|
HC ACU .045X5.75 ST GUIDE WIRE TI
|
Facility
OP
|
$212.40
|
|
| Hospital Charge Code |
41603245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$195.51 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Aetna Medicare |
$70.09
|
| Rate for Payer: Anthem Exchange |
$121.98
|
| Rate for Payer: Anthem Medicare |
$70.09
|
| Rate for Payer: Anthem PPO |
$121.98
|
| Rate for Payer: Anthem Traditional |
$132.77
|
| Rate for Payer: Caresource Just 4 Me |
$80.61
|
| Rate for Payer: Caresource Medicare |
$77.10
|
| Rate for Payer: Centivo/Paragon All Products |
$108.32
|
| Rate for Payer: Cigna All Products |
$183.30
|
| Rate for Payer: Coventry/First Health All Products |
$186.91
|
| Rate for Payer: Encore All Products |
$195.51
|
| Rate for Payer: Frontpath All Products |
$195.41
|
| Rate for Payer: Humana ChoiceCare |
$183.45
|
| Rate for Payer: Humana Medicare |
$108.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$108.32
|
| Rate for Payer: Lutheran Preferred All Products |
$191.16
|
| Rate for Payer: PHCS/Multiplan All Products |
$159.30
|
| Rate for Payer: PHP All Products |
$161.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$82.84
|
| Rate for Payer: Sagamore All Products |
$163.97
|
| Rate for Payer: Self Pay/Cash Rate |
$131.69
|
| Rate for Payer: Signature Care EPO |
$176.29
|
| Rate for Payer: Signature Care PPO |
$186.91
|
| Rate for Payer: Three Rivers Preferred All Products |
$180.54
|
| Rate for Payer: United Healthcare Commercial |
$167.37
|
| Rate for Payer: United Healthcare Medicare |
$70.09
|
|
|
HC ACU .045X5.75 ST GUIDE WIRE TI
|
Facility
IP
|
$212.40
|
|
| Hospital Charge Code |
41603245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.69 |
| Max. Negotiated Rate |
$195.51 |
| Rate for Payer: Aetna Commercial |
$183.51
|
| Rate for Payer: Cigna All Products |
$183.30
|
| Rate for Payer: Coventry/First Health All Products |
$186.91
|
| Rate for Payer: Encore All Products |
$195.51
|
| Rate for Payer: Frontpath All Products |
$195.41
|
| Rate for Payer: Humana ChoiceCare |
$183.45
|
| Rate for Payer: Lutheran Preferred All Products |
$191.16
|
| Rate for Payer: PHCS/Multiplan All Products |
$159.30
|
| Rate for Payer: PHP All Products |
$161.08
|
| Rate for Payer: Sagamore All Products |
$163.97
|
| Rate for Payer: Self Pay/Cash Rate |
$131.69
|
| Rate for Payer: Signature Care EPO |
$176.29
|
| Rate for Payer: Signature Care PPO |
$186.91
|
| Rate for Payer: United Healthcare Commercial |
$167.37
|
|
|
HC ACU .045X6 ST GUIDE WIRE
|
Facility
IP
|
$86.40
|
|
| Hospital Charge Code |
41602818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
|
|
HC ACU .045X6 ST GUIDE WIRE
|
Facility
OP
|
$86.40
|
|
| Hospital Charge Code |
41602818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$72.92
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Anthem Exchange |
$49.62
|
| Rate for Payer: Anthem Medicare |
$28.51
|
| Rate for Payer: Anthem PPO |
$49.62
|
| Rate for Payer: Anthem Traditional |
$54.01
|
| Rate for Payer: Caresource Just 4 Me |
$32.79
|
| Rate for Payer: Caresource Medicare |
$31.36
|
| Rate for Payer: Centivo/Paragon All Products |
$44.06
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Humana Medicare |
$44.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$44.06
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$33.70
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: Three Rivers Preferred All Products |
$73.44
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
