|
HC ACU 2.7X50 NON-LOCK HEX SCREW
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.52 |
| Max. Negotiated Rate |
$548.62 |
| Rate for Payer: Aetna Commercial |
$514.94
|
| Rate for Payer: Cigna All Products |
$514.35
|
| Rate for Payer: Coventry/First Health All Products |
$524.48
|
| Rate for Payer: Encore All Products |
$548.62
|
| Rate for Payer: Frontpath All Products |
$548.32
|
| Rate for Payer: Humana ChoiceCare |
$514.77
|
| Rate for Payer: Lutheran Preferred All Products |
$536.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$447.00
|
| Rate for Payer: PHP All Products |
$452.01
|
| Rate for Payer: Sagamore All Products |
$460.11
|
| Rate for Payer: Self Pay/Cash Rate |
$369.52
|
| Rate for Payer: Signature Care EPO |
$494.68
|
| Rate for Payer: Signature Care PPO |
$524.48
|
| Rate for Payer: United Healthcare Commercial |
$469.65
|
|
|
HC ACU 2.7X55 LOCK HEX SCREW
|
Facility
OP
|
$792.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$729.04 |
| Rate for Payer: Aetna Commercial |
$668.45
|
| Rate for Payer: Aetna Medicare |
$261.36
|
| Rate for Payer: Anthem Exchange |
$454.85
|
| Rate for Payer: Anthem Medicare |
$261.36
|
| Rate for Payer: Anthem PPO |
$454.85
|
| Rate for Payer: Anthem Traditional |
$495.08
|
| Rate for Payer: Caresource Just 4 Me |
$300.56
|
| Rate for Payer: Caresource Medicare |
$287.50
|
| Rate for Payer: Centivo/Paragon All Products |
$403.92
|
| Rate for Payer: Cigna All Products |
$683.50
|
| Rate for Payer: Coventry/First Health All Products |
$696.96
|
| Rate for Payer: Encore All Products |
$729.04
|
| Rate for Payer: Frontpath All Products |
$728.64
|
| Rate for Payer: Humana ChoiceCare |
$684.05
|
| Rate for Payer: Humana Medicare |
$403.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$403.92
|
| Rate for Payer: Lutheran Preferred All Products |
$712.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$594.00
|
| Rate for Payer: PHP All Products |
$600.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$308.88
|
| Rate for Payer: Sagamore All Products |
$611.42
|
| Rate for Payer: Self Pay/Cash Rate |
$491.04
|
| Rate for Payer: Signature Care EPO |
$657.36
|
| Rate for Payer: Signature Care PPO |
$696.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$673.20
|
| Rate for Payer: United Healthcare Commercial |
$624.10
|
| Rate for Payer: United Healthcare Medicare |
$261.36
|
|
|
HC ACU 2.7X55 LOCK HEX SCREW
|
Facility
IP
|
$792.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.04 |
| Max. Negotiated Rate |
$729.04 |
| Rate for Payer: Aetna Commercial |
$684.29
|
| Rate for Payer: Cigna All Products |
$683.50
|
| Rate for Payer: Coventry/First Health All Products |
$696.96
|
| Rate for Payer: Encore All Products |
$729.04
|
| Rate for Payer: Frontpath All Products |
$728.64
|
| Rate for Payer: Humana ChoiceCare |
$684.05
|
| Rate for Payer: Lutheran Preferred All Products |
$712.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$594.00
|
| Rate for Payer: PHP All Products |
$600.65
|
| Rate for Payer: Sagamore All Products |
$611.42
|
| Rate for Payer: Self Pay/Cash Rate |
$491.04
|
| Rate for Payer: Signature Care EPO |
$657.36
|
| Rate for Payer: Signature Care PPO |
$696.96
|
| Rate for Payer: United Healthcare Commercial |
$624.10
|
|
|
HC ACU 2.7X55 NON-LOCK HEX SCREW
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.68 |
| Max. Negotiated Rate |
$548.62 |
| Rate for Payer: Aetna Commercial |
$503.02
|
| Rate for Payer: Aetna Medicare |
$196.68
|
| Rate for Payer: Anthem Exchange |
$342.28
|
| Rate for Payer: Anthem Medicare |
$196.68
|
| Rate for Payer: Anthem PPO |
$342.28
|
| Rate for Payer: Anthem Traditional |
$372.56
|
