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Service Code CPT C1713
Hospital Charge Code 41602674
Hospital Revenue Code 278
Min. Negotiated Rate $325.87
Max. Negotiated Rate $483.81
Rate for Payer: Aetna Commercial $454.12
Rate for Payer: Cigna All Products $453.59
Rate for Payer: Coventry/First Health All Products $462.53
Rate for Payer: Encore All Products $483.81
Rate for Payer: Frontpath All Products $483.55
Rate for Payer: Humana ChoiceCare $453.96
Rate for Payer: Lutheran Preferred All Products $473.04
Rate for Payer: PHCS/Multiplan All Products $394.20
Rate for Payer: PHP All Products $398.62
Rate for Payer: Sagamore All Products $405.76
Rate for Payer: Self Pay/Cash Rate $325.87
Rate for Payer: Signature Care EPO $436.25
Rate for Payer: Signature Care PPO $462.53
Rate for Payer: United Healthcare Commercial $414.17
Service Code CPT C1713
Hospital Charge Code 41602674
Hospital Revenue Code 278
Min. Negotiated Rate $173.45
Max. Negotiated Rate $483.81
Rate for Payer: Aetna Commercial $443.61
Rate for Payer: Aetna Medicare $173.45
Rate for Payer: Anthem Exchange $301.85
Rate for Payer: Anthem Medicare $173.45
Rate for Payer: Anthem PPO $301.85
Rate for Payer: Anthem Traditional $328.55
Rate for Payer: Caresource Just 4 Me $199.47
Rate for Payer: Caresource Medicare $190.79
Rate for Payer: Centivo/Paragon All Products $268.06
Rate for Payer: Cigna All Products $453.59
Rate for Payer: Coventry/First Health All Products $462.53
Rate for Payer: Encore All Products $483.81
Rate for Payer: Frontpath All Products $483.55
Rate for Payer: Humana ChoiceCare $453.96
Rate for Payer: Humana Medicare $268.06
Rate for Payer: Lucent/Coldwater Veneers $268.06
Rate for Payer: Lutheran Preferred All Products $473.04
Rate for Payer: PHCS/Multiplan All Products $394.20
Rate for Payer: PHP All Products $398.62
Rate for Payer: Plain Church Group Ministry All Products $204.98
Rate for Payer: Sagamore All Products $405.76
Rate for Payer: Self Pay/Cash Rate $325.87
Rate for Payer: Signature Care EPO $436.25
Rate for Payer: Signature Care PPO $462.53
Rate for Payer: Three Rivers Preferred All Products $446.76
Rate for Payer: United Healthcare Commercial $414.17
Rate for Payer: United Healthcare Medicare $173.45
Service Code CPT C1713
Hospital Charge Code 41602690
Hospital Revenue Code 278
Min. Negotiated Rate $103.36
Max. Negotiated Rate $288.30
Rate for Payer: Aetna Commercial $264.34
Rate for Payer: Aetna Medicare $103.36
Rate for Payer: Anthem Exchange $179.87
Rate for Payer: Anthem Medicare $103.36
Rate for Payer: Anthem PPO $179.87
Rate for Payer: Anthem Traditional $195.78
Rate for Payer: Caresource Just 4 Me $118.86
Rate for Payer: Caresource Medicare $113.69
Rate for Payer: Centivo/Paragon All Products $159.73
Rate for Payer: Cigna All Products $270.29
Rate for Payer: Coventry/First Health All Products $275.62
Rate for Payer: Encore All Products $288.30
Rate for Payer: Frontpath All Products $288.14
Rate for Payer: Humana ChoiceCare $270.51
Rate for Payer: Humana Medicare $159.73
Rate for Payer: Lucent/Coldwater Veneers $159.73
Rate for Payer: Lutheran Preferred All Products $281.88
Rate for Payer: PHCS/Multiplan All Products $234.90
Rate for Payer: PHP All Products $237.53
Rate for Payer: Plain Church Group Ministry All Products $122.15
Rate for Payer: Sagamore All Products $241.79
Rate for Payer: Self Pay/Cash Rate $194.18