| Rate for Payer: United Healthcare Medicare |
$28.51
|
|
|
HC ACU .054X6 GUIDE WIRE
|
Facility
OP
|
$86.40
|
|
| Hospital Charge Code |
41602633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$72.92
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Anthem Exchange |
$49.62
|
| Rate for Payer: Anthem Medicare |
$28.51
|
| Rate for Payer: Anthem PPO |
$49.62
|
| Rate for Payer: Anthem Traditional |
$54.01
|
| Rate for Payer: Caresource Just 4 Me |
$32.79
|
| Rate for Payer: Caresource Medicare |
$31.36
|
| Rate for Payer: Centivo/Paragon All Products |
$44.06
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Humana Medicare |
$44.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$44.06
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$33.70
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: Three Rivers Preferred All Products |
$73.44
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
| Rate for Payer: United Healthcare Medicare |
$28.51
|
|
|
HC ACU .054X6 GUIDE WIRE
|
Facility
IP
|
$86.40
|
|
| Hospital Charge Code |
41602633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
|
|
HC ACU .062X3 PLATE TACK THREADED
|
Facility
IP
|
$205.20
|
|
| Hospital Charge Code |
41602815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$188.89 |
| Rate for Payer: Aetna Commercial |
$177.29
|
| Rate for Payer: Cigna All Products |
$177.09
|
| Rate for Payer: Coventry/First Health All Products |
$180.58
|
| Rate for Payer: Encore All Products |
$188.89
|
| Rate for Payer: Frontpath All Products |
$188.78
|
| Rate for Payer: Humana ChoiceCare |
$177.23
|
| Rate for Payer: Lutheran Preferred All Products |
$184.68
|
| Rate for Payer: PHCS/Multiplan All Products |
$153.90
|
| Rate for Payer: PHP All Products |
$155.62
|
| Rate for Payer: Sagamore All Products |
$158.41
|
| Rate for Payer: Self Pay/Cash Rate |
$127.22
|
| Rate for Payer: Signature Care EPO |
$170.32
|
| Rate for Payer: Signature Care PPO |
$180.58
|
| Rate for Payer: United Healthcare Commercial |
$161.70
|
|
|
HC ACU .062X3 PLATE TACK THREADED
|
Facility
OP
|
$205.20
|
|
| Hospital Charge Code |
41602815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$188.89 |
| Rate for Payer: Aetna Commercial |
$173.19
|
| Rate for Payer: Aetna Medicare |
$67.72
|
| Rate for Payer: Anthem Exchange |
$117.85
|
| Rate for Payer: Anthem Medicare |
$67.72
|
| Rate for Payer: Anthem PPO |
$117.85
|
| Rate for Payer: Anthem Traditional |
$128.27
|
| Rate for Payer: Caresource Just 4 Me |
$77.87
|
| Rate for Payer: Caresource Medicare |
$74.49
|
| Rate for Payer: Centivo/Paragon All Products |
$104.65
|
| Rate for Payer: Cigna All Products |
$177.09
|
| Rate for Payer: Coventry/First Health All Products |
$180.58
|
| Rate for Payer: Encore All Products |
$188.89
|
| Rate for Payer: Frontpath All Products |
$188.78
|
| Rate for Payer: Humana ChoiceCare |
$177.23
|
| Rate for Payer: Humana Medicare |
$104.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$104.65
|
| Rate for Payer: Lutheran Preferred All Products |
$184.68
|
| Rate for Payer: PHCS/Multiplan All Products |
$153.90
|
| Rate for Payer: PHP All Products |
$155.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$80.03
|
| Rate for Payer: Sagamore All Products |
$158.41
|
| Rate for Payer: Self Pay/Cash Rate |
$127.22
|
| Rate for Payer: Signature Care EPO |
$170.32
|
| Rate for Payer: Signature Care PPO |
$180.58
|
| Rate for Payer: Three Rivers Preferred All Products |
$174.42
|