| Rate for Payer: Caresource Just 4 Me |
$226.18
|
| Rate for Payer: Caresource Medicare |
$216.35
|
| Rate for Payer: Centivo/Paragon All Products |
$303.96
|
| Rate for Payer: Cigna All Products |
$514.35
|
| Rate for Payer: Coventry/First Health All Products |
$524.48
|
| Rate for Payer: Encore All Products |
$548.62
|
| Rate for Payer: Frontpath All Products |
$548.32
|
| Rate for Payer: Humana ChoiceCare |
$514.77
|
| Rate for Payer: Humana Medicare |
$303.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$303.96
|
| Rate for Payer: Lutheran Preferred All Products |
$536.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$447.00
|
| Rate for Payer: PHP All Products |
$452.01
|
| Rate for Payer: Plain Church Group Ministry All Products |
$232.44
|
| Rate for Payer: Sagamore All Products |
$460.11
|
| Rate for Payer: Self Pay/Cash Rate |
$369.52
|
| Rate for Payer: Signature Care EPO |
$494.68
|
| Rate for Payer: Signature Care PPO |
$524.48
|
| Rate for Payer: Three Rivers Preferred All Products |
$506.60
|
| Rate for Payer: United Healthcare Commercial |
$469.65
|
| Rate for Payer: United Healthcare Medicare |
$196.68
|
|
|
HC ACU 2.7X55 NON-LOCK HEX SCREW
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.52 |
| Max. Negotiated Rate |
$548.62 |
| Rate for Payer: Aetna Commercial |
$514.94
|
| Rate for Payer: Cigna All Products |
$514.35
|
| Rate for Payer: Coventry/First Health All Products |
$524.48
|
| Rate for Payer: Encore All Products |
$548.62
|
| Rate for Payer: Frontpath All Products |
$548.32
|
| Rate for Payer: Humana ChoiceCare |
$514.77
|
| Rate for Payer: Lutheran Preferred All Products |
$536.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$447.00
|
| Rate for Payer: PHP All Products |
$452.01
|
| Rate for Payer: Sagamore All Products |
$460.11
|
| Rate for Payer: Self Pay/Cash Rate |
$369.52
|
| Rate for Payer: Signature Care EPO |
$494.68
|
| Rate for Payer: Signature Care PPO |
$524.48
|
| Rate for Payer: United Healthcare Commercial |
$469.65
|
|
|
HC ACU 2.7X60 LOCK HEX SCREW
|
Facility
IP
|
$792.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.04 |
| Max. Negotiated Rate |
$729.04 |
| Rate for Payer: Aetna Commercial |
$684.29
|
| Rate for Payer: Cigna All Products |
$683.50
|
| Rate for Payer: Coventry/First Health All Products |
$696.96
|
| Rate for Payer: Encore All Products |
$729.04
|
| Rate for Payer: Frontpath All Products |
$728.64
|
| Rate for Payer: Humana ChoiceCare |
$684.05
|
| Rate for Payer: Lutheran Preferred All Products |
$712.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$594.00
|
| Rate for Payer: PHP All Products |
$600.65
|
| Rate for Payer: Sagamore All Products |
$611.42
|
| Rate for Payer: Self Pay/Cash Rate |
$491.04
|
| Rate for Payer: Signature Care EPO |
$657.36
|
| Rate for Payer: Signature Care PPO |
$696.96
|
| Rate for Payer: United Healthcare Commercial |
$624.10
|
|
|
HC ACU 2.7X60 LOCK HEX SCREW
|
Facility
OP
|
$792.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$729.04 |
| Rate for Payer: Aetna Commercial |
$668.45
|
| Rate for Payer: Aetna Medicare |
$261.36
|
| Rate for Payer: Anthem Exchange |
$454.85
|
| Rate for Payer: Anthem Medicare |
$261.36
|
| Rate for Payer: Anthem PPO |
$454.85
|
| Rate for Payer: Anthem Traditional |
$495.08
|
| Rate for Payer: Caresource Just 4 Me |
$300.56
|
| Rate for Payer: Caresource Medicare |
$287.50
|
| Rate for Payer: Centivo/Paragon All Products |
$403.92
|
| Rate for Payer: Cigna All Products |
$683.50
|
| Rate for Payer: Coventry/First Health All Products |
$696.96
|
| Rate for Payer: Encore All Products |
$729.04
|
| Rate for Payer: Frontpath All Products |
$728.64
|
