|
HC Z SCREW 6.5X60 S-T
|
Facility
IP
|
$579.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$539.03 |
| Rate for Payer: Aetna Commercial |
$500.77
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Cigna All Commercial |
$500.19
|
| Rate for Payer: CORVEL All Commercial |
$539.03
|
| Rate for Payer: Coventry All Commercial |
$510.05
|
| Rate for Payer: Encore All Commercial |
$533.52
|
| Rate for Payer: Frontpath All Commercial |
$533.23
|
| Rate for Payer: Humana ChoiceCare |
$500.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.64
|
| Rate for Payer: PHCS All Commercial |
$434.70
|
| Rate for Payer: PHP All Commercial |
$439.57
|
| Rate for Payer: Sagamore Health Network All Products |
$447.45
|
| Rate for Payer: Signature Care EPO |
$481.07
|
| Rate for Payer: Signature Care PPO |
$510.05
|
| Rate for Payer: United Healthcare Commercial |
$456.72
|
|
|
HC Z SCREW 6.5X70 S-T
|
Facility
IP
|
$579.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$539.03 |
| Rate for Payer: Aetna Commercial |
$500.77
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Cigna All Commercial |
$500.19
|
| Rate for Payer: CORVEL All Commercial |
$539.03
|
| Rate for Payer: Coventry All Commercial |
$510.05
|
| Rate for Payer: Encore All Commercial |
$533.52
|
| Rate for Payer: Frontpath All Commercial |
$533.23
|
| Rate for Payer: Humana ChoiceCare |
$500.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.64
|
| Rate for Payer: PHCS All Commercial |
$434.70
|
| Rate for Payer: PHP All Commercial |
$439.57
|
| Rate for Payer: Sagamore Health Network All Products |
$447.45
|
| Rate for Payer: Signature Care EPO |
$481.07
|
| Rate for Payer: Signature Care PPO |
$510.05
|
| Rate for Payer: United Healthcare Commercial |
$456.72
|
|
|
HC Z SCREW 6.5X70 S-T
|
Facility
OP
|
$579.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$539.03 |
| Rate for Payer: Aetna Commercial |
$489.18
|
| Rate for Payer: Aetna Medicare |
$191.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$332.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.39
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Centivo All Commercial |
$295.60
|
| Rate for Payer: Cigna All Commercial |
$500.19
|
| Rate for Payer: CORVEL All Commercial |
$539.03
|
| Rate for Payer: Coventry All Commercial |
$510.05
|
| Rate for Payer: Encore All Commercial |
$533.52
|
| Rate for Payer: Frontpath All Commercial |
$533.23
|
| Rate for Payer: Humana ChoiceCare |
$500.60
|
| Rate for Payer: Humana Medicare |
$295.60
|
| Rate for Payer: Lucent All Commercial |
$295.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$434.70
|
| Rate for Payer: PHP All Commercial |
$439.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.04
|
| Rate for Payer: Sagamore Health Network All Products |
$447.45
|
| Rate for Payer: Signature Care EPO |
$481.07
|
| Rate for Payer: Signature Care PPO |
$510.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$492.66
|
| Rate for Payer: United Healthcare Commercial |
$456.72
|
| Rate for Payer: United Healthcare Medicare |
$191.27
|
|
|
HC Z SCREW 6.5X80 S-T
|
Facility
OP
|
$579.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$539.03 |
| Rate for Payer: Aetna Commercial |
$489.18
|
| Rate for Payer: Aetna Medicare |
$191.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$191.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$332.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.39
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Centivo All Commercial |
$295.60
|
| Rate for Payer: Cigna All Commercial |
$500.19
|
| Rate for Payer: CORVEL All Commercial |
$539.03
|
| Rate for Payer: Coventry All Commercial |
$510.05
|
| Rate for Payer: Encore All Commercial |
$533.52
|
| Rate for Payer: Frontpath All Commercial |
$533.23
|
| Rate for Payer: Humana ChoiceCare |
$500.60
|
| Rate for Payer: Humana Medicare |
$295.60
|
| Rate for Payer: Lucent All Commercial |
$295.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$434.70
|
| Rate for Payer: PHP All Commercial |
$439.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.04
|
| Rate for Payer: Sagamore Health Network All Products |
$447.45
|
| Rate for Payer: Signature Care EPO |
$481.07
|
| Rate for Payer: Signature Care PPO |
$510.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$492.66
|
| Rate for Payer: United Healthcare Commercial |
$456.72
|
