|
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
|
|
|
HC ACU 1.3MM COMP PLATE 6 HOLE
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603183
|
|
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 1.3MM COMP PLATE 6 HOLE
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603183
|
|
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 1.3MM MC NECK PLATE LT
|
Facility
IP
|
$1,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.04 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,375.49
|
| Rate for Payer: Cigna All Products |
$1,373.90
|
| Rate for Payer: Coventry/First Health All Products |
$1,400.96
|
| Rate for Payer: Encore All Products |
$1,465.44
|
| Rate for Payer: Frontpath All Products |
$1,464.64
|
| Rate for Payer: Humana ChoiceCare |
$1,375.01
|
| Rate for Payer: Lutheran Preferred All Products |
$1,432.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,194.00
|
| Rate for Payer: PHP All Products |
$1,207.37
|
| Rate for Payer: Sagamore All Products |
$1,229.02
|
| Rate for Payer: Self Pay/Cash Rate |
$987.04
|
| Rate for Payer: Signature Care EPO |
$1,321.36
|
| Rate for Payer: Signature Care PPO |
$1,400.96
|
| Rate for Payer: United Healthcare Commercial |
$1,254.50
|
|
|
HC ACU 1.3MM MC NECK PLATE LT
|
Facility
OP
|
$1,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.36 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,343.65
|
| Rate for Payer: Aetna Medicare |
$525.36
|
| Rate for Payer: Anthem Exchange |
$914.29
|
| Rate for Payer: Anthem Medicare |
$525.36
|
| Rate for Payer: Anthem PPO |
$914.29
|
| Rate for Payer: Anthem Traditional |
$995.16
|
| Rate for Payer: Caresource Just 4 Me |
$604.16
|
| Rate for Payer: Caresource Medicare |
$577.90
|
| Rate for Payer: Centivo/Paragon All Products |
$811.92
|
| Rate for Payer: Cigna All Products |
$1,373.90
|
| Rate for Payer: Coventry/First Health All Products |
$1,400.96
|
| Rate for Payer: Encore All Products |
$1,465.44
|
| Rate for Payer: Frontpath All Products |
$1,464.64
|
| Rate for Payer: Humana ChoiceCare |
$1,375.01
|
| Rate for Payer: Humana Medicare |
$811.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$811.92
|
| Rate for Payer: Lutheran Preferred All Products |
$1,432.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,194.00
|
| Rate for Payer: PHP All Products |
$1,207.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$620.88
|
| Rate for Payer: Sagamore All Products |
$1,229.02
|
| Rate for Payer: Self Pay/Cash Rate |
$987.04
|
| Rate for Payer: Signature Care EPO |
$1,321.36
|
| Rate for Payer: Signature Care PPO |
$1,400.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,353.20
|
| Rate for Payer: United Healthcare Commercial |
$1,254.50
|
| Rate for Payer: United Healthcare Medicare |
$525.36
|
|
|
HC ACU 1.3MM MC NECK PLATE RT
|
Facility
IP
|
$1,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.04 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,375.49
|
| Rate for Payer: Cigna All Products |
$1,373.90
|
| Rate for Payer: Coventry/First Health All Products |
$1,400.96
|
| Rate for Payer: Encore All Products |
$1,465.44
|
| Rate for Payer: Frontpath All Products |
$1,464.64
|
| Rate for Payer: Humana ChoiceCare |
$1,375.01
|
| Rate for Payer: Lutheran Preferred All Products |
$1,432.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,194.00
|
| Rate for Payer: PHP All Products |
$1,207.37
|
| Rate for Payer: Sagamore All Products |
$1,229.02
|
| Rate for Payer: Self Pay/Cash Rate |
$987.04
|
| Rate for Payer: Signature Care EPO |
$1,321.36
|
| Rate for Payer: Signature Care PPO |
$1,400.96
|
| Rate for Payer: United Healthcare Commercial |
$1,254.50
|
|
|
HC ACU 1.3MM MC NECK PLATE RT
|
Facility
OP
|
$1,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.36 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,343.65
|
| Rate for Payer: Aetna Medicare |
$525.36
|
| Rate for Payer: Anthem Exchange |
$914.29
|
| Rate for Payer: Anthem Medicare |
$525.36
|
| Rate for Payer: Anthem PPO |
$914.29
|
| Rate for Payer: Anthem Traditional |
$995.16
|
| Rate for Payer: Caresource Just 4 Me |
$604.16
|
| Rate for Payer: Caresource Medicare |
$577.90
|
| Rate for Payer: Centivo/Paragon All Products |
$811.92
|
| Rate for Payer: Cigna All Products |
$1,373.90
|
| Rate for Payer: Coventry/First Health All Products |
$1,400.96
|
| Rate for Payer: Encore All Products |
$1,465.44
|
| Rate for Payer: Frontpath All Products |
$1,464.64
|
| Rate for Payer: Humana ChoiceCare |
$1,375.01
|
| Rate for Payer: Humana Medicare |
$811.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$811.92
|
| Rate for Payer: Lutheran Preferred All Products |
$1,432.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,194.00
|
| Rate for Payer: PHP All Products |
