|
HC SCREW MINI MAGNA 4.0 FT 12
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 12
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 16
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 16
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 20
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 20
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 24
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 24
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 28
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 28
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 32
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 32
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 36
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 36
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 40
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 40
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 44
|
Facility
OP
|
$1,225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Aetna Commercial |
$1,033.90
|
| Rate for Payer: Aetna Medicare |
$404.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$404.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$703.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$765.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$444.68
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Centivo All Commercial |
$624.75
|
| Rate for Payer: Cigna All Commercial |
$1,057.18
|
| Rate for Payer: CORVEL All Commercial |
$1,139.25
|
| Rate for Payer: Coventry All Commercial |
$1,078.00
|
| Rate for Payer: Encore All Commercial |
$1,127.61
|
| Rate for Payer: Frontpath All Commercial |
$1,127.00
|
| Rate for Payer: Humana ChoiceCare |
$1,058.03
|
| Rate for Payer: Humana Medicare |
$624.75
|
| Rate for Payer: Lucent All Commercial |
$624.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,102.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$918.75
|
| Rate for Payer: PHP All Commercial |
$929.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$477.75
|
| Rate for Payer: Sagamore Health Network All Products |
$945.70
|
| Rate for Payer: Signature Care EPO |
$1,016.75
|
| Rate for Payer: Signature Care PPO |
$1,078.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,041.25
|
| Rate for Payer: United Healthcare Commercial |
$965.30
|
| Rate for Payer: United Healthcare Medicare |
$404.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 44
|
Facility
IP
|
$1,225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Aetna Commercial |
$1,058.40
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna All Commercial |
$1,057.18
|
| Rate for Payer: CORVEL All Commercial |
$1,139.25
|
| Rate for Payer: Coventry All Commercial |
$1,078.00
|
| Rate for Payer: Encore All Commercial |
$1,127.61
|
| Rate for Payer: Frontpath All Commercial |
$1,127.00
|
| Rate for Payer: Humana ChoiceCare |
$1,058.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,102.50
|
| Rate for Payer: PHCS All Commercial |
$918.75
|
| Rate for Payer: PHP All Commercial |
$929.04
|
| Rate for Payer: Sagamore Health Network All Products |
$945.70
|
| Rate for Payer: Signature Care EPO |
$1,016.75
|
| Rate for Payer: Signature Care PPO |
$1,078.00
|
| Rate for Payer: United Healthcare Commercial |
$965.30
|
|
|
HC SCREW MINI MAGNA 4.0 FT 48
|
Facility
IP
|
$1,225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Aetna Commercial |
$1,058.40
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna All Commercial |
$1,057.18
|
| Rate for Payer: CORVEL All Commercial |
$1,139.25
|
| Rate for Payer: Coventry All Commercial |
$1,078.00
|
| Rate for Payer: Encore All Commercial |
$1,127.61
|
| Rate for Payer: Frontpath All Commercial |
$1,127.00
|
| Rate for Payer: Humana ChoiceCare |
$1,058.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,102.50
|
| Rate for Payer: PHCS All Commercial |
$918.75
|
| Rate for Payer: PHP All Commercial |
$929.04
|
| Rate for Payer: Sagamore Health Network All Products |
$945.70
|
| Rate for Payer: Signature Care EPO |
$1,016.75
|
| Rate for Payer: Signature Care PPO |
$1,078.00
|
| Rate for Payer: United Healthcare Commercial |
$965.30
|
|
|
HC SCREW MINI MAGNA 4.0 FT 48
|
Facility
OP
|
$1,225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Aetna Commercial |
$1,033.90
|
| Rate for Payer: Aetna Medicare |
$404.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$404.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$703.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$765.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$444.68
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Centivo All Commercial |
$624.75
|
| Rate for Payer: Cigna All Commercial |
$1,057.18
|
| Rate for Payer: CORVEL All Commercial |
$1,139.25
|
| Rate for Payer: Coventry All Commercial |