| Rate for Payer: United Healthcare Commercial |
$161.70
|
| Rate for Payer: United Healthcare Medicare |
$67.72
|
|
|
HC ACU .062X5.75 ST GUIDE WIRE TI
|
Facility
OP
|
$280.80
|
|
| Hospital Charge Code |
41603244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$237.00
|
| Rate for Payer: Aetna Medicare |
$92.66
|
| Rate for Payer: Anthem Exchange |
$161.26
|
| Rate for Payer: Anthem Medicare |
$92.66
|
| Rate for Payer: Anthem PPO |
$161.26
|
| Rate for Payer: Anthem Traditional |
$175.53
|
| Rate for Payer: Caresource Just 4 Me |
$106.56
|
| Rate for Payer: Caresource Medicare |
$101.93
|
| Rate for Payer: Centivo/Paragon All Products |
$143.21
|
| Rate for Payer: Cigna All Products |
$242.33
|
| Rate for Payer: Coventry/First Health All Products |
$247.10
|
| Rate for Payer: Encore All Products |
$258.48
|
| Rate for Payer: Frontpath All Products |
$258.34
|
| Rate for Payer: Humana ChoiceCare |
$242.53
|
| Rate for Payer: Humana Medicare |
$143.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$143.21
|
| Rate for Payer: Lutheran Preferred All Products |
$252.72
|
| Rate for Payer: PHCS/Multiplan All Products |
$210.60
|
| Rate for Payer: PHP All Products |
$212.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$109.51
|
| Rate for Payer: Sagamore All Products |
$216.78
|
| Rate for Payer: Self Pay/Cash Rate |
$174.10
|
| Rate for Payer: Signature Care EPO |
$233.06
|
| Rate for Payer: Signature Care PPO |
$247.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$238.68
|
| Rate for Payer: United Healthcare Commercial |
$221.27
|
| Rate for Payer: United Healthcare Medicare |
$92.66
|
|
|
HC ACU .062X5.75 ST GUIDE WIRE TI
|
Facility
IP
|
$280.80
|
|
| Hospital Charge Code |
41603244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna Commercial |
$242.61
|
| Rate for Payer: Cigna All Products |
$242.33
|
| Rate for Payer: Coventry/First Health All Products |
$247.10
|
| Rate for Payer: Encore All Products |
$258.48
|
| Rate for Payer: Frontpath All Products |
$258.34
|
| Rate for Payer: Humana ChoiceCare |
$242.53
|
| Rate for Payer: Lutheran Preferred All Products |
$252.72
|
| Rate for Payer: PHCS/Multiplan All Products |
$210.60
|
| Rate for Payer: PHP All Products |
$212.96
|
| Rate for Payer: Sagamore All Products |
$216.78
|
| Rate for Payer: Self Pay/Cash Rate |
$174.10
|
| Rate for Payer: Signature Care EPO |
$233.06
|
| Rate for Payer: Signature Care PPO |
$247.10
|
| Rate for Payer: United Healthcare Commercial |
$221.27
|
|
|
HC ACU .062X6 GUIDE WIRE
|
Facility
IP
|
$54.00
|
|
| Hospital Charge Code |
41602819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: Cigna All Products |
$46.60
|
| Rate for Payer: Coventry/First Health All Products |
$47.52
|
| Rate for Payer: Encore All Products |
$49.71
|
| Rate for Payer: Frontpath All Products |
$49.68
|
| Rate for Payer: Humana ChoiceCare |
$46.64
|
| Rate for Payer: Lutheran Preferred All Products |
$48.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.50
|
| Rate for Payer: PHP All Products |
$40.95
|
| Rate for Payer: Sagamore All Products |
$41.69
|
| Rate for Payer: Self Pay/Cash Rate |
$33.48
|
| Rate for Payer: Signature Care EPO |
$44.82
|
| Rate for Payer: Signature Care PPO |
$47.52
|
| Rate for Payer: United Healthcare Commercial |
$42.55
|
|
|
HC ACU .062X6 GUIDE WIRE
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
41602819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Aetna Commercial |
$45.58
|
| Rate for Payer: Aetna Medicare |