Rate for Payer: Signature Care EPO $259.96
Rate for Payer: Signature Care PPO $275.62
Rate for Payer: Three Rivers Preferred All Products $266.22
Rate for Payer: United Healthcare Commercial $246.80
Rate for Payer: United Healthcare Medicare $103.36
Service Code CPT C1713
Hospital Charge Code 41602690
Hospital Revenue Code 278
Min. Negotiated Rate $194.18
Max. Negotiated Rate $288.30
Rate for Payer: Aetna Commercial $270.60
Rate for Payer: Cigna All Products $270.29
Rate for Payer: Coventry/First Health All Products $275.62
Rate for Payer: Encore All Products $288.30
Rate for Payer: Frontpath All Products $288.14
Rate for Payer: Humana ChoiceCare $270.51
Rate for Payer: Lutheran Preferred All Products $281.88
Rate for Payer: PHCS/Multiplan All Products $234.90
Rate for Payer: PHP All Products $237.53
Rate for Payer: Sagamore All Products $241.79
Rate for Payer: Self Pay/Cash Rate $194.18
Rate for Payer: Signature Care EPO $259.96
Rate for Payer: Signature Care PPO $275.62
Rate for Payer: United Healthcare Commercial $246.80
Service Code CPT C1713
Hospital Charge Code 41602675
Hospital Revenue Code 278
Min. Negotiated Rate $173.45
Max. Negotiated Rate $483.81
Rate for Payer: Aetna Commercial $443.61
Rate for Payer: Aetna Medicare $173.45
Rate for Payer: Anthem Exchange $301.85
Rate for Payer: Anthem Medicare $173.45
Rate for Payer: Anthem PPO $301.85
Rate for Payer: Anthem Traditional $328.55
Rate for Payer: Caresource Just 4 Me $199.47
Rate for Payer: Caresource Medicare $190.79
Rate for Payer: Centivo/Paragon All Products $268.06
Rate for Payer: Cigna All Products $453.59
Rate for Payer: Coventry/First Health All Products $462.53
Rate for Payer: Encore All Products $483.81
Rate for Payer: Frontpath All Products $483.55
Rate for Payer: Humana ChoiceCare $453.96
Rate for Payer: Humana Medicare $268.06
Rate for Payer: Lucent/Coldwater Veneers $268.06
Rate for Payer: Lutheran Preferred All Products $473.04
Rate for Payer: PHCS/Multiplan All Products $394.20
Rate for Payer: PHP All Products $398.62
Rate for Payer: Plain Church Group Ministry All Products $204.98
Rate for Payer: Sagamore All Products $405.76
Rate for Payer: Self Pay/Cash Rate $325.87
Rate for Payer: Signature Care EPO $436.25
Rate for Payer: Signature Care PPO $462.53
Rate for Payer: Three Rivers Preferred All Products $446.76
Rate for Payer: United Healthcare Commercial $414.17
Rate for Payer: United Healthcare Medicare $173.45
Service Code CPT C1713
Hospital Charge Code 41602675
Hospital Revenue Code 278
Min. Negotiated Rate $325.87
Max. Negotiated Rate $483.81
Rate for Payer: Aetna Commercial $454.12
Rate for Payer: Cigna All Products $453.59
Rate for Payer: Coventry/First Health All Products $462.53
Rate for Payer: Encore All Products $483.81
Rate for Payer: Frontpath All Products $483.55
Rate for Payer: Humana ChoiceCare $453.96
Rate for Payer: Lutheran Preferred All Products $473.04
Rate for Payer: PHCS/Multiplan All Products $394.20
Rate for Payer: PHP All Products $398.62
Rate for Payer: Sagamore All Products $405.76
Rate for Payer: Self Pay/Cash Rate $325.87
Rate for Payer: Signature Care EPO $436.25
Rate for Payer: Signature Care PPO $462.53
Rate for Payer: United Healthcare Commercial $414.17
Service Code CPT C1713
Hospital Charge Code 41602691
Hospital Revenue Code 278
Min. Negotiated Rate $303.55
Max. Negotiated Rate $450.68
Rate for Payer: Aetna Commercial $423.01
