|
HC Z SCREW T15 3.5X44 M-D LOCK
|
Facility
OP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$771.46
|
| Rate for Payer: Aetna Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$571.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.80
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Centivo All Commercial |
$466.17
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Humana Medicare |
$466.17
|
| Rate for Payer: Lucent All Commercial |
$466.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.48
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.94
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
| Rate for Payer: United Healthcare Medicare |
$301.64
|
|
|
HC Z SCREW T15 3.5X44 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
|
HC Z SCREW T15 3.5X46 CORT LP
|
Facility
IP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$394.51 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
|
|
HC Z SCREW T15 3.5X46 CORT LP
|
Facility
OP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.98
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Centivo All Commercial |
$216.34
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Humana Medicare |
$216.34
|
| Rate for Payer: Lucent All Commercial |
$216.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.57
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
| Rate for Payer: United Healthcare Medicare |
$139.99
|
|
|
HC Z SCREW T15 3.5X46 M-D LOCK
|
Facility
OP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$771.46
|
| Rate for Payer: Aetna Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$571.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.80
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Centivo All Commercial |
$466.17
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Humana Medicare |
$466.17
|
| Rate for Payer: Lucent All Commercial |
$466.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.48
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.94
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
| Rate for Payer: United Healthcare Medicare |
$301.64
|
|
|
HC Z SCREW T15 3.5X46 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
|
HC Z SCREW T15 3.5X48 CORT LP
|
Facility
IP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$394.51 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
|
|
HC Z SCREW T15 3.5X48 CORT LP
|
Facility
OP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.98
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Centivo All Commercial |
$216.34
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Humana Medicare |
$216.34
|
| Rate for Payer: Lucent All Commercial |
$216.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.57
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
| Rate for Payer: United Healthcare Medicare |
$139.99
|
|
|
HC Z SCREW T15 3.5X48 M-D LOCK
|
Facility
OP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$771.46
|
| Rate for Payer: Aetna Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$571.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.80
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Centivo All Commercial |
$466.17
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Humana Medicare |
$466.17
|
| Rate for Payer: Lucent All Commercial |
$466.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.48
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.94
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
| Rate for Payer: United Healthcare Medicare |
$301.64
|
|
|
HC Z SCREW T15 3.5X48 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
|
HC Z SCREW T15 3.5X50 CORT LP
|
Facility
OP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.98
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Centivo All Commercial |
$216.34
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Humana Medicare |
$216.34
|
| Rate for Payer: Lucent All Commercial |
$216.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.57
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
| Rate for Payer: United Healthcare Medicare |
$139.99
|
|
|
HC Z SCREW T15 3.5X50 CORT LP
|
Facility
IP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$394.51 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
|
|
HC Z SCREW T15 3.5X50 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
|
HC Z SCREW T15 3.5X50 M-D LOCK
|
Facility
OP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$771.46
|
| Rate for Payer: Aetna Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$571.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.80
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Centivo All Commercial |
$466.17
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Humana Medicare |
$466.17
|
| Rate for Payer: Lucent All Commercial |
$466.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.48
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.94
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
| Rate for Payer: United Healthcare Medicare |
$301.64
|
|
|
HC Z SCREW T15 3.5X52 CORT LP
|
Facility
OP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.98
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Centivo All Commercial |
$216.34
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Humana Medicare |
$216.34
|
| Rate for Payer: Lucent All Commercial |
$216.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.57
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
| Rate for Payer: United Healthcare Medicare |
$139.99
|
|
|
HC Z SCREW T15 3.5X52 CORT LP
|
Facility
IP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$394.51 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
|
|
HC Z SCREW T15 3.5X52 M-D LOCK
|
Facility
OP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$771.46
|
| Rate for Payer: Aetna Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$571.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.80
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Centivo All Commercial |
$466.17
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Humana Medicare |
$466.17
|
| Rate for Payer: Lucent All Commercial |
$466.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.48
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.94
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
| Rate for Payer: United Healthcare Medicare |
$301.64
|
|
|
HC Z SCREW T15 3.5X52 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
|
HC Z SCREW T15 3.5X54 CORT LP
|
Facility
IP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$394.51 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
|
|
HC Z SCREW T15 3.5X54 CORT LP
|
Facility
OP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.98
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Centivo All Commercial |
$216.34
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Humana Medicare |
$216.34
|
| Rate for Payer: Lucent All Commercial |
$216.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.57
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
| Rate for Payer: United Healthcare Medicare |
$139.99
|
|
|
HC Z SCREW T15 3.5X54 M-D LOCK
|
Facility
OP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$771.46
|
| Rate for Payer: Aetna Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$571.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.80
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Centivo All Commercial |
$466.17
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Humana Medicare |
$466.17
|
| Rate for Payer: Lucent All Commercial |
$466.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.48
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.94
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
| Rate for Payer: United Healthcare Medicare |
$301.64
|
|
|
HC Z SCREW T15 3.5X54 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
|
HC Z SCREW T15 3.5X56 CORT LP
|
Facility
OP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.98
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Centivo All Commercial |
$216.34
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Humana Medicare |
$216.34
|
| Rate for Payer: Lucent All Commercial |
$216.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.44
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.57
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
| Rate for Payer: United Healthcare Medicare |
$139.99
|
|
|
HC Z SCREW T15 3.5X56 CORT LP
|
Facility
IP
|
$424.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.15 |
| Max. Negotiated Rate |
$394.51 |
| Rate for Payer: Aetna Commercial |
$366.51
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna All Commercial |
$366.08
|
| Rate for Payer: CORVEL All Commercial |
$394.51
|
| Rate for Payer: Coventry All Commercial |
$373.30
|
| Rate for Payer: Encore All Commercial |
$390.48
|
| Rate for Payer: Frontpath All Commercial |
$390.26
|
| Rate for Payer: Humana ChoiceCare |
$366.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.78
|
| Rate for Payer: PHCS All Commercial |
$318.15
|
| Rate for Payer: PHP All Commercial |
$321.71
|
| Rate for Payer: Sagamore Health Network All Products |
$327.48
|
| Rate for Payer: Signature Care EPO |
$352.09
|
| Rate for Payer: Signature Care PPO |
$373.30
|
| Rate for Payer: United Healthcare Commercial |
$334.27
|
|
|
HC Z SCREW T15 3.5X56 M-D LOCK
|
Facility
IP
|
$914.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.54 |
| Max. Negotiated Rate |
$850.07 |
| Rate for Payer: Aetna Commercial |
$789.74
|
| Rate for Payer: Cash Price |
$566.71
|
| Rate for Payer: Cigna All Commercial |
$788.83
|
| Rate for Payer: CORVEL All Commercial |
$850.07
|
| Rate for Payer: Coventry All Commercial |
$804.36
|
| Rate for Payer: Encore All Commercial |
$841.38
|
| Rate for Payer: Frontpath All Commercial |
$840.93
|
| Rate for Payer: Humana ChoiceCare |
$789.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$822.64
|
| Rate for Payer: PHCS All Commercial |
$685.54
|
| Rate for Payer: PHP All Commercial |
$693.22
|
| Rate for Payer: Sagamore Health Network All Products |
$705.65
|
| Rate for Payer: Signature Care EPO |
$758.66
|
| Rate for Payer: Signature Care PPO |
$804.36
|
| Rate for Payer: United Healthcare Commercial |
$720.27
|
|