$17.82
|
| Rate for Payer: Anthem Exchange |
$31.01
|
| Rate for Payer: Anthem Medicare |
$17.82
|
| Rate for Payer: Anthem PPO |
$31.01
|
| Rate for Payer: Anthem Traditional |
$33.76
|
| Rate for Payer: Caresource Just 4 Me |
$20.49
|
| Rate for Payer: Caresource Medicare |
$19.60
|
| Rate for Payer: Centivo/Paragon All Products |
$27.54
|
| Rate for Payer: Cigna All Products |
$46.60
|
| Rate for Payer: Coventry/First Health All Products |
$47.52
|
| Rate for Payer: Encore All Products |
$49.71
|
| Rate for Payer: Frontpath All Products |
$49.68
|
| Rate for Payer: Humana ChoiceCare |
$46.64
|
| Rate for Payer: Humana Medicare |
$27.54
|
| Rate for Payer: Lucent/Coldwater Veneers |
$27.54
|
| Rate for Payer: Lutheran Preferred All Products |
$48.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.50
|
| Rate for Payer: PHP All Products |
$40.95
|
| Rate for Payer: Plain Church Group Ministry All Products |
$21.06
|
| Rate for Payer: Sagamore All Products |
$41.69
|
| Rate for Payer: Self Pay/Cash Rate |
$33.48
|
| Rate for Payer: Signature Care EPO |
$44.82
|
| Rate for Payer: Signature Care PPO |
$47.52
|
| Rate for Payer: Three Rivers Preferred All Products |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$42.55
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
|
|
HC ACU 0.8MM AVULSION HOOK PLATE
|
Facility
IP
|
$946.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.52 |
| Max. Negotiated Rate |
$870.79 |
| Rate for Payer: Aetna Commercial |
$817.34
|
| Rate for Payer: Cigna All Products |
$816.40
|
| Rate for Payer: Coventry/First Health All Products |
$832.48
|
| Rate for Payer: Encore All Products |
$870.79
|
| Rate for Payer: Frontpath All Products |
$870.32
|
| Rate for Payer: Humana ChoiceCare |
$817.06
|
| Rate for Payer: Lutheran Preferred All Products |
$851.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$709.50
|
| Rate for Payer: PHP All Products |
$717.45
|
| Rate for Payer: Sagamore All Products |
$730.31
|
| Rate for Payer: Self Pay/Cash Rate |
$586.52
|
| Rate for Payer: Signature Care EPO |
$785.18
|
| Rate for Payer: Signature Care PPO |
$832.48
|
| Rate for Payer: United Healthcare Commercial |
$745.45
|
|
|
HC ACU 0.8MM AVULSION HOOK PLATE
|
Facility
OP
|
$946.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.18 |
| Max. Negotiated Rate |
$870.79 |
| Rate for Payer: Aetna Commercial |
$798.42
|
| Rate for Payer: Aetna Medicare |
$312.18
|
| Rate for Payer: Anthem Exchange |
$543.29
|
| Rate for Payer: Anthem Medicare |
$312.18
|
| Rate for Payer: Anthem PPO |
$543.29
|
| Rate for Payer: Anthem Traditional |
$591.34
|
| Rate for Payer: Caresource Just 4 Me |
$359.01
|
| Rate for Payer: Caresource Medicare |
$343.40
|
| Rate for Payer: Centivo/Paragon All Products |
$482.46
|
| Rate for Payer: Cigna All Products |
$816.40
|
| Rate for Payer: Coventry/First Health All Products |
$832.48
|
| Rate for Payer: Encore All Products |
$870.79
|
| Rate for Payer: Frontpath All Products |
$870.32
|
| Rate for Payer: Humana ChoiceCare |
$817.06
|
| Rate for Payer: Humana Medicare |
$482.46
|
| Rate for Payer: Lucent/Coldwater Veneers |
$482.46
|
| Rate for Payer: Lutheran Preferred All Products |
$851.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$709.50
|
| Rate for Payer: PHP All Products |
$717.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$368.94
|
| Rate for Payer: Sagamore All Products |
$730.31
|
| Rate for Payer: Self Pay/Cash Rate |
$586.52
|