Rate for Payer: Cigna All Products $422.52
Rate for Payer: Coventry/First Health All Products $430.85
Rate for Payer: Encore All Products $450.68
Rate for Payer: Frontpath All Products $450.43
Rate for Payer: Humana ChoiceCare $422.87
Rate for Payer: Lutheran Preferred All Products $440.64
Rate for Payer: PHCS/Multiplan All Products $367.20
Rate for Payer: PHP All Products $371.31
Rate for Payer: Sagamore All Products $377.97
Rate for Payer: Self Pay/Cash Rate $303.55
Rate for Payer: Signature Care EPO $406.37
Rate for Payer: Signature Care PPO $430.85
Rate for Payer: United Healthcare Commercial $385.80
Service Code CPT C1713
Hospital Charge Code 41602691
Hospital Revenue Code 278
Min. Negotiated Rate $161.57
Max. Negotiated Rate $450.68
Rate for Payer: Signature Care PPO $430.85
Rate for Payer: Aetna Commercial $413.22
Rate for Payer: Aetna Medicare $161.57
Rate for Payer: Anthem Exchange $281.18
Rate for Payer: Anthem Medicare $161.57
Rate for Payer: Anthem PPO $281.18
Rate for Payer: Anthem Traditional $306.05
Rate for Payer: Caresource Just 4 Me $185.80
Rate for Payer: Caresource Medicare $177.72
Rate for Payer: Centivo/Paragon All Products $249.70
Rate for Payer: Cigna All Products $422.52
Rate for Payer: Coventry/First Health All Products $430.85
Rate for Payer: Encore All Products $450.68
Rate for Payer: Frontpath All Products $450.43
Rate for Payer: Humana ChoiceCare $422.87
Rate for Payer: Humana Medicare $249.70
Rate for Payer: Lucent/Coldwater Veneers $249.70
Rate for Payer: Lutheran Preferred All Products $440.64
Rate for Payer: PHCS/Multiplan All Products $367.20
Rate for Payer: PHP All Products $371.31
Rate for Payer: Plain Church Group Ministry All Products $190.94
Rate for Payer: Sagamore All Products $377.97
Rate for Payer: Self Pay/Cash Rate $303.55
Rate for Payer: Signature Care EPO $406.37
Rate for Payer: Three Rivers Preferred All Products $416.16
Rate for Payer: United Healthcare Commercial $385.80
Rate for Payer: United Healthcare Medicare $161.57
Service Code CPT C1713
Hospital Charge Code 41602676
Hospital Revenue Code 278
Min. Negotiated Rate $431.52
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $601.34
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: United Healthcare Commercial $548.45
Service Code CPT C1713
Hospital Charge Code 41602676
Hospital Revenue Code 278
Min. Negotiated Rate $229.68
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $587.42
Rate for Payer: Aetna Medicare $229.68
Rate for Payer: Anthem Exchange $399.71
Rate for Payer: Anthem Medicare $229.68
Rate for Payer: Anthem PPO $399.71
Rate for Payer: Anthem Traditional $435.07
Rate for Payer: Caresource Just 4 Me $264.13
Rate for Payer: Caresource Medicare $252.65
Rate for Payer: Centivo/Paragon All Products $354.96
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Humana Medicare $354.96
Rate for Payer: Lucent/Coldwater Veneers $354.96
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Plain Church Group Ministry All Products $271.44
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: Three Rivers Preferred All Products $591.60
Rate for Payer: United Healthcare Commercial $548.45
Rate for Payer: United Healthcare Medicare $229.68
Service Code CPT C1713
Hospital Charge Code 41602692
Hospital Revenue Code 278
Min. Negotiated Rate $194.18
Max. Negotiated Rate $288.30
Rate for Payer: Aetna Commercial $270.60