$1,078.00
|
| Rate for Payer: Encore All Commercial |
$1,127.61
|
| Rate for Payer: Frontpath All Commercial |
$1,127.00
|
| Rate for Payer: Humana ChoiceCare |
$1,058.03
|
| Rate for Payer: Humana Medicare |
$624.75
|
| Rate for Payer: Lucent All Commercial |
$624.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,102.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$918.75
|
| Rate for Payer: PHP All Commercial |
$929.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$477.75
|
| Rate for Payer: Sagamore Health Network All Products |
$945.70
|
| Rate for Payer: Signature Care EPO |
$1,016.75
|
| Rate for Payer: Signature Care PPO |
$1,078.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,041.25
|
| Rate for Payer: United Healthcare Commercial |
$965.30
|
| Rate for Payer: United Healthcare Medicare |
$404.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 55
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.58 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$606.61
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
|
|
HC SCREW MINI MAGNA 4.0 FT 55
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
|
HC SCREW MINI MAGNA 4.0 FT 65
|
Facility
IP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$1,105.92
|
| Rate for Payer: Cash Price |
$793.60
|
| Rate for Payer: Cigna All Commercial |
$1,104.64
|
| Rate for Payer: CORVEL All Commercial |
$1,190.40
|
| Rate for Payer: Coventry All Commercial |
$1,126.40
|
| Rate for Payer: Encore All Commercial |
$1,178.24
|
| Rate for Payer: Frontpath All Commercial |
$1,177.60
|
| Rate for Payer: Humana ChoiceCare |
$1,105.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.00
|
| Rate for Payer: PHCS All Commercial |
$960.00
|
| Rate for Payer: PHP All Commercial |
$970.75
|
| Rate for Payer: Sagamore Health Network All Products |
$988.16
|
| Rate for Payer: Signature Care EPO |
$1,062.40
|
| Rate for Payer: Signature Care PPO |
$1,126.40
|
| Rate for Payer: United Healthcare Commercial |
$1,008.64
|
|
|
HC SCREW MINI MAGNA 4.0 FT 65
|
Facility
OP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.40 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$1,080.32
|
| Rate for Payer: Aetna Medicare |
$422.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$422.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$735.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$800.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$485.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$464.64
|
| Rate for Payer: Cash Price |
$793.60
|
| Rate for Payer: Cash Price |
$793.60
|
| Rate for Payer: Centivo All Commercial |
$652.80
|
| Rate for Payer: Cigna All Commercial |
$1,104.64
|
| Rate for Payer: CORVEL All Commercial |
$1,190.40
|
| Rate for Payer: Coventry All Commercial |
$1,126.40
|
| Rate for Payer: Encore All Commercial |
$1,178.24
|
| Rate for Payer: Frontpath All Commercial |
$1,177.60
|
| Rate for Payer: Humana ChoiceCare |
$1,105.54
|
| Rate for Payer: Humana Medicare |
$652.80
|
| Rate for Payer: Lucent All Commercial |
$652.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$960.00
|
| Rate for Payer: PHP All Commercial |
$970.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.20
|
| Rate for Payer: Sagamore Health Network All Products |
$988.16
|
| Rate for Payer: Signature Care EPO |
$1,062.40
|
| Rate for Payer: Signature Care PPO |
$1,126.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,088.00
|
| Rate for Payer: United Healthcare Commercial |
$1,008.64
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
|
|
HC SCREW MINI MAGNA 4.0 PT 24
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.69 |
| Max. Negotiated Rate |
$652.95 |
| Rate for Payer: Aetna Commercial |
$592.57
|
| Rate for Payer: Aetna Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$231.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Centivo All Commercial |
$358.07
|
| Rate for Payer: Cigna All Commercial |
$605.91
|
| Rate for Payer: CORVEL All Commercial |
$652.95
|
| Rate for Payer: Coventry All Commercial |
$617.85
|
| Rate for Payer: Encore All Commercial |
$646.28
|
| Rate for Payer: Frontpath All Commercial |
$645.93
|
| Rate for Payer: Humana ChoiceCare |
$606.40
|
| Rate for Payer: Humana Medicare |
$358.07
|
| Rate for Payer: Lucent All Commercial |
$358.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$526.58
|
| Rate for Payer: PHP All Commercial |
$532.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.82
|
| Rate for Payer: Sagamore Health Network All Products |
$542.02
|
| Rate for Payer: Signature Care EPO |
$582.74
|
| Rate for Payer: Signature Care PPO |
$617.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$596.78
|
| Rate for Payer: United Healthcare Commercial |
$553.25
|
| Rate for Payer: United Healthcare Medicare |
$231.69
|
|
