|
HC ACU 2 VDR PLT STD LONG L
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602875
|
|
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 LONG L
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602875
|
|
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 LONG R
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602876
|
|
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 LONG R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602876
|
|
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 R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602869
|
|
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 R
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602869
|
|
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 WIDE L
|
Facility
OP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$1,813.38 |
| Rate for Payer: Signature Care PPO |
$1,733.60
|
| 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: 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 WIDE L
|
Facility
IP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602872
|
|
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 WIDE R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602873
|
|
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 WIDE R
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602873
|
|
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 PROX PLT NARR L
|
Facility
OP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602864
|
|
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 PROX PLT NARR L
|
Facility
IP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602864
|
|
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 PROX PLT NARR R
|
Facility
OP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602865
|
|
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 PROX PLT NARR R
|
Facility
IP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602865
|
|
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 PROX PLT STD L
|
Facility
OP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602862
|
|
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 PROX PLT STD L
|
Facility
IP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602862
|
|
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 PROX PLT STD, R
|
Facility
IP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602863
|
|
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 PROX PLT STD, R
|
Facility
OP
|
$1,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602863
|
|
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 PROX PLT WIDE L
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602866
|
|
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 PROX PLT WIDE L
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602866
|
|
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 PROX PLT WIDE R
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602867
|
|
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 PROX PLT WIDE R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602867
|
|
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 PR PLT NARR LONG L
|
Facility
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602881
|
|
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 PR PLT NARR LONG L
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602881
|
|
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 PR PLT NARR LONG R
|
Facility
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602882
|
|
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
|
|