Rate for Payer: Cigna All Products $270.29
Rate for Payer: Coventry/First Health All Products $275.62
Rate for Payer: Encore All Products $288.30
Rate for Payer: Frontpath All Products $288.14
Rate for Payer: Humana ChoiceCare $270.51
Rate for Payer: Lutheran Preferred All Products $281.88
Rate for Payer: PHCS/Multiplan All Products $234.90
Rate for Payer: PHP All Products $237.53
Rate for Payer: Sagamore All Products $241.79
Rate for Payer: Self Pay/Cash Rate $194.18
Rate for Payer: Signature Care EPO $259.96
Rate for Payer: Signature Care PPO $275.62
Rate for Payer: United Healthcare Commercial $246.80
Service Code CPT C1713
Hospital Charge Code 41602692
Hospital Revenue Code 278
Min. Negotiated Rate $103.36
Max. Negotiated Rate $288.30
Rate for Payer: Aetna Commercial $264.34
Rate for Payer: Aetna Medicare $103.36
Rate for Payer: Anthem Exchange $179.87
Rate for Payer: Anthem Medicare $103.36
Rate for Payer: Anthem PPO $179.87
Rate for Payer: Anthem Traditional $195.78
Rate for Payer: Caresource Just 4 Me $118.86
Rate for Payer: Caresource Medicare $113.69
Rate for Payer: Centivo/Paragon All Products $159.73
Rate for Payer: Cigna All Products $270.29
Rate for Payer: Coventry/First Health All Products $275.62
Rate for Payer: Encore All Products $288.30
Rate for Payer: Frontpath All Products $288.14
Rate for Payer: Humana ChoiceCare $270.51
Rate for Payer: Humana Medicare $159.73
Rate for Payer: Lucent/Coldwater Veneers $159.73
Rate for Payer: Lutheran Preferred All Products $281.88
Rate for Payer: PHCS/Multiplan All Products $234.90
Rate for Payer: PHP All Products $237.53
Rate for Payer: Plain Church Group Ministry All Products $122.15
Rate for Payer: Sagamore All Products $241.79
Rate for Payer: Self Pay/Cash Rate $194.18
Rate for Payer: Signature Care EPO $259.96
Rate for Payer: Signature Care PPO $275.62
Rate for Payer: Three Rivers Preferred All Products $266.22
Rate for Payer: United Healthcare Commercial $246.80
Rate for Payer: United Healthcare Medicare $103.36
Service Code CPT C1713
Hospital Charge Code 41602677
Hospital Revenue Code 278
Min. Negotiated Rate $229.68
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $587.42
Rate for Payer: Aetna Medicare $229.68
Rate for Payer: Anthem Exchange $399.71
Rate for Payer: Anthem Medicare $229.68
Rate for Payer: Anthem PPO $399.71
Rate for Payer: Anthem Traditional $435.07
Rate for Payer: Caresource Just 4 Me $264.13
Rate for Payer: Caresource Medicare $252.65
Rate for Payer: Centivo/Paragon All Products $354.96
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Humana Medicare $354.96
Rate for Payer: Lucent/Coldwater Veneers $354.96
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Plain Church Group Ministry All Products $271.44
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: Three Rivers Preferred All Products $591.60
Rate for Payer: United Healthcare Commercial $548.45
Rate for Payer: United Healthcare Medicare $229.68
Service Code CPT C1713
Hospital Charge Code 41602677
Hospital Revenue Code 278
Min. Negotiated Rate $431.52
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $601.34
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: United Healthcare Commercial $548.45
Service Code CPT C1713
Hospital Charge Code 41602693
Hospital Revenue Code 278
Min. Negotiated Rate $103.36
Max. Negotiated Rate $288.30
Rate for Payer: Aetna Commercial $264.34
