|
HC ACU DORSAL PLATE NARR LT
|
Facility
OP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.55 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Aetna Commercial |
$1,886.34
|
| Rate for Payer: Aetna Medicare |
$737.55
|
| Rate for Payer: Anthem Exchange |
$1,283.56
|
| Rate for Payer: Anthem Medicare |
$737.55
|
| Rate for Payer: Anthem PPO |
$1,283.56
|
| Rate for Payer: Anthem Traditional |
$1,397.10
|
| Rate for Payer: Caresource Just 4 Me |
$848.18
|
| Rate for Payer: Caresource Medicare |
$811.30
|
| Rate for Payer: Centivo/Paragon All Products |
$1,139.85
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Humana Medicare |
$1,139.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,139.85
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$871.65
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,899.75
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
| Rate for Payer: United Healthcare Medicare |
$737.55
|
|
|
HC ACU DORSAL PLATE NARR RT
|
Facility
IP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.70 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Aetna Commercial |
$1,931.04
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
|
|
HC ACU DORSAL PLATE NARR RT
|
Facility
OP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.55 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Aetna Commercial |
$1,886.34
|
| Rate for Payer: Aetna Medicare |
$737.55
|
| Rate for Payer: Anthem Exchange |
$1,283.56
|
| Rate for Payer: Anthem Medicare |
$737.55
|
| Rate for Payer: Anthem PPO |
$1,283.56
|
| Rate for Payer: Anthem Traditional |
$1,397.10
|
| Rate for Payer: Caresource Just 4 Me |
$848.18
|
| Rate for Payer: Caresource Medicare |
$811.30
|
| Rate for Payer: Centivo/Paragon All Products |
$1,139.85
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Humana Medicare |
$1,139.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,139.85
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$871.65
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,899.75
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
| Rate for Payer: United Healthcare Medicare |
$737.55
|
|
|
HC ACU DORSAL PLATE STND LT
|
Facility
IP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.70 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Aetna Commercial |
$1,931.04
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
|
|
HC ACU DORSAL PLATE STND LT
|
Facility
OP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.55 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: Aetna Commercial |
$1,886.34
|
| Rate for Payer: Aetna Medicare |
$737.55
|
| Rate for Payer: Anthem Exchange |
$1,283.56
|
| Rate for Payer: Anthem Medicare |
$737.55
|
| Rate for Payer: Anthem PPO |
$1,283.56
|
| Rate for Payer: Anthem Traditional |
$1,397.10
|
| Rate for Payer: Caresource Just 4 Me |
$848.18
|
| Rate for Payer: Caresource Medicare |
$811.30
|
| Rate for Payer: Centivo/Paragon All Products |
$1,139.85
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Humana Medicare |
$1,139.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,139.85
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$871.65
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,899.75
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
| Rate for Payer: United Healthcare Medicare |
$737.55
|
|
|
HC ACU DORSAL PLATE STND RT
|
Facility
IP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.70 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Aetna Commercial |
$1,931.04
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
|
|
HC ACU DORSAL PLATE STND RT
|
Facility
OP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.55 |
| Max. Negotiated Rate |