$1,207.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$620.88
|
| Rate for Payer: Sagamore All Products |
$1,229.02
|
| Rate for Payer: Self Pay/Cash Rate |
$987.04
|
| Rate for Payer: Signature Care EPO |
$1,321.36
|
| Rate for Payer: Signature Care PPO |
$1,400.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,353.20
|
| Rate for Payer: United Healthcare Commercial |
$1,254.50
|
| Rate for Payer: United Healthcare Medicare |
$525.36
|
|
|
HC ACU 1.3MM ROL FX HOOK PLATE
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603181
|
|
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 1.3MM ROL FX HOOK PLATE
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603181
|
|
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 1.3MM ROT CORRECT PLATE
|
Facility
IP
|
$1,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.04 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,375.49
|
| Rate for Payer: Cigna All Products |
$1,373.90
|
| Rate for Payer: Coventry/First Health All Products |
$1,400.96
|
| Rate for Payer: Encore All Products |
$1,465.44
|
| Rate for Payer: Frontpath All Products |
$1,464.64
|
| Rate for Payer: Humana ChoiceCare |
$1,375.01
|
| Rate for Payer: Lutheran Preferred All Products |
$1,432.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,194.00
|
| Rate for Payer: PHP All Products |
$1,207.37
|
| Rate for Payer: Sagamore All Products |
$1,229.02
|
| Rate for Payer: Self Pay/Cash Rate |
$987.04
|
| Rate for Payer: Signature Care EPO |
$1,321.36
|
| Rate for Payer: Signature Care PPO |
$1,400.96
|
| Rate for Payer: United Healthcare Commercial |
$1,254.50
|
|
|
HC ACU 1.3MM ROT CORRECT PLATE
|
Facility
OP
|
$1,592.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.36 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,343.65
|
| Rate for Payer: Aetna Medicare |
$525.36
|
| Rate for Payer: Anthem Exchange |
$914.29
|
| Rate for Payer: Anthem Medicare |
$525.36
|
| Rate for Payer: Anthem PPO |
$914.29
|
| Rate for Payer: Anthem Traditional |
$995.16
|
| Rate for Payer: Caresource Just 4 Me |
$604.16
|
| Rate for Payer: Caresource Medicare |
$577.90
|
| Rate for Payer: Centivo/Paragon All Products |
$811.92
|
| Rate for Payer: Cigna All Products |
$1,373.90
|
| Rate for Payer: Coventry/First Health All Products |
$1,400.96
|
| Rate for Payer: Encore All Products |
$1,465.44
|
| Rate for Payer: Frontpath All Products |
$1,464.64
|
| Rate for Payer: Humana ChoiceCare |
$1,375.01
|
| Rate for Payer: Humana Medicare |
$811.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$811.92
|
| Rate for Payer: Lutheran Preferred All Products |
$1,432.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,194.00
|
| Rate for Payer: PHP All Products |
$1,207.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$620.88
|
| Rate for Payer: Sagamore All Products |
$1,229.02
|
| Rate for Payer: Self Pay/Cash Rate |
$987.04
|
| Rate for Payer: Signature Care EPO |
$1,321.36
|
| Rate for Payer: Signature Care PPO |
$1,400.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,353.20
|
| Rate for Payer: United Healthcare Commercial |
$1,254.50
|
| Rate for Payer: United Healthcare Medicare |
$525.36
|
|
|
HC ACU 1.3MM ST PLATE 10 HOLE
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603184
|
|
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 1.3MM ST PLATE 10 HOLE
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603184
|
|
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 1.3MM T-PLATE
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603180
|
|
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 1.3MM T-PLATE
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603180
|
|
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 1.3 NON-TD GUIDE WIRE 150
|
Facility
IP
|
$54.00
|
|
| Hospital Charge Code |
41602813
|
|
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 1.3 NON-TD GUIDE WIRE 150
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
41602813
|
|
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 1.5MM X 10MM HEX LAG SCREW
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.16 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$490.75
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
|
|
HC ACU 1.5MM X 10MM HEX LAG SCREW
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$479.39
|
| Rate for Payer: Aetna Medicare |
$187.44
|
| Rate for Payer: Anthem Exchange |
$326.20
|
| Rate for Payer: Anthem Medicare |
$187.44
|
| Rate for Payer: Anthem PPO |
$326.20
|
| Rate for Payer: Anthem Traditional |
$355.06
|
| Rate for Payer: Caresource Just 4 Me |
$215.56
|
| Rate for Payer: Caresource Medicare |
$206.18
|
| Rate for Payer: Centivo/Paragon All Products |
$289.68
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Humana Medicare |
$289.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$289.68
