|
HC Z SF SCREW HEX 4.0X26
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604209
|
|
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 SF SCREW HEX 4.0X26
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604210
|
|
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 SF SCREW HEX 4.0X26
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604210
|
|
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 SF SCREW HEX 4.0X28
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604211
|
|
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 SF SCREW HEX 4.0X28
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604212
|
|
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 SF SCREW HEX 4.0X28
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604212
|
|
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 SF SCREW HEX 4.0X28
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604211
|
|
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 SF SCREW HEX 4.0X30
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604214
|
|
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 SF SCREW HEX 4.0X30
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604213
|
|
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 SF SCREW HEX 4.0X30
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604213
|
|
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 SF SCREW HEX 4.0X30
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604214
|
|
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 SF SCREW HEX 4.0X32
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604215
|
|
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 SF SCREW HEX 4.0X32
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604215
|
|
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 SF SCREW HEX 4.0X34
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604216
|
|
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 SF SCREW HEX 4.0X34
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604216
|
|
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 SF SCREW HEX 4.0X35
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604217
|
|
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 SF SCREW HEX 4.0X35
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604217
|
|
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 SF SCREW HEX 4.0X36
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604218
|
|
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 SF SCREW HEX 4.0X36
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604218
|
|
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 SF SCREW HEX 4.0X38
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604219
|
|
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 SF SCREW HEX 4.0X38
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604219
|
|
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 SF SCREW HEX 4.0X40
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604220
|
|
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 SF SCREW HEX 4.0X40
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604220
|
|
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 SF SCREW HEX 4.0X45
|
Facility
OP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604221
|
|
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 SF SCREW HEX 4.0X45
|
Facility
IP
|
$139.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604221
|
|
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
|
|