$2,057.32 |
| Rate for Payer: Aetna Commercial |
$1,886.34
|
| Rate for Payer: Aetna Medicare |
$737.55
|
| Rate for Payer: Anthem Exchange |
$1,283.56
|
| Rate for Payer: Anthem Medicare |
$737.55
|
| Rate for Payer: Anthem PPO |
$1,283.56
|
| Rate for Payer: Anthem Traditional |
$1,397.10
|
| Rate for Payer: Caresource Just 4 Me |
$848.18
|
| Rate for Payer: Caresource Medicare |
$811.30
|
| Rate for Payer: Centivo/Paragon All Products |
$1,139.85
|
| Rate for Payer: Cigna All Products |
$1,928.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.80
|
| Rate for Payer: Encore All Products |
$2,057.32
|
| Rate for Payer: Frontpath All Products |
$2,056.20
|
| Rate for Payer: Humana ChoiceCare |
$1,930.37
|
| Rate for Payer: Humana Medicare |
$1,139.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,139.85
|
| Rate for Payer: Lutheran Preferred All Products |
$2,011.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,676.25
|
| Rate for Payer: PHP All Products |
$1,695.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$871.65
|
| Rate for Payer: Sagamore All Products |
$1,725.42
|
| Rate for Payer: Self Pay/Cash Rate |
$1,385.70
|
| Rate for Payer: Signature Care EPO |
$1,855.05
|
| Rate for Payer: Signature Care PPO |
$1,966.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,899.75
|
| Rate for Payer: United Healthcare Commercial |
$1,761.18
|
| Rate for Payer: United Healthcare Medicare |
$737.55
|
|
|
HC ACU DORSAL RIM BUTT PLATE LT
|
Facility
OP
|
$2,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.95 |
| Max. Negotiated Rate |
$1,946.86 |
| Rate for Payer: Aetna Commercial |
$1,785.06
|
| Rate for Payer: Aetna Medicare |
$697.95
|
| Rate for Payer: Anthem Exchange |
$1,214.64
|
| Rate for Payer: Anthem Medicare |
$697.95
|
| Rate for Payer: Anthem PPO |
$1,214.64
|
| Rate for Payer: Anthem Traditional |
$1,322.09
|
| Rate for Payer: Caresource Just 4 Me |
$802.64
|
| Rate for Payer: Caresource Medicare |
$767.75
|
| Rate for Payer: Centivo/Paragon All Products |
$1,078.65
|
| Rate for Payer: Cigna All Products |
$1,825.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.20
|
| Rate for Payer: Encore All Products |
$1,946.86
|
| Rate for Payer: Frontpath All Products |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$1,826.73
|
| Rate for Payer: Humana Medicare |
$1,078.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,078.65
|
| Rate for Payer: Lutheran Preferred All Products |
$1,903.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,586.25
|
| Rate for Payer: PHP All Products |
$1,604.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$824.85
|
| Rate for Payer: Sagamore All Products |
$1,632.78
|
| Rate for Payer: Self Pay/Cash Rate |
$1,311.30
|
| Rate for Payer: Signature Care EPO |
$1,755.45
|
| Rate for Payer: Signature Care PPO |
$1,861.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,797.75
|
| Rate for Payer: United Healthcare Commercial |
$1,666.62
|
| Rate for Payer: United Healthcare Medicare |
$697.95
|
|
|
HC ACU DORSAL RIM BUTT PLATE LT
|
Facility
IP
|
$2,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.30 |
| Max. Negotiated Rate |
$1,946.86 |
| Rate for Payer: Aetna Commercial |
$1,827.36
|
| Rate for Payer: Cigna All Products |
$1,825.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.20
|
| Rate for Payer: Encore All Products |
$1,946.86
|
| Rate for Payer: Frontpath All Products |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$1,826.73
|
| Rate for Payer: Lutheran Preferred All Products |
$1,903.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,586.25
|
| Rate for Payer: PHP All Products |
$1,604.02
|
| Rate for Payer: Sagamore All Products |
