|
HC SCREW MINI MAGNA 4.0 PT 24
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602128
|
|
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 PT 26
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602129
|
|
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 PT 26
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602129
|
|
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 PT 28
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602130
|
|
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 PT 28
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602130
|
|
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 PT 30
|
Facility
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.12 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$982.42
|
| Rate for Payer: Aetna Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$668.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$727.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$441.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.53
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Centivo All Commercial |
$593.64
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Humana Medicare |
$593.64
|
| Rate for Payer: Lucent All Commercial |
$593.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.96
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$989.40
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
| Rate for Payer: United Healthcare Medicare |
$384.12
|
|
|
HC SCREW MINI MAGNA 4.0 PT 30
|
Facility
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.00 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$1,005.70
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
|
|
HC SCREW MINI MAGNA 4.0 PT 32
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602132
|
|
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 PT 32
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602132
|
|
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 PT 34
|
Facility
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.00 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$1,005.70
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
|
|
HC SCREW MINI MAGNA 4.0 PT 34
|
Facility
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.12 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$982.42
|
| Rate for Payer: Aetna Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$668.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$727.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$441.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.53
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Centivo All Commercial |
$593.64
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Humana Medicare |
$593.64
|
| Rate for Payer: Lucent All Commercial |
$593.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.96
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$989.40
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
| Rate for Payer: United Healthcare Medicare |
$384.12
|
|
|
HC SCREW MINI MAGNA 4.0 PT 36
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602134
|
|
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 PT 36
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602134
|
|
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 PT 38
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602135
|
|
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 PT 38
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602135
|
|
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 PT 40
|
Facility
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.12 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$982.42
|
| Rate for Payer: Aetna Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$668.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$727.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$441.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.53
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Centivo All Commercial |
$593.64
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Humana Medicare |
$593.64
|
| Rate for Payer: Lucent All Commercial |
$593.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.96
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$989.40
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
| Rate for Payer: United Healthcare Medicare |
$384.12
|
|
|
HC SCREW MINI MAGNA 4.0 PT 40
|
Facility
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.00 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$1,005.70
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
|
|
HC SCREW MINI MAGNA 4.0 PT 42
|
Facility
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.12 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$982.42
|
| Rate for Payer: Aetna Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$384.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$668.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$727.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$441.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.53
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Centivo All Commercial |
$593.64
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Humana Medicare |
$593.64
|
| Rate for Payer: Lucent All Commercial |
$593.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.96
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$989.40
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
| Rate for Payer: United Healthcare Medicare |
$384.12
|
|
|
HC SCREW MINI MAGNA 4.0 PT 42
|
Facility
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.00 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Aetna Commercial |
$1,005.70
|
| Rate for Payer: Cash Price |
$721.68
|
| Rate for Payer: Cigna All Commercial |
$1,004.53
|
| Rate for Payer: CORVEL All Commercial |
$1,082.52
|
| Rate for Payer: Coventry All Commercial |
$1,024.32
|
| Rate for Payer: Encore All Commercial |
$1,071.46
|
| Rate for Payer: Frontpath All Commercial |
$1,070.88
|
| Rate for Payer: Humana ChoiceCare |
$1,005.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,047.60
|
| Rate for Payer: PHCS All Commercial |
$873.00
|
| Rate for Payer: PHP All Commercial |
$882.78
|
| Rate for Payer: Sagamore Health Network All Products |
$898.61
|
| Rate for Payer: Signature Care EPO |
$966.12
|
| Rate for Payer: Signature Care PPO |
$1,024.32
|
| Rate for Payer: United Healthcare Commercial |
$917.23
|
|
|
HC SCREW MINI MAGNA 4.0 PT 44
|
Facility
OP
|
$785.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.23 |
| Max. Negotiated Rate |
$730.56 |
| Rate for Payer: Aetna Commercial |
$663.00
|
| Rate for Payer: Aetna Medicare |
$259.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$259.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$451.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$491.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$298.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$285.15
|
| Rate for Payer: Cash Price |
$487.04
|
| Rate for Payer: Cash Price |
$487.04
|
| Rate for Payer: Centivo All Commercial |
$400.63
|
| Rate for Payer: Cigna All Commercial |
$677.93
|
| Rate for Payer: CORVEL All Commercial |
$730.56
|
| Rate for Payer: Coventry All Commercial |
$691.28
|
| Rate for Payer: Encore All Commercial |
$723.10
|
| Rate for Payer: Frontpath All Commercial |
$722.71
|
| Rate for Payer: Humana ChoiceCare |
$678.48
|
| Rate for Payer: Humana Medicare |
$400.63
|
| Rate for Payer: Lucent All Commercial |
$400.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$707.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$589.16
|
| Rate for Payer: PHP All Commercial |
$595.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.36
|
| Rate for Payer: Sagamore Health Network All Products |
$606.44
|
| Rate for Payer: Signature Care EPO |
$652.01
|
| Rate for Payer: Signature Care PPO |
$691.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$667.72
|
| Rate for Payer: United Healthcare Commercial |
$619.01
|
| Rate for Payer: United Healthcare Medicare |
$259.23
|
|
|
HC SCREW MINI MAGNA 4.0 PT 44
|
Facility
IP
|
$785.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.16 |
| Max. Negotiated Rate |
$730.56 |
| Rate for Payer: Aetna Commercial |
$678.72
|
| Rate for Payer: Cash Price |
$487.04
|
| Rate for Payer: Cigna All Commercial |
$677.93
|
| Rate for Payer: CORVEL All Commercial |
$730.56
|
| Rate for Payer: Coventry All Commercial |
$691.28
|
| Rate for Payer: Encore All Commercial |
$723.10
|
| Rate for Payer: Frontpath All Commercial |
$722.71
|
| Rate for Payer: Humana ChoiceCare |
$678.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$707.00
|
| Rate for Payer: PHCS All Commercial |
$589.16
|
| Rate for Payer: PHP All Commercial |
$595.76
|
| Rate for Payer: Sagamore Health Network All Products |
$606.44
|
| Rate for Payer: Signature Care EPO |
$652.01
|
| Rate for Payer: Signature Care PPO |
$691.28
|
| Rate for Payer: United Healthcare Commercial |
$619.01
|
|
|
HC SCREW MINI MAGNA 4.0 PT 46
|
Facility
OP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602139
|
|
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 46
|
Facility
IP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602139
|
|
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 PT 48
|
Facility
OP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602140
|
|
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 PT 48
|
Facility
IP
|
$702.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602140
|
|
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
|
|