| Rate for Payer: United Healthcare Medicare |
$191.27
|
|
|
HC Z SCREW 6.5X80 S-T
|
Facility
IP
|
$579.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$539.03 |
| Rate for Payer: Aetna Commercial |
$500.77
|
| Rate for Payer: Cash Price |
$359.35
|
| Rate for Payer: Cigna All Commercial |
$500.19
|
| Rate for Payer: CORVEL All Commercial |
$539.03
|
| Rate for Payer: Coventry All Commercial |
$510.05
|
| Rate for Payer: Encore All Commercial |
$533.52
|
| Rate for Payer: Frontpath All Commercial |
$533.23
|
| Rate for Payer: Humana ChoiceCare |
$500.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.64
|
| Rate for Payer: PHCS All Commercial |
$434.70
|
| Rate for Payer: PHP All Commercial |
$439.57
|
| Rate for Payer: Sagamore Health Network All Products |
$447.45
|
| Rate for Payer: Signature Care EPO |
$481.07
|
| Rate for Payer: Signature Care PPO |
$510.05
|
| Rate for Payer: United Healthcare Commercial |
$456.72
|
|
|
HC Z SCREW 6.5X95 CANC
|
Facility
IP
|
$388.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.64 |
| Max. Negotiated Rate |
$361.63 |
| Rate for Payer: Aetna Commercial |
$335.97
|
| Rate for Payer: Cash Price |
$241.09
|
| Rate for Payer: Cigna All Commercial |
$335.58
|
| Rate for Payer: CORVEL All Commercial |
$361.63
|
| Rate for Payer: Coventry All Commercial |
$342.19
|
| Rate for Payer: Encore All Commercial |
$357.94
|
| Rate for Payer: Frontpath All Commercial |
$357.74
|
| Rate for Payer: Humana ChoiceCare |
$335.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.96
|
| Rate for Payer: PHCS All Commercial |
$291.64
|
| Rate for Payer: PHP All Commercial |
$294.90
|
| Rate for Payer: Sagamore Health Network All Products |
$300.19
|
| Rate for Payer: Signature Care EPO |
$322.75
|
| Rate for Payer: Signature Care PPO |
$342.19
|
| Rate for Payer: United Healthcare Commercial |
$306.41
|
|
|
HC Z SCREW 6.5X95 CANC
|
Facility
OP
|
$388.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.32 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$328.19
|
| Rate for Payer: Aetna Medicare |
$128.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$223.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.15
|
| Rate for Payer: Cash Price |
$241.09
|
| Rate for Payer: Cash Price |
$241.09
|
| Rate for Payer: Centivo All Commercial |
$198.31
|
| Rate for Payer: Cigna All Commercial |
$335.58
|
| Rate for Payer: CORVEL All Commercial |
$361.63
|
| Rate for Payer: Coventry All Commercial |
$342.19
|
| Rate for Payer: Encore All Commercial |
$357.94
|
| Rate for Payer: Frontpath All Commercial |
$357.74
|
| Rate for Payer: Humana ChoiceCare |
$335.85
|
| Rate for Payer: Humana Medicare |
$198.31
|
| Rate for Payer: Lucent All Commercial |
$198.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$291.64
|
| Rate for Payer: PHP All Commercial |
$294.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.65
|
| Rate for Payer: Sagamore Health Network All Products |
$300.19
|
| Rate for Payer: Signature Care EPO |
$322.75
|
| Rate for Payer: Signature Care PPO |
$342.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$330.52
|
| Rate for Payer: United Healthcare Commercial |
$306.41
|
| Rate for Payer: United Healthcare Medicare |
$128.32
|
|
|
HC Z SCREW 7.0X100 16 CAN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X100 16 CAN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X100 32 CAN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X100 32 CAN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X100 CANN F
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X100 CANN F
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X105 16 CAN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X105 16 CAN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X105 32 CAN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X105 32 CAN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X105 CANN F
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X105 CANN F
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X110 16 CAN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X110 16 CAN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X110 32 CAN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X110 32 CAN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X110 CANN F
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X110 CANN F
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