| Rate for Payer: Humana ChoiceCare |
$684.05
|
| Rate for Payer: Humana Medicare |
$403.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$403.92
|
| Rate for Payer: Lutheran Preferred All Products |
$712.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$594.00
|
| Rate for Payer: PHP All Products |
$600.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$308.88
|
| Rate for Payer: Sagamore All Products |
$611.42
|
| Rate for Payer: Self Pay/Cash Rate |
$491.04
|
| Rate for Payer: Signature Care EPO |
$657.36
|
| Rate for Payer: Signature Care PPO |
$696.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$673.20
|
| Rate for Payer: United Healthcare Commercial |
$624.10
|
| Rate for Payer: United Healthcare Medicare |
$261.36
|
|
|
HC ACU 2.7X60 NON-LOCK HEX SCREW
|
Facility
OP
|
$410.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$377.77 |
| Rate for Payer: Aetna Commercial |
$346.38
|
| Rate for Payer: Aetna Medicare |
$135.43
|
| Rate for Payer: Anthem Exchange |
$235.69
|
| Rate for Payer: Anthem Medicare |
$135.43
|
| Rate for Payer: Anthem PPO |
$235.69
|
| Rate for Payer: Anthem Traditional |
$256.54
|
| Rate for Payer: Caresource Just 4 Me |
$155.75
|
| Rate for Payer: Caresource Medicare |
$148.98
|
| Rate for Payer: Centivo/Paragon All Products |
$209.30
|
| Rate for Payer: Cigna All Products |
$354.18
|
| Rate for Payer: Coventry/First Health All Products |
$361.15
|
| Rate for Payer: Encore All Products |
$377.77
|
| Rate for Payer: Frontpath All Products |
$377.57
|
| Rate for Payer: Humana ChoiceCare |
$354.46
|
| Rate for Payer: Humana Medicare |
$209.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$209.30
|
| Rate for Payer: Lutheran Preferred All Products |
$369.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$307.80
|
| Rate for Payer: PHP All Products |
$311.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$160.06
|
| Rate for Payer: Sagamore All Products |
$316.83
|
| Rate for Payer: Self Pay/Cash Rate |
$254.45
|
| Rate for Payer: Signature Care EPO |
$340.63
|
| Rate for Payer: Signature Care PPO |
$361.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$348.84
|
| Rate for Payer: United Healthcare Commercial |
$323.40
|
| Rate for Payer: United Healthcare Medicare |
$135.43
|
|
|
HC ACU 2.7X60 NON-LOCK HEX SCREW
|
Facility
IP
|
$410.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.45 |
| Max. Negotiated Rate |
$377.77 |
| Rate for Payer: Aetna Commercial |
$354.59
|
| Rate for Payer: Cigna All Products |
$354.18
|
| Rate for Payer: Coventry/First Health All Products |
$361.15
|
| Rate for Payer: Encore All Products |
$377.77
|
| Rate for Payer: Frontpath All Products |
$377.57
|
| Rate for Payer: Humana ChoiceCare |
$354.46
|
| Rate for Payer: Lutheran Preferred All Products |
$369.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$307.80
|
| Rate for Payer: PHP All Products |
$311.25
|
| Rate for Payer: Sagamore All Products |
$316.83
|
| Rate for Payer: Self Pay/Cash Rate |
$254.45
|
| Rate for Payer: Signature Care EPO |
$340.63
|
| Rate for Payer: Signature Care PPO |
$361.15
|
| Rate for Payer: United Healthcare Commercial |
$323.40
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL
|
Facility
OP
|
$475.20
|
|
| Hospital Charge Code |
41602635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.82 |
| Max. Negotiated Rate |
$437.42 |
| Rate for Payer: Aetna Commercial |
$401.07
|
| Rate for Payer: Aetna Medicare |
$156.82
|
| Rate for Payer: Anthem Exchange |
$272.91
|
| Rate for Payer: Anthem Medicare |
$156.82
|
| Rate for Payer: Anthem PPO |
$272.91
|
| Rate for Payer: Anthem Traditional |
$297.05
|
| Rate for Payer: Caresource Just 4 Me |