| Rate for Payer: Signature Care EPO |
$785.18
|
| Rate for Payer: Signature Care PPO |
$832.48
|
| Rate for Payer: Three Rivers Preferred All Products |
$804.10
|
| Rate for Payer: United Healthcare Commercial |
$745.45
|
| Rate for Payer: United Healthcare Medicare |
$312.18
|
|
|
HC ACU 0.8MM COMP PLATE 6 HOLE
|
Facility
IP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.52 |
| Max. Negotiated Rate |
$916.82 |
| Rate for Payer: Aetna Commercial |
$860.54
|
| Rate for Payer: Cigna All Products |
$859.55
|
| Rate for Payer: Coventry/First Health All Products |
$876.48
|
| Rate for Payer: Encore All Products |
$916.82
|
| Rate for Payer: Frontpath All Products |
$916.32
|
| Rate for Payer: Humana ChoiceCare |
$860.25
|
| Rate for Payer: Lutheran Preferred All Products |
$896.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$747.00
|
| Rate for Payer: PHP All Products |
$755.37
|
| Rate for Payer: Sagamore All Products |
$768.91
|
| Rate for Payer: Self Pay/Cash Rate |
$617.52
|
| Rate for Payer: Signature Care EPO |
$826.68
|
| Rate for Payer: Signature Care PPO |
$876.48
|
| Rate for Payer: United Healthcare Commercial |
$784.85
|
|
|
HC ACU 0.8MM COMP PLATE 6 HOLE
|
Facility
OP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.68 |
| Max. Negotiated Rate |
$916.82 |
| Rate for Payer: Aetna Commercial |
$840.62
|
| Rate for Payer: Aetna Medicare |
$328.68
|
| Rate for Payer: Anthem Exchange |
$572.00
|
| Rate for Payer: Anthem Medicare |
$328.68
|
| Rate for Payer: Anthem PPO |
$572.00
|
| Rate for Payer: Anthem Traditional |
$622.60
|
| Rate for Payer: Caresource Just 4 Me |
$377.98
|
| Rate for Payer: Caresource Medicare |
$361.55
|
| Rate for Payer: Centivo/Paragon All Products |
$507.96
|
| Rate for Payer: Cigna All Products |
$859.55
|
| Rate for Payer: Coventry/First Health All Products |
$876.48
|
| Rate for Payer: Encore All Products |
$916.82
|
| Rate for Payer: Frontpath All Products |
$916.32
|
| Rate for Payer: Humana ChoiceCare |
$860.25
|
| Rate for Payer: Humana Medicare |
$507.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$507.96
|
| Rate for Payer: Lutheran Preferred All Products |
$896.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$747.00
|
| Rate for Payer: PHP All Products |
$755.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$388.44
|
| Rate for Payer: Sagamore All Products |
$768.91
|
| Rate for Payer: Self Pay/Cash Rate |
$617.52
|
| Rate for Payer: Signature Care EPO |
$826.68
|
| Rate for Payer: Signature Care PPO |
$876.48
|
| Rate for Payer: Three Rivers Preferred All Products |
$846.60
|
| Rate for Payer: United Healthcare Commercial |
$784.85
|
| Rate for Payer: United Healthcare Medicare |
$328.68
|
|
|
HC ACU 0.8MM CVD MED/LAT PLATE
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.60 |
| Max. Negotiated Rate |
$1,362.34 |
| Rate for Payer: Aetna Commercial |
$1,278.72
|
| Rate for Payer: Cigna All Products |
$1,277.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,302.40
|
| Rate for Payer: Encore All Products |
$1,362.34
|
| Rate for Payer: Frontpath All Products |
$1,361.60
|
| Rate for Payer: Humana ChoiceCare |
$1,278.28
|
| Rate for Payer: Lutheran Preferred All Products |
$1,332.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,110.00
|
| Rate for Payer: PHP All Products |
$1,122.43
|
| Rate for Payer: Sagamore All Products |
$1,142.56
|
| Rate for Payer: Self Pay/Cash Rate |
$917.60
|
| Rate for Payer: Signature Care EPO |
$1,228.40
|