Rate for Payer: Aetna Medicare $103.36
Rate for Payer: Anthem Exchange $179.87
Rate for Payer: Anthem Medicare $103.36
Rate for Payer: Anthem PPO $179.87
Rate for Payer: Anthem Traditional $195.78
Rate for Payer: Caresource Just 4 Me $118.86
Rate for Payer: Caresource Medicare $113.69
Rate for Payer: Centivo/Paragon All Products $159.73
Rate for Payer: Cigna All Products $270.29
Rate for Payer: Coventry/First Health All Products $275.62
Rate for Payer: Encore All Products $288.30
Rate for Payer: Frontpath All Products $288.14
Rate for Payer: Humana ChoiceCare $270.51
Rate for Payer: Humana Medicare $159.73
Rate for Payer: Lucent/Coldwater Veneers $159.73
Rate for Payer: Lutheran Preferred All Products $281.88
Rate for Payer: PHCS/Multiplan All Products $234.90
Rate for Payer: PHP All Products $237.53
Rate for Payer: Plain Church Group Ministry All Products $122.15
Rate for Payer: Sagamore All Products $241.79
Rate for Payer: Self Pay/Cash Rate $194.18
Rate for Payer: Signature Care EPO $259.96
Rate for Payer: Signature Care PPO $275.62
Rate for Payer: Three Rivers Preferred All Products $266.22
Rate for Payer: United Healthcare Commercial $246.80
Rate for Payer: United Healthcare Medicare $103.36
Service Code CPT C1713
Hospital Charge Code 41602693
Hospital Revenue Code 278
Min. Negotiated Rate $194.18
Max. Negotiated Rate $288.30
Rate for Payer: Aetna Commercial $270.60
Rate for Payer: Cigna All Products $270.29
Rate for Payer: Coventry/First Health All Products $275.62
Rate for Payer: Encore All Products $288.30
Rate for Payer: Frontpath All Products $288.14
Rate for Payer: Humana ChoiceCare $270.51
Rate for Payer: Lutheran Preferred All Products $281.88
Rate for Payer: PHCS/Multiplan All Products $234.90
Rate for Payer: PHP All Products $237.53
Rate for Payer: Sagamore All Products $241.79
Rate for Payer: Self Pay/Cash Rate $194.18
Rate for Payer: Signature Care EPO $259.96
Rate for Payer: Signature Care PPO $275.62
Rate for Payer: United Healthcare Commercial $246.80
Service Code CPT C1713
Hospital Charge Code 41602678
Hospital Revenue Code 278
Min. Negotiated Rate $229.68
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $587.42
Rate for Payer: Aetna Medicare $229.68
Rate for Payer: Anthem Exchange $399.71
Rate for Payer: Anthem Medicare $229.68
Rate for Payer: Anthem PPO $399.71
Rate for Payer: Anthem Traditional $435.07
Rate for Payer: Caresource Just 4 Me $264.13
Rate for Payer: Caresource Medicare $252.65
Rate for Payer: Centivo/Paragon All Products $354.96
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Humana Medicare $354.96
Rate for Payer: Lucent/Coldwater Veneers $354.96
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Plain Church Group Ministry All Products $271.44
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: Three Rivers Preferred All Products $591.60
Rate for Payer: United Healthcare Commercial $548.45
Rate for Payer: United Healthcare Medicare $229.68
Service Code CPT C1713
Hospital Charge Code 41602678
Hospital Revenue Code 278
Min. Negotiated Rate $431.52
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $601.34
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: United Healthcare Commercial $548.45
Service Code CPT C1713
Hospital Charge Code 41602694
Hospital Revenue Code 278
Min. Negotiated Rate $161.57
Max. Negotiated Rate $450.68
Rate for Payer: Aetna Commercial $413.22