$1,632.78
|
| Rate for Payer: Self Pay/Cash Rate |
$1,311.30
|
| Rate for Payer: Signature Care EPO |
$1,755.45
|
| Rate for Payer: Signature Care PPO |
$1,861.20
|
| Rate for Payer: United Healthcare Commercial |
$1,666.62
|
|
|
HC ACU DORSAL RIM BUTT PLATE RT
|
Facility
OP
|
$2,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.95 |
| Max. Negotiated Rate |
$1,946.86 |
| Rate for Payer: Aetna Commercial |
$1,785.06
|
| Rate for Payer: Aetna Medicare |
$697.95
|
| Rate for Payer: Anthem Exchange |
$1,214.64
|
| Rate for Payer: Anthem Medicare |
$697.95
|
| Rate for Payer: Anthem PPO |
$1,214.64
|
| Rate for Payer: Anthem Traditional |
$1,322.09
|
| Rate for Payer: Caresource Just 4 Me |
$802.64
|
| Rate for Payer: Caresource Medicare |
$767.75
|
| Rate for Payer: Centivo/Paragon All Products |
$1,078.65
|
| Rate for Payer: Cigna All Products |
$1,825.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.20
|
| Rate for Payer: Encore All Products |
$1,946.86
|
| Rate for Payer: Frontpath All Products |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$1,826.73
|
| Rate for Payer: Humana Medicare |
$1,078.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,078.65
|
| Rate for Payer: Lutheran Preferred All Products |
$1,903.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,586.25
|
| Rate for Payer: PHP All Products |
$1,604.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$824.85
|
| Rate for Payer: Sagamore All Products |
$1,632.78
|
| Rate for Payer: Self Pay/Cash Rate |
$1,311.30
|
| Rate for Payer: Signature Care EPO |
$1,755.45
|
| Rate for Payer: Signature Care PPO |
$1,861.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,797.75
|
| Rate for Payer: United Healthcare Commercial |
$1,666.62
|
| Rate for Payer: United Healthcare Medicare |
$697.95
|
|
|
HC ACU DORSAL RIM BUTT PLATE RT
|
Facility
IP
|
$2,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.30 |
| Max. Negotiated Rate |
$1,946.86 |
| Rate for Payer: Aetna Commercial |
$1,827.36
|
| Rate for Payer: Cigna All Products |
$1,825.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.20
|
| Rate for Payer: Encore All Products |
$1,946.86
|
| Rate for Payer: Frontpath All Products |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$1,826.73
|
| Rate for Payer: Lutheran Preferred All Products |
$1,903.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,586.25
|
| Rate for Payer: PHP All Products |
$1,604.02
|
| Rate for Payer: Sagamore All Products |
$1,632.78
|
| Rate for Payer: Self Pay/Cash Rate |
$1,311.30
|
| Rate for Payer: Signature Care EPO |
$1,755.45
|
| Rate for Payer: Signature Care PPO |
$1,861.20
|
| Rate for Payer: United Healthcare Commercial |
$1,666.62
|
|
|
HC ACU DRILL 3.5 X 5 QUICK REL
|
Facility
IP
|
$309.60
|
|
| Hospital Charge Code |
41603397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.95 |
| Max. Negotiated Rate |
$284.99 |
| Rate for Payer: Aetna Commercial |
$267.49
|
| Rate for Payer: Cigna All Products |
$267.18
|
| Rate for Payer: Coventry/First Health All Products |
$272.45
|
| Rate for Payer: Encore All Products |
$284.99
|
| Rate for Payer: Frontpath All Products |
$284.83
|
| Rate for Payer: Humana ChoiceCare |
$267.40
|
| Rate for Payer: Lutheran Preferred All Products |
$278.64
|
| Rate for Payer: PHCS/Multiplan All Products |
$232.20
|
| Rate for Payer: PHP All Products |
$234.80
|
| Rate for Payer: Sagamore All Products |
$239.01
|
| Rate for Payer: Self Pay/Cash Rate |
$191.95
|
| Rate for Payer: Signature Care EPO |
$256.97
|
| Rate for Payer: Signature Care PPO |
$272.45
|
| Rate for Payer: United Healthcare Commercial |
$243.96
|
|
|
HC ACU DRILL 3.5 X 5 QUICK REL
|
Facility
OP
|
$309.60
|
|