$180.34
|
| Rate for Payer: Caresource Medicare |
$172.50
|
| Rate for Payer: Centivo/Paragon All Products |
$242.35
|
| Rate for Payer: Cigna All Products |
$410.10
|
| Rate for Payer: Coventry/First Health All Products |
$418.18
|
| Rate for Payer: Encore All Products |
$437.42
|
| Rate for Payer: Frontpath All Products |
$437.18
|
| Rate for Payer: Humana ChoiceCare |
$410.43
|
| Rate for Payer: Humana Medicare |
$242.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$242.35
|
| Rate for Payer: Lutheran Preferred All Products |
$427.68
|
| Rate for Payer: PHCS/Multiplan All Products |
$356.40
|
| Rate for Payer: PHP All Products |
$360.39
|
| Rate for Payer: Plain Church Group Ministry All Products |
$185.33
|
| Rate for Payer: Sagamore All Products |
$366.85
|
| Rate for Payer: Self Pay/Cash Rate |
$294.62
|
| Rate for Payer: Signature Care EPO |
$394.42
|
| Rate for Payer: Signature Care PPO |
$418.18
|
| Rate for Payer: Three Rivers Preferred All Products |
$403.92
|
| Rate for Payer: United Healthcare Commercial |
$374.46
|
| Rate for Payer: United Healthcare Medicare |
$156.82
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL
|
Facility
IP
|
$475.20
|
|
| Hospital Charge Code |
41602635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.62 |
| Max. Negotiated Rate |
$437.42 |
| Rate for Payer: Aetna Commercial |
$410.57
|
| Rate for Payer: Cigna All Products |
$410.10
|
| Rate for Payer: Coventry/First Health All Products |
$418.18
|
| Rate for Payer: Encore All Products |
$437.42
|
| Rate for Payer: Frontpath All Products |
$437.18
|
| Rate for Payer: Humana ChoiceCare |
$410.43
|
| Rate for Payer: Lutheran Preferred All Products |
$427.68
|
| Rate for Payer: PHCS/Multiplan All Products |
$356.40
|
| Rate for Payer: PHP All Products |
$360.39
|
| Rate for Payer: Sagamore All Products |
$366.85
|
| Rate for Payer: Self Pay/Cash Rate |
$294.62
|
| Rate for Payer: Signature Care EPO |
$394.42
|
| Rate for Payer: Signature Care PPO |
$418.18
|
| Rate for Payer: United Healthcare Commercial |
$374.46
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL DM
|
Facility
OP
|
$556.00
|
|
| Hospital Charge Code |
41603279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$511.80 |
| Rate for Payer: Aetna Commercial |
$469.26
|
| Rate for Payer: Aetna Medicare |
$183.48
|
| Rate for Payer: Anthem Exchange |
$319.31
|
| Rate for Payer: Anthem Medicare |
$183.48
|
| Rate for Payer: Anthem PPO |
$319.31
|
| Rate for Payer: Anthem Traditional |
$347.56
|
| Rate for Payer: Caresource Just 4 Me |
$211.00
|
| Rate for Payer: Caresource Medicare |
$201.83
|
| Rate for Payer: Centivo/Paragon All Products |
$283.56
|
| Rate for Payer: Cigna All Products |
$479.83
|
| Rate for Payer: Coventry/First Health All Products |
$489.28
|
| Rate for Payer: Encore All Products |
$511.80
|
| Rate for Payer: Frontpath All Products |
$511.52
|
| Rate for Payer: Humana ChoiceCare |
$480.22
|
| Rate for Payer: Humana Medicare |
$283.56
|
| Rate for Payer: Lucent/Coldwater Veneers |
$283.56
|
| Rate for Payer: Lutheran Preferred All Products |
$500.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$417.00
|
| Rate for Payer: PHP All Products |
$421.67
|
| Rate for Payer: Plain Church Group Ministry All Products |
$216.84
|
| Rate for Payer: Sagamore All Products |
$429.23
|
| Rate for Payer: Self Pay/Cash Rate |
$344.72
|
| Rate for Payer: Signature Care EPO |
$461.48
|
| Rate for Payer: Signature Care PPO |
$489.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$472.60
|
| Rate for Payer: United Healthcare Commercial |
$438.13
|
| Rate for Payer: United Healthcare Medicare |
$183.48
|
|
|
HC ACU 2.8 QR SURGIBIT DRILL DM
