|
HC Z SCREW 5X65 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606567
|
|
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 5X70 CANN FT
|
Facility
OP
|
$862.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.51 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Aetna Medicare |
$284.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$284.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$495.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$538.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$327.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.96
|
| Rate for Payer: Cash Price |
$534.53
|
| Rate for Payer: Cash Price |
$534.53
|
| Rate for Payer: Centivo All Commercial |
$439.70
|
| Rate for Payer: Cigna All Commercial |
$744.04
|
| Rate for Payer: CORVEL All Commercial |
$801.80
|
| Rate for Payer: Coventry All Commercial |
$758.69
|
| Rate for Payer: Encore All Commercial |
$793.61
|
| Rate for Payer: Frontpath All Commercial |
$793.18
|
| Rate for Payer: Humana ChoiceCare |
$744.64
|
| Rate for Payer: Humana Medicare |
$439.70
|
| Rate for Payer: Lucent All Commercial |
$439.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$775.94
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$646.61
|
| Rate for Payer: PHP All Commercial |
$653.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$336.24
|
| Rate for Payer: Sagamore Health Network All Products |
$665.58
|
| Rate for Payer: Signature Care EPO |
$715.58
|
| Rate for Payer: Signature Care PPO |
$758.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$732.83
|
| Rate for Payer: United Healthcare Commercial |
$679.37
|
| Rate for Payer: United Healthcare Medicare |
$284.51
|
|
|
HC Z SCREW 5X70 CANN FT
|
Facility
IP
|
$862.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.61 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Aetna Commercial |
$744.90
|
| Rate for Payer: Cash Price |
$534.53
|
| Rate for Payer: Cigna All Commercial |
$744.04
|
| Rate for Payer: CORVEL All Commercial |
$801.80
|
| Rate for Payer: Coventry All Commercial |
$758.69
|
| Rate for Payer: Encore All Commercial |
$793.61
|
| Rate for Payer: Frontpath All Commercial |
$793.18
|
| Rate for Payer: Humana ChoiceCare |
$744.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$775.94
|
| Rate for Payer: PHCS All Commercial |
$646.61
|
| Rate for Payer: PHP All Commercial |
$653.85
|
| Rate for Payer: Sagamore Health Network All Products |
$665.58
|
| Rate for Payer: Signature Care EPO |
$715.58
|
| Rate for Payer: Signature Care PPO |
$758.69
|
| Rate for Payer: United Healthcare Commercial |
$679.37
|
|
|
HC Z SCREW 5X70 NCB CANC
|
Facility
OP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$786.71
|
| Rate for Payer: Aetna Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.36
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Centivo All Commercial |
$475.38
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Humana Medicare |
$475.38
|
| Rate for Payer: Lucent All Commercial |
$475.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.53
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$792.30
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
| Rate for Payer: United Healthcare Medicare |
$307.60
|
|
|
HC Z SCREW 5X70 NCB CANC
|
Facility
IP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.09 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
|
|
HC Z SCREW 5X70 NCB CORT ST
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606558
|
|
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 5X70 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606558
|
|
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 5X75 NCB CANC
|
Facility
OP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$786.71
|
| Rate for Payer: Aetna Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.36
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Centivo All Commercial |
$475.38
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Humana Medicare |
$475.38
|
| Rate for Payer: Lucent All Commercial |
$475.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.53
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$792.30
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
| Rate for Payer: United Healthcare Medicare |
$307.60
|
|
|
HC Z SCREW 5X75 NCB CANC
|
Facility
IP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.09 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
|
|
HC Z SCREW 5X75 NCB CORT ST
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606559
|
|
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 5X75 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606559
|
|
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 5X80 LOCK AD
|
Facility
OP
|
$2,054.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,910.68 |
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: Aetna Medicare |
$677.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$677.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,179.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,284.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$779.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$745.78