Rate for Payer: Aetna Medicare $161.57
Rate for Payer: Anthem Exchange $281.18
Rate for Payer: Anthem Medicare $161.57
Rate for Payer: Anthem PPO $281.18
Rate for Payer: Anthem Traditional $306.05
Rate for Payer: Caresource Just 4 Me $185.80
Rate for Payer: Caresource Medicare $177.72
Rate for Payer: Centivo/Paragon All Products $249.70
Rate for Payer: Cigna All Products $422.52
Rate for Payer: Coventry/First Health All Products $430.85
Rate for Payer: Encore All Products $450.68
Rate for Payer: Frontpath All Products $450.43
Rate for Payer: Humana ChoiceCare $422.87
Rate for Payer: Humana Medicare $249.70
Rate for Payer: Lucent/Coldwater Veneers $249.70
Rate for Payer: Lutheran Preferred All Products $440.64
Rate for Payer: PHCS/Multiplan All Products $367.20
Rate for Payer: PHP All Products $371.31
Rate for Payer: Plain Church Group Ministry All Products $190.94
Rate for Payer: Sagamore All Products $377.97
Rate for Payer: Self Pay/Cash Rate $303.55
Rate for Payer: Signature Care EPO $406.37
Rate for Payer: Signature Care PPO $430.85
Rate for Payer: Three Rivers Preferred All Products $416.16
Rate for Payer: United Healthcare Commercial $385.80
Rate for Payer: United Healthcare Medicare $161.57
Service Code CPT C1713
Hospital Charge Code 41602694
Hospital Revenue Code 278
Min. Negotiated Rate $303.55
Max. Negotiated Rate $450.68
Rate for Payer: Aetna Commercial $423.01
Rate for Payer: Cigna All Products $422.52
Rate for Payer: Coventry/First Health All Products $430.85
Rate for Payer: Encore All Products $450.68
Rate for Payer: Frontpath All Products $450.43
Rate for Payer: Humana ChoiceCare $422.87
Rate for Payer: Lutheran Preferred All Products $440.64
Rate for Payer: PHCS/Multiplan All Products $367.20
Rate for Payer: PHP All Products $371.31
Rate for Payer: Sagamore All Products $377.97
Rate for Payer: Self Pay/Cash Rate $303.55
Rate for Payer: Signature Care EPO $406.37
Rate for Payer: Signature Care PPO $430.85
Rate for Payer: United Healthcare Commercial $385.80
Service Code CPT C1713
Hospital Charge Code 41602679
Hospital Revenue Code 278
Min. Negotiated Rate $229.68
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $587.42
Rate for Payer: Aetna Medicare $229.68
Rate for Payer: Anthem Exchange $399.71
Rate for Payer: Anthem Medicare $229.68
Rate for Payer: Anthem PPO $399.71
Rate for Payer: Anthem Traditional $435.07
Rate for Payer: Caresource Just 4 Me $264.13
Rate for Payer: Caresource Medicare $252.65
Rate for Payer: Centivo/Paragon All Products $354.96
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Humana Medicare $354.96
Rate for Payer: Lucent/Coldwater Veneers $354.96
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Plain Church Group Ministry All Products $271.44
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: Three Rivers Preferred All Products $591.60
Rate for Payer: United Healthcare Commercial $548.45
Rate for Payer: United Healthcare Medicare $229.68
Service Code CPT C1713
Hospital Charge Code 41602679
Hospital Revenue Code 278
Min. Negotiated Rate $431.52
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $601.34
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: United Healthcare Commercial $548.45
Service Code CPT C1713
Hospital Charge Code 41602695
Hospital Revenue Code 278
Min. Negotiated Rate $303.55
Max. Negotiated Rate $450.68
Rate for Payer: Aetna Commercial $423.01