|
Facility
IP
|
$556.00
|
|
| Hospital Charge Code |
41603279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.72 |
| Max. Negotiated Rate |
$511.80 |
| Rate for Payer: Aetna Commercial |
$480.38
|
| Rate for Payer: Cigna All Products |
$479.83
|
| Rate for Payer: Coventry/First Health All Products |
$489.28
|
| Rate for Payer: Encore All Products |
$511.80
|
| Rate for Payer: Frontpath All Products |
$511.52
|
| Rate for Payer: Humana ChoiceCare |
$480.22
|
| Rate for Payer: Lutheran Preferred All Products |
$500.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$417.00
|
| Rate for Payer: PHP All Products |
$421.67
|
| Rate for Payer: Sagamore All Products |
$429.23
|
| Rate for Payer: Self Pay/Cash Rate |
$344.72
|
| Rate for Payer: Signature Care EPO |
$461.48
|
| Rate for Payer: Signature Care PPO |
$489.28
|
| Rate for Payer: United Healthcare Commercial |
$438.13
|
|
|
HC ACU 2 VDR EXT PLATE NEUT
|
Facility
IP
|
$1,972.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.64 |
| Max. Negotiated Rate |
$1,815.23 |
| Rate for Payer: Aetna Commercial |
$1,703.81
|
| Rate for Payer: Cigna All Products |
$1,701.84
|
| Rate for Payer: Coventry/First Health All Products |
$1,735.36
|
| Rate for Payer: Encore All Products |
$1,815.23
|
| Rate for Payer: Frontpath All Products |
$1,814.24
|
| Rate for Payer: Humana ChoiceCare |
$1,703.22
|
| Rate for Payer: Lutheran Preferred All Products |
$1,774.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,479.00
|
| Rate for Payer: PHP All Products |
$1,495.56
|
| Rate for Payer: Sagamore All Products |
$1,522.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,222.64
|
| Rate for Payer: Signature Care EPO |
$1,636.76
|
| Rate for Payer: Signature Care PPO |
$1,735.36
|
| Rate for Payer: United Healthcare Commercial |
$1,553.94
|
|
|
HC ACU 2 VDR EXT PLATE NEUT
|
Facility
OP
|
$1,972.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.76 |
| Max. Negotiated Rate |
$1,815.23 |
| Rate for Payer: Aetna Commercial |
$1,664.37
|
| Rate for Payer: Aetna Medicare |
$650.76
|
| Rate for Payer: Anthem Exchange |
$1,132.52
|
| Rate for Payer: Anthem Medicare |
$650.76
|
| Rate for Payer: Anthem PPO |
$1,132.52
|
| Rate for Payer: Anthem Traditional |
$1,232.70
|
| Rate for Payer: Caresource Just 4 Me |
$748.37
|
| Rate for Payer: Caresource Medicare |
$715.84
|
| Rate for Payer: Centivo/Paragon All Products |
$1,005.72
|
| Rate for Payer: Cigna All Products |
$1,701.84
|
| Rate for Payer: Coventry/First Health All Products |
$1,735.36
|
| Rate for Payer: Encore All Products |
$1,815.23
|
| Rate for Payer: Frontpath All Products |
$1,814.24
|
| Rate for Payer: Humana ChoiceCare |
$1,703.22
|
| Rate for Payer: Humana Medicare |
$1,005.72
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,005.72
|
| Rate for Payer: Lutheran Preferred All Products |
$1,774.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,479.00
|
| Rate for Payer: PHP All Products |
$1,495.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$769.08
|
| Rate for Payer: Sagamore All Products |
$1,522.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,222.64
|
| Rate for Payer: Signature Care EPO |
$1,636.76
|
| Rate for Payer: Signature Care PPO |
$1,735.36
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,676.20
|
| Rate for Payer: United Healthcare Commercial |
$1,553.94
|
| Rate for Payer: United Healthcare Medicare |
$650.76
|
|
|
HC ACU 2 VDR PLT NARR L
|
Facility
OP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$1,813.38 |
| Rate for Payer: Aetna Commercial |
$1,662.68
|
| Rate for Payer: Aetna Medicare |
$650.10
|
| Rate for Payer: Anthem Exchange |
$1,131.37
|
