|
HC Z SCREW HEX 4.0X40 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.0X40 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X45 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X45 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.0X50 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X50 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.0X55 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X55 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.0X60 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X60 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.0X65 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X65 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.0X70 CAN
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.77
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Centivo All Commercial |
$71.33
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Humana Medicare |
$71.33
|
| Rate for Payer: Lucent All Commercial |
$71.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.55
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.88
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
| Rate for Payer: United Healthcare Medicare |
$46.15
|
|
|
HC Z SCREW HEX 4.0X70 CAN
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$130.07 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna All Commercial |
$120.70
|
| Rate for Payer: CORVEL All Commercial |
$130.07
|
| Rate for Payer: Coventry All Commercial |
$123.08
|
| Rate for Payer: Encore All Commercial |
$128.74
|
| Rate for Payer: Frontpath All Commercial |
$128.67
|
| Rate for Payer: Humana ChoiceCare |
$120.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.87
|
| Rate for Payer: PHCS All Commercial |
$104.90
|
| Rate for Payer: PHP All Commercial |
$106.07
|
| Rate for Payer: Sagamore Health Network All Products |
$107.97
|
| Rate for Payer: Signature Care EPO |
$116.08
|
| Rate for Payer: Signature Care PPO |
$123.08
|
| Rate for Payer: United Healthcare Commercial |
$110.21
|
|
|
HC Z SCREW HEX 4.5X30 CORT ST
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z SCREW HEX 4.5X30 CORT ST
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z SCREW HEX 4.5X32 CORT ST
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z SCREW HEX 4.5X32 CORT ST
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z SCREW HEX 4.5X34 CORT ST
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z SCREW HEX 4.5X34 CORT ST
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z SCREW LAG 10.5X100
|
Facility
IP
|
$2,279.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.83 |
| Max. Negotiated Rate |
$2,120.19 |
| Rate for Payer: Aetna Commercial |
$1,969.72
|
| Rate for Payer: Cash Price |
$1,413.46
|
| Rate for Payer: Cigna All Commercial |
$1,967.44
|
| Rate for Payer: CORVEL All Commercial |
$2,120.19
|
| Rate for Payer: Coventry All Commercial |
$2,006.20
|
| Rate for Payer: Encore All Commercial |
$2,098.53
|
| Rate for Payer: Frontpath All Commercial |
$2,097.39
|
| Rate for Payer: Humana ChoiceCare |
$1,969.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,051.79
|
| Rate for Payer: PHCS All Commercial |
$1,709.83
|
| Rate for Payer: PHP All Commercial |
$1,728.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,759.98
|
| Rate for Payer: Signature Care EPO |
$1,892.21
|
| Rate for Payer: Signature Care PPO |
$2,006.20
|
| Rate for Payer: United Healthcare Commercial |
$1,796.46
|
|
|
HC Z SCREW LAG 10.5X100
|
Facility
OP
|
$2,279.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,120.19 |
| Rate for Payer: Aetna Commercial |
$1,924.13
|
| Rate for Payer: Aetna Medicare |
$752.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$752.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,309.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,425.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$865.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$827.56
|
| Rate for Payer: Cash Price |
$1,413.46
|
| Rate for Payer: Cash Price |
$1,413.46
|
| Rate for Payer: Centivo All Commercial |
$1,162.68
|
| Rate for Payer: Cigna All Commercial |
$1,967.44
|
| Rate for Payer: CORVEL All Commercial |
$2,120.19
|
| Rate for Payer: Coventry All Commercial |
$2,006.20
|
| Rate for Payer: Encore All Commercial |