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Centivo All Commercial |
$1,047.80
|
| Rate for Payer: Cigna All Commercial |
$1,773.03
|
| Rate for Payer: CORVEL All Commercial |
$1,910.68
|
| Rate for Payer: Coventry All Commercial |
$1,807.96
|
| Rate for Payer: Encore All Commercial |
$1,891.17
|
| Rate for Payer: Frontpath All Commercial |
$1,890.14
|
| Rate for Payer: Humana ChoiceCare |
$1,774.47
|
| Rate for Payer: Humana Medicare |
$1,047.80
|
| Rate for Payer: Lucent All Commercial |
$1,047.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,540.88
|
| Rate for Payer: PHP All Commercial |
$1,558.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$801.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.07
|
| Rate for Payer: Signature Care EPO |
$1,705.24
|
| Rate for Payer: Signature Care PPO |
$1,807.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,746.32
|
| Rate for Payer: United Healthcare Commercial |
$1,618.95
|
| Rate for Payer: United Healthcare Medicare |
$677.98
|
|
|
HC Z SCREW 5X80 LOCK AD
|
Facility
IP
|
$2,054.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.88 |
| Max. Negotiated Rate |
$1,910.68 |
| Rate for Payer: Aetna Commercial |
$1,775.09
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Cigna All Commercial |
$1,773.03
|
| Rate for Payer: CORVEL All Commercial |
$1,910.68
|
| Rate for Payer: Coventry All Commercial |
$1,807.96
|
| Rate for Payer: Encore All Commercial |
$1,891.17
|
| Rate for Payer: Frontpath All Commercial |
$1,890.14
|
| Rate for Payer: Humana ChoiceCare |
$1,774.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.05
|
| Rate for Payer: PHCS All Commercial |
$1,540.88
|
| Rate for Payer: PHP All Commercial |
$1,558.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.07
|
| Rate for Payer: Signature Care EPO |
$1,705.24
|
| Rate for Payer: Signature Care PPO |
$1,807.96
|
| Rate for Payer: United Healthcare Commercial |
$1,618.95
|
|
|
HC Z SCREW 5X80 NCB CANC
|
Facility
OP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$786.71
|
| Rate for Payer: Aetna Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.36
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Centivo All Commercial |
$475.38
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Humana Medicare |
$475.38
|
| Rate for Payer: Lucent All Commercial |
$475.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.53
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$792.30
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
| Rate for Payer: United Healthcare Medicare |
$307.60
|
|
|
HC Z SCREW 5X80 NCB CANC
|
Facility
IP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.09 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
|
|
HC Z SCREW 5X80 NCB CORT ST
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606560
|
|
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 5X80 NCB CORT ST
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606560
|
|
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 5X85 NCB CANC
|
Facility
OP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$786.71
|
| Rate for Payer: Aetna Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.36
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Centivo All Commercial |
$475.38
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Humana Medicare |
$475.38
|
| Rate for Payer: Lucent All Commercial |
$475.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.53
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$792.30
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
| Rate for Payer: United Healthcare Medicare |
$307.60
|
|
|
HC Z SCREW 5X85 NCB CANC
|
Facility
IP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.09 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
|
|
HC Z SCREW 5X90 LOCK AD
|
Facility
IP
|
$2,054.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.88 |
| Max. Negotiated Rate |
$1,910.68 |
| Rate for Payer: Aetna Commercial |
$1,775.09
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Cigna All Commercial |
$1,773.03
|
| Rate for Payer: CORVEL All Commercial |
$1,910.68
|
| Rate for Payer: Coventry All Commercial |
$1,807.96
|
| Rate for Payer: Encore All Commercial |
$1,891.17
|
| Rate for Payer: Frontpath All Commercial |
$1,890.14
|
| Rate for Payer: Humana ChoiceCare |
$1,774.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.05
|
| Rate for Payer: PHCS All Commercial |
$1,540.88
|
| Rate for Payer: PHP All Commercial |
$1,558.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.07
|
| Rate for Payer: Signature Care EPO |
$1,705.24
|
| Rate for Payer: Signature Care PPO |
$1,807.96
|
| Rate for Payer: United Healthcare Commercial |
$1,618.95
|
|
|
HC Z SCREW 5X90 LOCK AD
|
Facility
OP
|
$2,054.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,910.68 |
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: Aetna Medicare |