| Rate for Payer: Signature Care PPO |
$1,302.40
|
| Rate for Payer: United Healthcare Commercial |
$1,166.24
|
|
|
HC ACU 0.8MM CVD MED/LAT PLATE
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,362.34 |
| Rate for Payer: Aetna Commercial |
$1,249.12
|
| Rate for Payer: Aetna Medicare |
$488.40
|
| Rate for Payer: Anthem Exchange |
$849.96
|
| Rate for Payer: Anthem Medicare |
$488.40
|
| Rate for Payer: Anthem PPO |
$849.96
|
| Rate for Payer: Anthem Traditional |
$925.15
|
| Rate for Payer: Caresource Just 4 Me |
$561.66
|
| Rate for Payer: Caresource Medicare |
$537.24
|
| Rate for Payer: Centivo/Paragon All Products |
$754.80
|
| Rate for Payer: Cigna All Products |
$1,277.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,302.40
|
| Rate for Payer: Encore All Products |
$1,362.34
|
| Rate for Payer: Frontpath All Products |
$1,361.60
|
| Rate for Payer: Humana ChoiceCare |
$1,278.28
|
| Rate for Payer: Humana Medicare |
$754.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$754.80
|
| Rate for Payer: Lutheran Preferred All Products |
$1,332.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,110.00
|
| Rate for Payer: PHP All Products |
$1,122.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$577.20
|
| Rate for Payer: Sagamore All Products |
$1,142.56
|
| Rate for Payer: Self Pay/Cash Rate |
$917.60
|
| Rate for Payer: Signature Care EPO |
$1,228.40
|
| Rate for Payer: Signature Care PPO |
$1,302.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,258.00
|
| Rate for Payer: United Healthcare Commercial |
$1,166.24
|
| Rate for Payer: United Healthcare Medicare |
$488.40
|
|
|
HC ACU 0.8MM OFFSET PLATE
|
Facility
IP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.24 |
| Max. Negotiated Rate |
$1,290.54 |
| Rate for Payer: Aetna Commercial |
$1,211.33
|
| Rate for Payer: Cigna All Products |
$1,209.93
|
| Rate for Payer: Coventry/First Health All Products |
$1,233.76
|
| Rate for Payer: Encore All Products |
$1,290.54
|
| Rate for Payer: Frontpath All Products |
$1,289.84
|
| Rate for Payer: Humana ChoiceCare |
$1,210.91
|
| Rate for Payer: Lutheran Preferred All Products |
$1,261.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,051.50
|
| Rate for Payer: PHP All Products |
$1,063.28
|
| Rate for Payer: Sagamore All Products |
$1,082.34
|
| Rate for Payer: Self Pay/Cash Rate |
$869.24
|
| Rate for Payer: Signature Care EPO |
$1,163.66
|
| Rate for Payer: Signature Care PPO |
$1,233.76
|
| Rate for Payer: United Healthcare Commercial |
$1,104.78
|
|
|
HC ACU 0.8MM OFFSET PLATE
|
Facility
OP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.66 |
| Max. Negotiated Rate |
$1,290.54 |
| Rate for Payer: Aetna Commercial |
$1,183.29
|
| Rate for Payer: Aetna Medicare |
$462.66
|
| Rate for Payer: Anthem Exchange |
$805.17
|
| Rate for Payer: Anthem Medicare |
$462.66
|
| Rate for Payer: Anthem PPO |
$805.17
|
| Rate for Payer: Anthem Traditional |
$876.39
|
| Rate for Payer: Caresource Just 4 Me |
$532.06
|
| Rate for Payer: Caresource Medicare |
$508.93
|
| Rate for Payer: Centivo/Paragon All Products |
$715.02
|
| Rate for Payer: Cigna All Products |
$1,209.93
|
| Rate for Payer: Coventry/First Health All Products |
$1,233.76
|
| Rate for Payer: Encore All Products |
$1,290.54
|
| Rate for Payer: Frontpath All Products |
$1,289.84
|
| Rate for Payer: Humana ChoiceCare |
$1,210.91
|
| Rate for Payer: Humana Medicare |
$715.02
|
| Rate for Payer: Lucent/Coldwater Veneers |
$715.02
|
| Rate for Payer: Lutheran Preferred All Products |