| Hospital Charge Code |
41603397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.17 |
| Max. Negotiated Rate |
$284.99 |
| Rate for Payer: Aetna Commercial |
$261.30
|
| Rate for Payer: Aetna Medicare |
$102.17
|
| Rate for Payer: Anthem Exchange |
$177.80
|
| Rate for Payer: Anthem Medicare |
$102.17
|
| Rate for Payer: Anthem PPO |
$177.80
|
| Rate for Payer: Anthem Traditional |
$193.53
|
| Rate for Payer: Caresource Just 4 Me |
$117.49
|
| Rate for Payer: Caresource Medicare |
$112.38
|
| Rate for Payer: Centivo/Paragon All Products |
$157.90
|
| Rate for Payer: Cigna All Products |
$267.18
|
| Rate for Payer: Coventry/First Health All Products |
$272.45
|
| Rate for Payer: Encore All Products |
$284.99
|
| Rate for Payer: Frontpath All Products |
$284.83
|
| Rate for Payer: Humana ChoiceCare |
$267.40
|
| Rate for Payer: Humana Medicare |
$157.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$157.90
|
| Rate for Payer: Lutheran Preferred All Products |
$278.64
|
| Rate for Payer: PHCS/Multiplan All Products |
$232.20
|
| Rate for Payer: PHP All Products |
$234.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$120.74
|
| Rate for Payer: Sagamore All Products |
$239.01
|
| Rate for Payer: Self Pay/Cash Rate |
$191.95
|
| Rate for Payer: Signature Care EPO |
$256.97
|
| Rate for Payer: Signature Care PPO |
$272.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$263.16
|
| Rate for Payer: United Healthcare Commercial |
$243.96
|
| Rate for Payer: United Healthcare Medicare |
$102.17
|
|
|
HC ACU DRILL BIT POLARUS 2.8 SHRT
|
Facility
IP
|
$529.20
|
|
| Hospital Charge Code |
41603547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.10 |
| Max. Negotiated Rate |
$487.13 |
| Rate for Payer: Aetna Commercial |
$457.23
|
| Rate for Payer: Cigna All Products |
$456.70
|
| Rate for Payer: Coventry/First Health All Products |
$465.70
|
| Rate for Payer: Encore All Products |
$487.13
|
| Rate for Payer: Frontpath All Products |
$486.86
|
| Rate for Payer: Humana ChoiceCare |
$457.07
|
| Rate for Payer: Lutheran Preferred All Products |
$476.28
|
| Rate for Payer: PHCS/Multiplan All Products |
$396.90
|
| Rate for Payer: PHP All Products |
$401.35
|
| Rate for Payer: Sagamore All Products |
$408.54
|
| Rate for Payer: Self Pay/Cash Rate |
$328.10
|
| Rate for Payer: Signature Care EPO |
$439.24
|
| Rate for Payer: Signature Care PPO |
$465.70
|
| Rate for Payer: United Healthcare Commercial |
$417.01
|
|
|
HC ACU DRILL BIT POLARUS 2.8 SHRT
|
Facility
OP
|
$529.20
|
|
| Hospital Charge Code |
41603547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.64 |
| Max. Negotiated Rate |
$487.13 |
| Rate for Payer: Aetna Commercial |
$446.64
|
| Rate for Payer: Aetna Medicare |
$174.64
|
| Rate for Payer: Anthem Exchange |
$303.92
|
| Rate for Payer: Anthem Medicare |
$174.64
|
| Rate for Payer: Anthem PPO |
$303.92
|
| Rate for Payer: Anthem Traditional |
$330.80
|
| Rate for Payer: Caresource Just 4 Me |
$200.83
|
| Rate for Payer: Caresource Medicare |
$192.10
|
| Rate for Payer: Centivo/Paragon All Products |
$269.89
|
| Rate for Payer: Cigna All Products |
$456.70
|
| Rate for Payer: Coventry/First Health All Products |
$465.70
|
| Rate for Payer: Encore All Products |
$487.13
|
| Rate for Payer: Frontpath All Products |
$486.86
|
| Rate for Payer: Humana ChoiceCare |
$457.07
|
| Rate for Payer: Humana Medicare |
$269.89
|
| Rate for Payer: Lucent/Coldwater Veneers |
$269.89
|
| Rate for Payer: Lutheran Preferred All Products |
$476.28
|
| Rate for Payer: PHCS/Multiplan All Products |
$396.90
|
| Rate for Payer: PHP All Products |
$401.35
|
| Rate for Payer: Plain Church Group Ministry All Products |
$206.39
|