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$221.52
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$482.80
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
| Rate for Payer: United Healthcare Medicare |
$187.44
|
|
|
HC ACU 1.5MM X 10MM HEX MLT SCREW
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$479.39
|
| Rate for Payer: Aetna Medicare |
$187.44
|
| Rate for Payer: Anthem Exchange |
$326.20
|
| Rate for Payer: Anthem Medicare |
$187.44
|
| Rate for Payer: Anthem PPO |
$326.20
|
| Rate for Payer: Anthem Traditional |
$355.06
|
| Rate for Payer: Caresource Just 4 Me |
$215.56
|
| Rate for Payer: Caresource Medicare |
$206.18
|
| Rate for Payer: Centivo/Paragon All Products |
$289.68
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Humana Medicare |
$289.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$289.68
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$221.52
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$482.80
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
| Rate for Payer: United Healthcare Medicare |
$187.44
|
|
|
HC ACU 1.5MM X 10MM HEX MLT SCREW
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.16 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$490.75
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
|
|
HC ACU 1.5MM X 11MM HEX LAG SCREW
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$347.95 |
| Rate for Payer: Aetna Commercial |
$319.03
|
| Rate for Payer: Aetna Medicare |
$124.74
|
| Rate for Payer: Anthem Exchange |
$217.09
|
| Rate for Payer: Anthem Medicare |
$124.74
|
| Rate for Payer: Anthem PPO |
$217.09
|
| Rate for Payer: Anthem Traditional |
$236.29
|
| Rate for Payer: Caresource Just 4 Me |
$143.45
|
| Rate for Payer: Caresource Medicare |
$137.21
|
| Rate for Payer: Centivo/Paragon All Products |
$192.78
|
| Rate for Payer: Cigna All Products |
$326.21
|
| Rate for Payer: Coventry/First Health All Products |
$332.64
|
| Rate for Payer: Encore All Products |
$347.95
|
| Rate for Payer: Frontpath All Products |
$347.76
|
| Rate for Payer: Humana ChoiceCare |
$326.48
|
| Rate for Payer: Humana Medicare |
$192.78
|
| Rate for Payer: Lucent/Coldwater Veneers |
$192.78
|
| Rate for Payer: Lutheran Preferred All Products |
$340.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$283.50
|
| Rate for Payer: PHP All Products |
$286.68
|
| Rate for Payer: Plain Church Group Ministry All Products |
$147.42
|
| Rate for Payer: Sagamore All Products |
$291.82
|
| Rate for Payer: Self Pay/Cash Rate |
$234.36
|
| Rate for Payer: Signature Care EPO |
$313.74
|
| Rate for Payer: Signature Care PPO |
$332.64
|
| Rate for Payer: Three Rivers Preferred All Products |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$297.86
|
| Rate for Payer: United Healthcare Medicare |
$124.74
|
|
|
HC ACU 1.5MM X 11MM HEX LAG SCREW
|
Facility
IP
|
$378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.36 |
| Max. Negotiated Rate |
$347.95 |
| Rate for Payer: Aetna Commercial |
$326.59
|
| Rate for Payer: Cigna All Products |
$326.21
|
| Rate for Payer: Coventry/First Health All Products |
$332.64
|
| Rate for Payer: Encore All Products |
$347.95
|
| Rate for Payer: Frontpath All Products |
$347.76
|
| Rate for Payer: Humana ChoiceCare |
$326.48
|
| Rate for Payer: Lutheran Preferred All Products |
$340.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$283.50
|
| Rate for Payer: PHP All Products |
$286.68
|
| Rate for Payer: Sagamore All Products |
$291.82
|
| Rate for Payer: Self Pay/Cash Rate |
$234.36
|
| Rate for Payer: Signature Care EPO |
$313.74
|
| Rate for Payer: Signature Care PPO |
$332.64
|
| Rate for Payer: United Healthcare Commercial |
$297.86
|
|
|
HC ACU 1.5MM X 11MM HEX MLT SCREW
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$479.39
|
| Rate for Payer: Aetna Medicare |
$187.44
|
| Rate for Payer: Anthem Exchange |
$326.20
|
| Rate for Payer: Anthem Medicare |
$187.44
|
| Rate for Payer: Anthem PPO |
$326.20
|
| Rate for Payer: Anthem Traditional |
$355.06
|
| Rate for Payer: Caresource Just 4 Me |
$215.56
|
| Rate for Payer: Caresource Medicare |
$206.18
|
| Rate for Payer: Centivo/Paragon All Products |
$289.68
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Humana Medicare |
$289.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$289.68
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$221.52
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$482.80
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
| Rate for Payer: United Healthcare Medicare |
$187.44
|
|
|
HC ACU 1.5MM X 11MM HEX MLT SCREW
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.16 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$490.75
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
|