$1,261.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,051.50
|
| Rate for Payer: PHP All Products |
$1,063.28
|
| Rate for Payer: Plain Church Group Ministry All Products |
$546.78
|
| Rate for Payer: Sagamore All Products |
$1,082.34
|
| Rate for Payer: Self Pay/Cash Rate |
$869.24
|
| Rate for Payer: Signature Care EPO |
$1,163.66
|
| Rate for Payer: Signature Care PPO |
$1,233.76
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,191.70
|
| Rate for Payer: United Healthcare Commercial |
$1,104.78
|
| Rate for Payer: United Healthcare Medicare |
$462.66
|
|
|
HC ACU 0.8MM ST PLATE 10 HOLE
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.56 |
| Max. Negotiated Rate |
$1,093.55 |
| Rate for Payer: Aetna Commercial |
$1,026.43
|
| Rate for Payer: Cigna All Products |
$1,025.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,045.44
|
| Rate for Payer: Encore All Products |
$1,093.55
|
| Rate for Payer: Frontpath All Products |
$1,092.96
|
| Rate for Payer: Humana ChoiceCare |
$1,026.08
|
| Rate for Payer: Lutheran Preferred All Products |
$1,069.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$891.00
|
| Rate for Payer: PHP All Products |
$900.98
|
| Rate for Payer: Sagamore All Products |
$917.14
|
| Rate for Payer: Self Pay/Cash Rate |
$736.56
|
| Rate for Payer: Signature Care EPO |
$986.04
|
| Rate for Payer: Signature Care PPO |
$1,045.44
|
| Rate for Payer: United Healthcare Commercial |
$936.14
|
|
|
HC ACU 0.8MM ST PLATE 10 HOLE
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.04 |
| Max. Negotiated Rate |
$1,093.55 |
| Rate for Payer: Aetna Commercial |
$1,002.67
|
| Rate for Payer: Aetna Medicare |
$392.04
|
| Rate for Payer: Anthem Exchange |
$682.27
|
| Rate for Payer: Anthem Medicare |
$392.04
|
| Rate for Payer: Anthem PPO |
$682.27
|
| Rate for Payer: Anthem Traditional |
$742.62
|
| Rate for Payer: Caresource Just 4 Me |
$450.85
|
| Rate for Payer: Caresource Medicare |
$431.24
|
| Rate for Payer: Centivo/Paragon All Products |
$605.88
|
| Rate for Payer: Cigna All Products |
$1,025.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,045.44
|
| Rate for Payer: Encore All Products |
$1,093.55
|
| Rate for Payer: Frontpath All Products |
$1,092.96
|
| Rate for Payer: Humana ChoiceCare |
$1,026.08
|
| Rate for Payer: Humana Medicare |
$605.88
|
| Rate for Payer: Lucent/Coldwater Veneers |
$605.88
|
| Rate for Payer: Lutheran Preferred All Products |
$1,069.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$891.00
|
| Rate for Payer: PHP All Products |
$900.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$463.32
|
| Rate for Payer: Sagamore All Products |
$917.14
|
| Rate for Payer: Self Pay/Cash Rate |
$736.56
|
| Rate for Payer: Signature Care EPO |
$986.04
|
| Rate for Payer: Signature Care PPO |
$1,045.44
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,009.80
|
| Rate for Payer: United Healthcare Commercial |
$936.14
|
| Rate for Payer: United Healthcare Medicare |
$392.04
|
|
|
HC ACU 0.8MM T-PLATE
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.60 |
| Max. Negotiated Rate |
$1,362.34 |
| Rate for Payer: Aetna Commercial |
$1,278.72
|
| Rate for Payer: Cigna All Products |
$1,277.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,302.40
|
| Rate for Payer: Encore All Products |
$1,362.34
|
| Rate for Payer: Frontpath All Products |
$1,361.60
|
| Rate for Payer: Humana ChoiceCare |
$1,278.28
|
| Rate for Payer: Lutheran Preferred All Products |
