|
HC ACU 4.0X28 PT CAN HXLB SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X30 CAN HEX SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X30 CAN HEX SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X30 PT CAN HXLB SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X30 PT CAN HXLB SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X35 CAN HEX SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X35 CAN HEX SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X35 PT CAN HXLB SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X35 PT CAN HXLB SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X36 CANN SCREW LONG TD
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 4.0X36 CANN SCREW LONG TD
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 4.0X40 CAN HEX SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X40 CAN HEX SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X40 PT CAN HXLB SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X40 PT CAN HXLB SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X42 CANN SCREW LONG TD
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 4.0X42 CANN SCREW LONG TD
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 4.0X45 CAN HEX SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X45 CAN HEX SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X45 PT CAN HXLB SCREW
|
Facility
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC ACU 4.0X45 PT CAN HXLB SCREW
|
Facility
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.95
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Cash Price |
$577.22
|
| Rate for Payer: Centivo All Commercial |
$474.81
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$474.81
|
| Rate for Payer: Lucent All Commercial |
$474.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$307.23
|
|
|
HC ACU 4.0X48 CANN SCREW LONG TD
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$708.48
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
|
|
HC ACU 4.0X48 CANN SCREW LONG TD
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$762.60 |
| Rate for Payer: Aetna Commercial |
$692.08
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Cash Price |
$508.40
|
| Rate for Payer: Centivo All Commercial |
$418.20
|
| Rate for Payer: Cigna All Commercial |
$707.66
|
| Rate for Payer: CORVEL All Commercial |
$762.60
|
| Rate for Payer: Coventry All Commercial |
$721.60
|
| Rate for Payer: Encore All Commercial |
$754.81
|
| Rate for Payer: Frontpath All Commercial |
$754.40
|
| Rate for Payer: Humana ChoiceCare |
$708.23
|
| Rate for Payer: Humana Medicare |
$418.20
|
| Rate for Payer: Lucent All Commercial |
$418.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$738.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$615.00
|
| Rate for Payer: PHP All Commercial |
$621.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.80
|
| Rate for Payer: Sagamore Health Network All Products |
$633.04
|
| Rate for Payer: Signature Care EPO |
$680.60
|
| Rate for Payer: Signature Care PPO |
$721.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$646.16
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
|
|
HC ACU 4.0X50 CAN HEX SCREW
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU 4.0X50 CAN HEX SCREW
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