$677.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$677.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,179.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,284.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$779.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$745.78
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Centivo All Commercial |
$1,047.80
|
| Rate for Payer: Cigna All Commercial |
$1,773.03
|
| Rate for Payer: CORVEL All Commercial |
$1,910.68
|
| Rate for Payer: Coventry All Commercial |
$1,807.96
|
| Rate for Payer: Encore All Commercial |
$1,891.17
|
| Rate for Payer: Frontpath All Commercial |
$1,890.14
|
| Rate for Payer: Humana ChoiceCare |
$1,774.47
|
| Rate for Payer: Humana Medicare |
$1,047.80
|
| Rate for Payer: Lucent All Commercial |
$1,047.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,540.88
|
| Rate for Payer: PHP All Commercial |
$1,558.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$801.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.07
|
| Rate for Payer: Signature Care EPO |
$1,705.24
|
| Rate for Payer: Signature Care PPO |
$1,807.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,746.32
|
| Rate for Payer: United Healthcare Commercial |
$1,618.95
|
| Rate for Payer: United Healthcare Medicare |
$677.98
|
|
|
HC Z SCREW 5X90 NCB CANC
|
Facility
IP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.09 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
|
|
HC Z SCREW 5X90 NCB CANC
|
Facility
OP
|
$932.12
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$866.87 |
| Rate for Payer: Aetna Commercial |
$786.71
|
| Rate for Payer: Aetna Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.36
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Cash Price |
$577.91
|
| Rate for Payer: Centivo All Commercial |
$475.38
|
| Rate for Payer: Cigna All Commercial |
$804.42
|
| Rate for Payer: CORVEL All Commercial |
$866.87
|
| Rate for Payer: Coventry All Commercial |
$820.27
|
| Rate for Payer: Encore All Commercial |
$858.02
|
| Rate for Payer: Frontpath All Commercial |
$857.55
|
| Rate for Payer: Humana ChoiceCare |
$805.07
|
| Rate for Payer: Humana Medicare |
$475.38
|
| Rate for Payer: Lucent All Commercial |
$475.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$838.91
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$699.09
|
| Rate for Payer: PHP All Commercial |
$706.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.53
|
| Rate for Payer: Sagamore Health Network All Products |
$719.60
|
| Rate for Payer: Signature Care EPO |
$773.66
|
| Rate for Payer: Signature Care PPO |
$820.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$792.30
|
| Rate for Payer: United Healthcare Commercial |
$734.51
|
| Rate for Payer: United Healthcare Medicare |
$307.60
|
|
|
HC Z SCREW 5X95 LOCK AD
|
Facility
OP
|
$2,054.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,910.68 |
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: Aetna Medicare |
$677.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$677.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,179.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,284.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$779.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$745.78
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Centivo All Commercial |
$1,047.80
|
| Rate for Payer: Cigna All Commercial |
$1,773.03
|
| Rate for Payer: CORVEL All Commercial |
$1,910.68
|
| Rate for Payer: Coventry All Commercial |
$1,807.96
|
| Rate for Payer: Encore All Commercial |
$1,891.17
|
| Rate for Payer: Frontpath All Commercial |
$1,890.14
|
| Rate for Payer: Humana ChoiceCare |
$1,774.47
|
| Rate for Payer: Humana Medicare |
$1,047.80
|
| Rate for Payer: Lucent All Commercial |
$1,047.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,540.88
|
| Rate for Payer: PHP All Commercial |
$1,558.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$801.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.07
|
| Rate for Payer: Signature Care EPO |
$1,705.24
|
| Rate for Payer: Signature Care PPO |
$1,807.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,746.32
|
| Rate for Payer: United Healthcare Commercial |
$1,618.95
|
| Rate for Payer: United Healthcare Medicare |
$677.98
|
|
|
HC Z SCREW 5X95 LOCK AD
|
Facility
IP
|
$2,054.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.88 |
| Max. Negotiated Rate |
$1,910.68 |
| Rate for Payer: Aetna Commercial |
$1,775.09
|
| Rate for Payer: Cash Price |
$1,273.79
|
| Rate for Payer: Cigna All Commercial |
$1,773.03
|
| Rate for Payer: CORVEL All Commercial |
$1,910.68
|
| Rate for Payer: Coventry All Commercial |
$1,807.96
|
| Rate for Payer: Encore All Commercial |
$1,891.17
|
| Rate for Payer: Frontpath All Commercial |
$1,890.14
|
| Rate for Payer: Humana ChoiceCare |
$1,774.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,849.05
|
| Rate for Payer: PHCS All Commercial |
$1,540.88
|
| Rate for Payer: PHP All Commercial |
$1,558.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,586.07
|
| Rate for Payer: Signature Care EPO |
$1,705.24
|
| Rate for Payer: Signature Care PPO |
$1,807.96
|
| Rate for Payer: United Healthcare Commercial |
$1,618.95
|
|
