|
HC ACU 4.0X28 PT CAN HXLB SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X30 CAN HEX SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X30 CAN HEX SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X30 PT CAN HXLB SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X30 PT CAN HXLB SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X35 CAN HEX SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X35 CAN HEX SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X35 PT CAN HXLB SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X35 PT CAN HXLB SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X36 CANN SCREW LONG TD
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$479.39
|
| Rate for Payer: Aetna Medicare |
$187.44
|
| Rate for Payer: Anthem Exchange |
$326.20
|
| Rate for Payer: Anthem Medicare |
$187.44
|
| Rate for Payer: Anthem PPO |
$326.20
|
| Rate for Payer: Anthem Traditional |
$355.06
|
| Rate for Payer: Caresource Just 4 Me |
$215.56
|
| Rate for Payer: Caresource Medicare |
$206.18
|
| Rate for Payer: Centivo/Paragon All Products |
$289.68
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Humana Medicare |
$289.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$289.68
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$221.52
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$482.80
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
| Rate for Payer: United Healthcare Medicare |
$187.44
|
|
|
HC ACU 4.0X36 CANN SCREW LONG TD
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.16 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$490.75
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
|
|
HC ACU 4.0X40 CAN HEX SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X40 CAN HEX SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X40 PT CAN HXLB SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X40 PT CAN HXLB SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X42 CANN SCREW LONG TD
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.16 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$490.75
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
|
|
HC ACU 4.0X42 CANN SCREW LONG TD
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$479.39
|
| Rate for Payer: Aetna Medicare |
$187.44
|
| Rate for Payer: Anthem Exchange |
$326.20
|
| Rate for Payer: Anthem Medicare |
$187.44
|
| Rate for Payer: Anthem PPO |
$326.20
|
| Rate for Payer: Anthem Traditional |
$355.06
|
| Rate for Payer: Caresource Just 4 Me |
$215.56
|
| Rate for Payer: Caresource Medicare |
$206.18
|
| Rate for Payer: Centivo/Paragon All Products |
$289.68
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Humana Medicare |
$289.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$289.68
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$221.52
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$482.80
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
| Rate for Payer: United Healthcare Medicare |
$187.44
|
|
|
HC ACU 4.0X45 CAN HEX SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X45 CAN HEX SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X45 PT CAN HXLB SCREW
|
Facility
IP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$413.68
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
|
|
HC ACU 4.0X45 PT CAN HXLB SCREW
|
Facility
OP
|
$478.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$440.74 |
| Rate for Payer: Aetna Commercial |
$404.11
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Anthem Exchange |
$274.97
|
| Rate for Payer: Anthem Medicare |
$158.00
|
| Rate for Payer: Anthem PPO |
$274.97
|
| Rate for Payer: Anthem Traditional |
$299.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.70
|
| Rate for Payer: Caresource Medicare |
$173.80
|
| Rate for Payer: Centivo/Paragon All Products |
$244.19
|
| Rate for Payer: Cigna All Products |
$413.20
|
| Rate for Payer: Coventry/First Health All Products |
$421.34
|
| Rate for Payer: Encore All Products |
$440.74
|
| Rate for Payer: Frontpath All Products |
$440.50
|
| Rate for Payer: Humana ChoiceCare |
$413.54
|
| Rate for Payer: Humana Medicare |
$244.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$244.19
|
| Rate for Payer: Lutheran Preferred All Products |
$430.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$359.10
|
| Rate for Payer: PHP All Products |
$363.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.73
|
| Rate for Payer: Sagamore All Products |
