW 5X12 NCB UNICORT
|
Facility
IP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.54 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$865.77
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
|
|
HC Z SCREW 5X14 NCB UNICORT
|
Facility
IP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.54 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$865.77
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
|
|
HC Z SCREW 5X14 NCB UNICORT
|
Facility
OP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.68 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$845.73
|
| Rate for Payer: Aetna Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$575.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$626.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.74
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Centivo All Commercial |
$511.05
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Humana Medicare |
$511.05
|
| Rate for Payer: Lucent All Commercial |
$511.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.80
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$851.74
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
| Rate for Payer: United Healthcare Medicare |
$330.68
|
|
|
HC Z SCREW 5X16 NCB UNICORT
|
Facility
IP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.54 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$865.77
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
|
|
HC Z SCREW 5X16 NCB UNICORT
|
Facility
OP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.68 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$845.73
|
| Rate for Payer: Aetna Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$575.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$626.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.74
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Centivo All Commercial |
$511.05
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Humana Medicare |
$511.05
|
| Rate for Payer: Lucent All Commercial |
$511.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.80
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$851.74
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
| Rate for Payer: United Healthcare Medicare |
$330.68
|
|
|
HC Z SCREW 5X18 NCB UNICORT
|
Facility
IP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.54 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$865.77
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
|
|
HC Z SCREW 5X18 NCB UNICORT
|
Facility
OP
|
$1,002.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.68 |
| Max. Negotiated Rate |
$931.91 |
| Rate for Payer: Aetna Commercial |
$845.73
|
| Rate for Payer: Aetna Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$575.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$626.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.74
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Cash Price |
$621.27
|
| Rate for Payer: Centivo All Commercial |
$511.05
|
| Rate for Payer: Cigna All Commercial |
$864.77
|
| Rate for Payer: CORVEL All Commercial |
$931.91
|
| Rate for Payer: Coventry All Commercial |
$881.80
|
| Rate for Payer: Encore All Commercial |
$922.39
|
| Rate for Payer: Frontpath All Commercial |
$921.89
|
| Rate for Payer: Humana ChoiceCare |
$865.47
|
| Rate for Payer: Humana Medicare |
$511.05
|
| Rate for Payer: Lucent All Commercial |
$511.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$751.54
|
| Rate for Payer: PHP All Commercial |
$759.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.80
|
| Rate for Payer: Sagamore Health Network All Products |
$773.58
|
| Rate for Payer: Signature Care EPO |
$831.70
|
| Rate for Payer: Signature Care PPO |
$881.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$851.74
|
| Rate for Payer: United Healthcare Commercial |
$789.62
|
| Rate for Payer: United Healthcare Medicare |
$330.68
|
|
|
HC Z SCREW 5X22 NCB CORT ST
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$296.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$283.99
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Centivo All Commercial |
$399.00
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Humana Medicare |
$399.00
|
| Rate for Payer: Lucent All Commercial |
$399.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.12
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.00
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
| Rate for Payer: United Healthcare Medicare |
$258.18
|
|
|
HC Z SCREW 5X22 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
|
HC Z SCREW 5X24 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
|
HC Z SCREW 5X24 NCB CORT ST
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$296.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$283.99
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Centivo All Commercial |
$399.00
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Humana Medicare |
$399.00
|
| Rate for Payer: Lucent All Commercial |
$399.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.12
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.00
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
| Rate for Payer: United Healthcare Medicare |
$258.18
|
|
|
HC Z SCREW 5X26 NCB CORT
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$296.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$283.99
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Centivo All Commercial |
$399.00
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Humana Medicare |
$399.00
|
| Rate for Payer: Lucent All Commercial |
$399.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.12
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.00
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
| Rate for Payer: United Healthcare Medicare |
$258.18
|
|
|
HC Z SCREW 5X26 NCB CORT
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
|
HC Z SCREW 5X30 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