| Rate for Payer: Anthem Medicare |
$650.10
|
| Rate for Payer: Anthem PPO |
$1,131.37
|
| Rate for Payer: Anthem Traditional |
$1,231.45
|
| Rate for Payer: Caresource Just 4 Me |
$747.62
|
| Rate for Payer: Caresource Medicare |
$715.11
|
| Rate for Payer: Centivo/Paragon All Products |
$1,004.70
|
| Rate for Payer: Cigna All Products |
$1,700.11
|
| Rate for Payer: Coventry/First Health All Products |
$1,733.60
|
| Rate for Payer: Encore All Products |
$1,813.38
|
| Rate for Payer: Frontpath All Products |
$1,812.40
|
| Rate for Payer: Humana ChoiceCare |
$1,701.49
|
| Rate for Payer: Humana Medicare |
$1,004.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,004.70
|
| Rate for Payer: Lutheran Preferred All Products |
$1,773.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,477.50
|
| Rate for Payer: PHP All Products |
$1,494.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$768.30
|
| Rate for Payer: Sagamore All Products |
$1,520.84
|
| Rate for Payer: Self Pay/Cash Rate |
$1,221.40
|
| Rate for Payer: Signature Care EPO |
$1,635.10
|
| Rate for Payer: Signature Care PPO |
$1,733.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,674.50
|
| Rate for Payer: United Healthcare Commercial |
$1,552.36
|
| Rate for Payer: United Healthcare Medicare |
$650.10
|
|
|
HC ACU 2 VDR PLT NARR L
|
Facility
IP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,221.40 |
| Max. Negotiated Rate |
$1,813.38 |
| Rate for Payer: Aetna Commercial |
$1,702.08
|
| Rate for Payer: Cigna All Products |
$1,700.11
|
| Rate for Payer: Coventry/First Health All Products |
$1,733.60
|
| Rate for Payer: Encore All Products |
$1,813.38
|
| Rate for Payer: Frontpath All Products |
$1,812.40
|
| Rate for Payer: Humana ChoiceCare |
$1,701.49
|
| Rate for Payer: Lutheran Preferred All Products |
$1,773.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,477.50
|
| Rate for Payer: PHP All Products |
$1,494.05
|
| Rate for Payer: Sagamore All Products |
$1,520.84
|
| Rate for Payer: Self Pay/Cash Rate |
$1,221.40
|
| Rate for Payer: Signature Care EPO |
$1,635.10
|
| Rate for Payer: Signature Care PPO |
$1,733.60
|
| Rate for Payer: United Healthcare Commercial |
$1,552.36
|
|
|
HC ACU 2 VDR PLT NARR LONG L
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.47 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,244.20
|
| Rate for Payer: Aetna Medicare |
$877.47
|
| Rate for Payer: Anthem Exchange |
$1,527.06
|
| Rate for Payer: Anthem Medicare |
$877.47
|
| Rate for Payer: Anthem PPO |
$1,527.06
|
| Rate for Payer: Anthem Traditional |
$1,662.14
|
| Rate for Payer: Caresource Just 4 Me |
$1,009.09
|
| Rate for Payer: Caresource Medicare |
$965.22
|
| Rate for Payer: Centivo/Paragon All Products |
$1,356.09
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Humana Medicare |
$1,356.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,356.09
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,037.01
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,260.15
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
| Rate for Payer: United Healthcare Medicare |
$877.47
|
|
|
HC ACU 2 VDR PLT NARR LONG L
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.58 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,297.38
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
|
|
HC ACU 2 VDR PLT NARR LONG R
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.47 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,244.20
|
| Rate for Payer: Aetna Medicare |
$877.47
|
| Rate for Payer: Anthem Exchange |
$1,527.06
|
| Rate for Payer: Anthem Medicare |
$877.47
|
| Rate for Payer: Anthem PPO |
$1,527.06
|
| Rate for Payer: Anthem Traditional |