$369.63
|
| Rate for Payer: Self Pay/Cash Rate |
$296.86
|
| Rate for Payer: Signature Care EPO |
$397.40
|
| Rate for Payer: Signature Care PPO |
$421.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$406.98
|
| Rate for Payer: United Healthcare Commercial |
$377.29
|
| Rate for Payer: United Healthcare Medicare |
$158.00
|
|
|
HC ACU 4.0X48 CANN SCREW LONG TD
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.16 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$490.75
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
|
|
HC ACU 4.0X48 CANN SCREW LONG TD
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$522.84 |
| Rate for Payer: Aetna Commercial |
$479.39
|
| Rate for Payer: Aetna Medicare |
$187.44
|
| Rate for Payer: Anthem Exchange |
$326.20
|
| Rate for Payer: Anthem Medicare |
$187.44
|
| Rate for Payer: Anthem PPO |
$326.20
|
| Rate for Payer: Anthem Traditional |
$355.06
|
| Rate for Payer: Caresource Just 4 Me |
$215.56
|
| Rate for Payer: Caresource Medicare |
$206.18
|
| Rate for Payer: Centivo/Paragon All Products |
$289.68
|
| Rate for Payer: Cigna All Products |
$490.18
|
| Rate for Payer: Coventry/First Health All Products |
$499.84
|
| Rate for Payer: Encore All Products |
$522.84
|
| Rate for Payer: Frontpath All Products |
$522.56
|
| Rate for Payer: Humana ChoiceCare |
$490.58
|
| Rate for Payer: Humana Medicare |
$289.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$289.68
|
| Rate for Payer: Lutheran Preferred All Products |
$511.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.00
|
| Rate for Payer: PHP All Products |
$430.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$221.52
|
| Rate for Payer: Sagamore All Products |
$438.50
|
| Rate for Payer: Self Pay/Cash Rate |
$352.16
|
| Rate for Payer: Signature Care EPO |
$471.44
|
| Rate for Payer: Signature Care PPO |
$499.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$482.80
|
| Rate for Payer: United Healthcare Commercial |
$447.58
|
| Rate for Payer: United Healthcare Medicare |
$187.44
|
|
|
HC ACU 4.0X50 CAN HEX SCREW
|
Facility
OP
|
$570.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$524.68 |
| Rate for Payer: Aetna Commercial |
$481.08
|
| Rate for Payer: Aetna Medicare |
$188.10
|
| Rate for Payer: Anthem Exchange |
$327.35
|
| Rate for Payer: Anthem Medicare |
$188.10
|
| Rate for Payer: Anthem PPO |
$327.35
|
| Rate for Payer: Anthem Traditional |
$356.31
|
| Rate for Payer: Caresource Just 4 Me |
$216.31
|
| Rate for Payer: Caresource Medicare |
$206.91
|
| Rate for Payer: Centivo/Paragon All Products |
$290.70
|
| Rate for Payer: Cigna All Products |
$491.91
|
| Rate for Payer: Coventry/First Health All Products |
$501.60
|
| Rate for Payer: Encore All Products |
$524.68
|
| Rate for Payer: Frontpath All Products |
$524.40
|
| Rate for Payer: Humana ChoiceCare |
$492.31
|
| Rate for Payer: Humana Medicare |
$290.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$290.70
|
| Rate for Payer: Lutheran Preferred All Products |
$513.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$427.50
|
| Rate for Payer: PHP All Products |
$432.29
|
| Rate for Payer: Plain Church Group Ministry All Products |
$222.30
|
| Rate for Payer: Sagamore All Products |
$440.04
|
| Rate for Payer: Self Pay/Cash Rate |
$353.40
|
| Rate for Payer: Signature Care EPO |
$473.10
|
| Rate for Payer: Signature Care PPO |
$501.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$484.50
|
| Rate for Payer: United Healthcare Commercial |
$449.16
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
|
|
HC ACU 4.0X50 CAN HEX SCREW
|
Facility
IP
|
$570.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.40 |
| Max. Negotiated Rate |
$524.68 |
| Rate for Payer: Aetna Commercial |
$492.48
|
| Rate for Payer: Cigna All Products |
$491.91
|
| Rate for Payer: Coventry/First Health All Products |
$501.60
|
| Rate for Payer: Encore All Products |
$524.68
|
| Rate for Payer: Frontpath All Products |
$524.40
|
| Rate for Payer: Humana ChoiceCare |
$492.31
|
| Rate for Payer: Lutheran Preferred All Products |
$513.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$427.50
|
| Rate for Payer: PHP All Products |
$432.29
|
| Rate for Payer: Sagamore All Products |
$440.04
|
| Rate for Payer: Self Pay/Cash Rate |
$353.40
|
| Rate for Payer: Signature Care EPO |
$473.10
|
| Rate for Payer: Signature Care PPO |
$501.60
|
| Rate for Payer: United Healthcare Commercial |
$449.16
|
|