Rate for Payer: Cigna All Products $422.52
Rate for Payer: Coventry/First Health All Products $430.85
Rate for Payer: Encore All Products $450.68
Rate for Payer: Frontpath All Products $450.43
Rate for Payer: Humana ChoiceCare $422.87
Rate for Payer: Lutheran Preferred All Products $440.64
Rate for Payer: PHCS/Multiplan All Products $367.20
Rate for Payer: PHP All Products $371.31
Rate for Payer: Sagamore All Products $377.97
Rate for Payer: Self Pay/Cash Rate $303.55
Rate for Payer: Signature Care EPO $406.37
Rate for Payer: Signature Care PPO $430.85
Rate for Payer: United Healthcare Commercial $385.80
Service Code CPT C1713
Hospital Charge Code 41602695
Hospital Revenue Code 278
Min. Negotiated Rate $161.57
Max. Negotiated Rate $450.68
Rate for Payer: Aetna Commercial $413.22
Rate for Payer: Aetna Medicare $161.57
Rate for Payer: Anthem Exchange $281.18
Rate for Payer: Anthem Medicare $161.57
Rate for Payer: Anthem PPO $281.18
Rate for Payer: Anthem Traditional $306.05
Rate for Payer: Caresource Just 4 Me $185.80
Rate for Payer: Caresource Medicare $177.72
Rate for Payer: Centivo/Paragon All Products $249.70
Rate for Payer: Cigna All Products $422.52
Rate for Payer: Coventry/First Health All Products $430.85
Rate for Payer: Encore All Products $450.68
Rate for Payer: Frontpath All Products $450.43
Rate for Payer: Humana ChoiceCare $422.87
Rate for Payer: Humana Medicare $249.70
Rate for Payer: Lucent/Coldwater Veneers $249.70
Rate for Payer: Lutheran Preferred All Products $440.64
Rate for Payer: PHCS/Multiplan All Products $367.20
Rate for Payer: PHP All Products $371.31
Rate for Payer: Plain Church Group Ministry All Products $190.94
Rate for Payer: Sagamore All Products $377.97
Rate for Payer: Self Pay/Cash Rate $303.55
Rate for Payer: Signature Care EPO $406.37
Rate for Payer: Signature Care PPO $430.85
Rate for Payer: Three Rivers Preferred All Products $416.16
Rate for Payer: United Healthcare Commercial $385.80
Rate for Payer: United Healthcare Medicare $161.57
Service Code CPT C1713
Hospital Charge Code 41602680
Hospital Revenue Code 278
Min. Negotiated Rate $229.68
Max. Negotiated Rate $640.67
Rate for Payer: Aetna Commercial $587.42
Rate for Payer: Aetna Medicare $229.68
Rate for Payer: Anthem Exchange $399.71
Rate for Payer: Anthem Medicare $229.68
Rate for Payer: Anthem PPO $399.71
Rate for Payer: Anthem Traditional $435.07
Rate for Payer: Caresource Just 4 Me $264.13
Rate for Payer: Caresource Medicare $252.65
Rate for Payer: Centivo/Paragon All Products $354.96
Rate for Payer: Cigna All Products $600.65
Rate for Payer: Coventry/First Health All Products $612.48
Rate for Payer: Encore All Products $640.67
Rate for Payer: Frontpath All Products $640.32
Rate for Payer: Humana ChoiceCare $601.14
Rate for Payer: Humana Medicare $354.96
Rate for Payer: Lucent/Coldwater Veneers $354.96
Rate for Payer: Lutheran Preferred All Products $626.40
Rate for Payer: PHCS/Multiplan All Products $522.00
Rate for Payer: PHP All Products $527.85
Rate for Payer: Plain Church Group Ministry All Products $271.44
Rate for Payer: Sagamore All Products $537.31
Rate for Payer: Self Pay/Cash Rate $431.52
Rate for Payer: Signature Care EPO $577.68
Rate for Payer: Signature Care PPO $612.48
Rate for Payer: Three Rivers Preferred All Products $591.60
Rate for Payer: United Healthcare Commercial $548.45
Rate for Payer: United Healthcare Medicare $229.68