$1,662.14
|
| Rate for Payer: Caresource Just 4 Me |
$1,009.09
|
| Rate for Payer: Caresource Medicare |
$965.22
|
| Rate for Payer: Centivo/Paragon All Products |
$1,356.09
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Humana Medicare |
$1,356.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,356.09
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,037.01
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,260.15
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
| Rate for Payer: United Healthcare Medicare |
$877.47
|
|
|
HC ACU 2 VDR PLT NARR LONG R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.58 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,297.38
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
|
|
HC ACU 2 VDR PLT NARR R
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.47 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,244.20
|
| Rate for Payer: Aetna Medicare |
$877.47
|
| Rate for Payer: Anthem Exchange |
$1,527.06
|
| Rate for Payer: Anthem Medicare |
$877.47
|
| Rate for Payer: Anthem PPO |
$1,527.06
|
| Rate for Payer: Anthem Traditional |
$1,662.14
|
| Rate for Payer: Caresource Just 4 Me |
$1,009.09
|
| Rate for Payer: Caresource Medicare |
$965.22
|
| Rate for Payer: Centivo/Paragon All Products |
$1,356.09
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Humana Medicare |
$1,356.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,356.09
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,037.01
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,260.15
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
| Rate for Payer: United Healthcare Medicare |
$877.47
|
|
|
HC ACU 2 VDR PLT NARR R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.58 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,297.38
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
|
|
HC ACU 2 VDR PLT STD L
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.47 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,244.20
|
| Rate for Payer: Aetna Medicare |
$877.47
|
| Rate for Payer: Anthem Exchange |
$1,527.06
|
| Rate for Payer: Anthem Medicare |
$877.47
|
| Rate for Payer: Anthem PPO |
$1,527.06
|
| Rate for Payer: Anthem Traditional |
$1,662.14
|
| Rate for Payer: Caresource Just 4 Me |
$1,009.09
|
| Rate for Payer: Caresource Medicare |
$965.22
|
| Rate for Payer: Centivo/Paragon All Products |
$1,356.09
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Humana Medicare |
$1,356.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,356.09
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,037.01
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,260.15
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
| Rate for Payer: United Healthcare Medicare |
$877.47
|
|
|
HC ACU 2 VDR PLT STD L
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.58 |
| Max. Negotiated Rate |
$2,447.61 |
| Rate for Payer: Aetna Commercial |
$2,297.38
|
| Rate for Payer: Cigna All Products |
$2,294.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,339.92
|
| Rate for Payer: Encore All Products |
$2,447.61
|
| Rate for Payer: Frontpath All Products |
$2,446.28
|
| Rate for Payer: Humana ChoiceCare |
$2,296.58
|
| Rate for Payer: Lutheran Preferred All Products |
$2,393.10
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,994.25
|
| Rate for Payer: PHP All Products |
$2,016.59
|
| Rate for Payer: Sagamore All Products |
$2,052.75
|
| Rate for Payer: Self Pay/Cash Rate |
$1,648.58
|
| Rate for Payer: Signature Care EPO |
$2,206.97
|
| Rate for Payer: Signature Care PPO |
$2,339.92
|
| Rate for Payer: United Healthcare Commercial |
$2,095.29
|
|