$1,332.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,110.00
|
| Rate for Payer: PHP All Products |
$1,122.43
|
| Rate for Payer: Sagamore All Products |
$1,142.56
|
| Rate for Payer: Self Pay/Cash Rate |
$917.60
|
| Rate for Payer: Signature Care EPO |
$1,228.40
|
| Rate for Payer: Signature Care PPO |
$1,302.40
|
| Rate for Payer: United Healthcare Commercial |
$1,166.24
|
|
|
HC ACU 0.8MM T-PLATE
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,362.34 |
| Rate for Payer: Aetna Commercial |
$1,249.12
|
| Rate for Payer: Aetna Medicare |
$488.40
|
| Rate for Payer: Anthem Exchange |
$849.96
|
| Rate for Payer: Anthem Medicare |
$488.40
|
| Rate for Payer: Anthem PPO |
$849.96
|
| Rate for Payer: Anthem Traditional |
$925.15
|
| Rate for Payer: Caresource Just 4 Me |
$561.66
|
| Rate for Payer: Caresource Medicare |
$537.24
|
| Rate for Payer: Centivo/Paragon All Products |
$754.80
|
| Rate for Payer: Cigna All Products |
$1,277.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,302.40
|
| Rate for Payer: Encore All Products |
$1,362.34
|
| Rate for Payer: Frontpath All Products |
$1,361.60
|
| Rate for Payer: Humana ChoiceCare |
$1,278.28
|
| Rate for Payer: Humana Medicare |
$754.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$754.80
|
| Rate for Payer: Lutheran Preferred All Products |
$1,332.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,110.00
|
| Rate for Payer: PHP All Products |
$1,122.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$577.20
|
| Rate for Payer: Sagamore All Products |
$1,142.56
|
| Rate for Payer: Self Pay/Cash Rate |
$917.60
|
| Rate for Payer: Signature Care EPO |
$1,228.40
|
| Rate for Payer: Signature Care PPO |
$1,302.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,258.00
|
| Rate for Payer: United Healthcare Commercial |
$1,166.24
|
| Rate for Payer: United Healthcare Medicare |
$488.40
|
|
|
HC ACU 1.1MMX3.5 SURGIBIT DRILL
|
Facility
OP
|
$457.20
|
|
| Hospital Charge Code |
41603240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.88 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna Commercial |
$385.88
|
| Rate for Payer: Aetna Medicare |
$150.88
|
| Rate for Payer: Anthem Exchange |
$262.57
|
| Rate for Payer: Anthem Medicare |
$150.88
|
| Rate for Payer: Anthem PPO |
$262.57
|
| Rate for Payer: Anthem Traditional |
$285.80
|
| Rate for Payer: Caresource Just 4 Me |
$173.51
|
| Rate for Payer: Caresource Medicare |
$165.96
|
| Rate for Payer: Centivo/Paragon All Products |
$233.17
|
| Rate for Payer: Cigna All Products |
$394.56
|
| Rate for Payer: Coventry/First Health All Products |
$402.34
|
| Rate for Payer: Encore All Products |
$420.85
|
| Rate for Payer: Frontpath All Products |
$420.62
|
| Rate for Payer: Humana ChoiceCare |
$394.88
|
| Rate for Payer: Humana Medicare |
$233.17
|
| Rate for Payer: Lucent/Coldwater Veneers |
$233.17
|
| Rate for Payer: Lutheran Preferred All Products |
$411.48
|
| Rate for Payer: PHCS/Multiplan All Products |
$342.90
|
| Rate for Payer: PHP All Products |
$346.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$178.31
|
| Rate for Payer: Sagamore All Products |
$352.96
|
| Rate for Payer: Self Pay/Cash Rate |
$283.46
|
| Rate for Payer: Signature Care EPO |
$379.48
|
| Rate for Payer: Signature Care PPO |
$402.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$388.62
|
| Rate for Payer: United Healthcare Commercial |
$360.27
|
| Rate for Payer: United Healthcare Medicare |
$150.88
|
|