| Rate for Payer: Sagamore All Products |
$408.54
|
| Rate for Payer: Self Pay/Cash Rate |
$328.10
|
| Rate for Payer: Signature Care EPO |
$439.24
|
| Rate for Payer: Signature Care PPO |
$465.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$449.82
|
| Rate for Payer: United Healthcare Commercial |
$417.01
|
| Rate for Payer: United Healthcare Medicare |
$174.64
|
|
|
HC ACU FRAG-LOC COMP SCREW
|
Facility
OP
|
$684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$629.62 |
| Rate for Payer: Aetna Commercial |
$577.30
|
| Rate for Payer: Aetna Medicare |
$225.72
|
| Rate for Payer: Anthem Exchange |
$392.82
|
| Rate for Payer: Anthem Medicare |
$225.72
|
| Rate for Payer: Anthem PPO |
$392.82
|
| Rate for Payer: Anthem Traditional |
$427.57
|
| Rate for Payer: Caresource Just 4 Me |
$259.58
|
| Rate for Payer: Caresource Medicare |
$248.29
|
| Rate for Payer: Centivo/Paragon All Products |
$348.84
|
| Rate for Payer: Cigna All Products |
$590.29
|
| Rate for Payer: Coventry/First Health All Products |
$601.92
|
| Rate for Payer: Encore All Products |
$629.62
|
| Rate for Payer: Frontpath All Products |
$629.28
|
| Rate for Payer: Humana ChoiceCare |
$590.77
|
| Rate for Payer: Humana Medicare |
$348.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$348.84
|
| Rate for Payer: Lutheran Preferred All Products |
$615.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$513.00
|
| Rate for Payer: PHP All Products |
$518.75
|
| Rate for Payer: Plain Church Group Ministry All Products |
$266.76
|
| Rate for Payer: Sagamore All Products |
$528.05
|
| Rate for Payer: Self Pay/Cash Rate |
$424.08
|
| Rate for Payer: Signature Care EPO |
$567.72
|
| Rate for Payer: Signature Care PPO |
$601.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$581.40
|
| Rate for Payer: United Healthcare Commercial |
$538.99
|
| Rate for Payer: United Healthcare Medicare |
$225.72
|
|
|
HC ACU FRAG-LOC COMP SCREW
|
Facility
IP
|
$684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.08 |
| Max. Negotiated Rate |
$629.62 |
| Rate for Payer: Aetna Commercial |
$590.98
|
| Rate for Payer: Cigna All Products |
$590.29
|
| Rate for Payer: Coventry/First Health All Products |
$601.92
|
| Rate for Payer: Encore All Products |
$629.62
|
| Rate for Payer: Frontpath All Products |
$629.28
|
| Rate for Payer: Humana ChoiceCare |
$590.77
|
| Rate for Payer: Lutheran Preferred All Products |
$615.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$513.00
|
| Rate for Payer: PHP All Products |
$518.75
|
| Rate for Payer: Sagamore All Products |
$528.05
|
| Rate for Payer: Self Pay/Cash Rate |
$424.08
|
| Rate for Payer: Signature Care EPO |
$567.72
|
| Rate for Payer: Signature Care PPO |
$601.92
|
| Rate for Payer: United Healthcare Commercial |
$538.99
|
|
|
HC ACU FRAG-LOC COMP SCREW LONG
|
Facility
OP
|
$684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$629.62 |
| Rate for Payer: Aetna Commercial |
$577.30
|
| Rate for Payer: Aetna Medicare |
$225.72
|
| Rate for Payer: Anthem Exchange |
$392.82
|
| Rate for Payer: Anthem Medicare |
$225.72
|
| Rate for Payer: Anthem PPO |
$392.82
|
| Rate for Payer: Anthem Traditional |
$427.57
|
| Rate for Payer: Caresource Just 4 Me |
$259.58
|
| Rate for Payer: Caresource Medicare |
$248.29
|
| Rate for Payer: Centivo/Paragon All Products |
$348.84
|
| Rate for Payer: Cigna All Products |
$590.29
|
| Rate for Payer: Coventry/First Health All Products |
$601.92
|
| Rate for Payer: Encore All Products |
$629.62
|
| Rate for Payer: Frontpath All Products |
$629.28
|
| Rate for Payer: Humana ChoiceCare |
$590.77
|
| Rate for Payer: Humana Medicare |
$348.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$348.84