$2,098.53
|
| Rate for Payer: Frontpath All Commercial |
$2,097.39
|
| Rate for Payer: Humana ChoiceCare |
$1,969.04
|
| Rate for Payer: Humana Medicare |
$1,162.68
|
| Rate for Payer: Lucent All Commercial |
$1,162.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,051.79
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,709.83
|
| Rate for Payer: PHP All Commercial |
$1,728.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$889.11
|
| Rate for Payer: Sagamore Health Network All Products |
$1,759.98
|
| Rate for Payer: Signature Care EPO |
$1,892.21
|
| Rate for Payer: Signature Care PPO |
$2,006.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,937.80
|
| Rate for Payer: United Healthcare Commercial |
$1,796.46
|
| Rate for Payer: United Healthcare Medicare |
$752.32
|
|
|
HC Z SCREW LAG 4.0X30 CANN
|
Facility
OP
|
$858.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.30 |
| Max. Negotiated Rate |
$798.40 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Aetna Medicare |
$283.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$283.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$493.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$536.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$325.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$311.64
|
| Rate for Payer: Cash Price |
$532.27
|
| Rate for Payer: Cash Price |
$532.27
|
| Rate for Payer: Centivo All Commercial |
$437.84
|
| Rate for Payer: Cigna All Commercial |
$740.89
|
| Rate for Payer: CORVEL All Commercial |
$798.40
|
| Rate for Payer: Coventry All Commercial |
$755.48
|
| Rate for Payer: Encore All Commercial |
$790.25
|
| Rate for Payer: Frontpath All Commercial |
$789.82
|
| Rate for Payer: Humana ChoiceCare |
$741.49
|
| Rate for Payer: Humana Medicare |
$437.84
|
| Rate for Payer: Lucent All Commercial |
$437.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$772.65
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$643.88
|
| Rate for Payer: PHP All Commercial |
$651.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$334.82
|
| Rate for Payer: Sagamore Health Network All Products |
$662.76
|
| Rate for Payer: Signature Care EPO |
$712.56
|
| Rate for Payer: Signature Care PPO |
$755.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$729.72
|
| Rate for Payer: United Healthcare Commercial |
$676.50
|
| Rate for Payer: United Healthcare Medicare |
$283.30
|
|
|
HC Z SCREW LAG 4.0X30 CANN
|
Facility
IP
|
$858.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.88 |
| Max. Negotiated Rate |
$798.40 |
| Rate for Payer: Aetna Commercial |
$741.74
|
| Rate for Payer: Cash Price |
$532.27
|
| Rate for Payer: Cigna All Commercial |
$740.89
|
| Rate for Payer: CORVEL All Commercial |
$798.40
|
| Rate for Payer: Coventry All Commercial |
$755.48
|
| Rate for Payer: Encore All Commercial |
$790.25
|
| Rate for Payer: Frontpath All Commercial |
$789.82
|
| Rate for Payer: Humana ChoiceCare |
$741.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$772.65
|
| Rate for Payer: PHCS All Commercial |
$643.88
|
| Rate for Payer: PHP All Commercial |
$651.09
|
| Rate for Payer: Sagamore Health Network All Products |
$662.76
|
| Rate for Payer: Signature Care EPO |
$712.56
|
| Rate for Payer: Signature Care PPO |
$755.48
|
| Rate for Payer: United Healthcare Commercial |
$676.50
|
|
|
HC Z SCREW LAG 4.0X44 CANN
|
Facility
IP
|
$858.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.88 |
| Max. Negotiated Rate |
$798.40 |
| Rate for Payer: Aetna Commercial |
$741.74
|
| Rate for Payer: Cash Price |
$532.27
|
| Rate for Payer: Cigna All Commercial |
$740.89
|
| Rate for Payer: CORVEL All Commercial |
$798.40
|
| Rate for Payer: Coventry All Commercial |
$755.48
|
| Rate for Payer: Encore All Commercial |
$790.25
|
| Rate for Payer: Frontpath All Commercial |
$789.82
|
| Rate for Payer: Humana ChoiceCare |
$741.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$772.65
|
| Rate for Payer: PHCS All Commercial |
$643.88
|
| Rate for Payer: PHP All Commercial |
$651.09
|
| Rate for Payer: Sagamore Health Network All Products |
$662.76
|
| Rate for Payer: Signature Care EPO |
$712.56
|
| Rate for Payer: Signature Care PPO |
$755.48
|
| Rate for Payer: United Healthcare Commercial |
$676.50
|
|