|
| Rate for Payer: Lutheran Preferred All Products |
$615.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$513.00
|
| Rate for Payer: PHP All Products |
$518.75
|
| Rate for Payer: Plain Church Group Ministry All Products |
$266.76
|
| Rate for Payer: Sagamore All Products |
$528.05
|
| Rate for Payer: Self Pay/Cash Rate |
$424.08
|
| Rate for Payer: Signature Care EPO |
$567.72
|
| Rate for Payer: Signature Care PPO |
$601.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$581.40
|
| Rate for Payer: United Healthcare Commercial |
$538.99
|
| Rate for Payer: United Healthcare Medicare |
$225.72
|
|
|
HC ACU FRAG-LOC COMP SCREW LONG
|
Facility
IP
|
$684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.08 |
| Max. Negotiated Rate |
$629.62 |
| Rate for Payer: Aetna Commercial |
$590.98
|
| Rate for Payer: Cigna All Products |
$590.29
|
| Rate for Payer: Coventry/First Health All Products |
$601.92
|
| Rate for Payer: Encore All Products |
$629.62
|
| Rate for Payer: Frontpath All Products |
$629.28
|
| Rate for Payer: Humana ChoiceCare |
$590.77
|
| Rate for Payer: Lutheran Preferred All Products |
$615.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$513.00
|
| Rate for Payer: PHP All Products |
$518.75
|
| Rate for Payer: Sagamore All Products |
$528.05
|
| Rate for Payer: Self Pay/Cash Rate |
$424.08
|
| Rate for Payer: Signature Care EPO |
$567.72
|
| Rate for Payer: Signature Care PPO |
$601.92
|
| Rate for Payer: United Healthcare Commercial |
$538.99
|
|
|
HC ACU FRAG-LOC COMP SLEEVE
|
Facility
IP
|
$980.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$902.09 |
| Rate for Payer: Aetna Commercial |
$846.72
|
| Rate for Payer: Cigna All Products |
$845.74
|
| Rate for Payer: Coventry/First Health All Products |
$862.40
|
| Rate for Payer: Encore All Products |
$902.09
|
| Rate for Payer: Frontpath All Products |
$901.60
|
| Rate for Payer: Humana ChoiceCare |
$846.43
|
| Rate for Payer: Lutheran Preferred All Products |
$882.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$735.00
|
| Rate for Payer: PHP All Products |
$743.23
|
| Rate for Payer: Sagamore All Products |
$756.56
|
| Rate for Payer: Self Pay/Cash Rate |
$607.60
|
| Rate for Payer: Signature Care EPO |
$813.40
|
| Rate for Payer: Signature Care PPO |
$862.40
|
| Rate for Payer: United Healthcare Commercial |
$772.24
|
|
|
HC ACU FRAG-LOC COMP SLEEVE
|
Facility
OP
|
$980.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$902.09 |
| Rate for Payer: Aetna Commercial |
$827.12
|
| Rate for Payer: Aetna Medicare |
$323.40
|
| Rate for Payer: Anthem Exchange |
$562.81
|
| Rate for Payer: Anthem Medicare |
$323.40
|
| Rate for Payer: Anthem PPO |
$562.81
|
| Rate for Payer: Anthem Traditional |
$612.60
|
| Rate for Payer: Caresource Just 4 Me |
$371.91
|
| Rate for Payer: Caresource Medicare |
$355.74
|
| Rate for Payer: Centivo/Paragon All Products |
$499.80
|
| Rate for Payer: Cigna All Products |
$845.74
|
| Rate for Payer: Coventry/First Health All Products |
$862.40
|
| Rate for Payer: Encore All Products |
$902.09
|
| Rate for Payer: Frontpath All Products |
$901.60
|
| Rate for Payer: Humana ChoiceCare |
$846.43
|
| Rate for Payer: Humana Medicare |
$499.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$499.80
|
| Rate for Payer: Lutheran Preferred All Products |
$882.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$735.00
|
| Rate for Payer: PHP All Products |
$743.23
|
| Rate for Payer: Plain Church Group Ministry All Products |
$382.20
|
| Rate for Payer: Sagamore All Products |
$756.56
|
| Rate for Payer: Self Pay/Cash Rate |
$607.60
|
| Rate for Payer: Signature Care EPO |
$813.40
|
| Rate for Payer: Signature Care PPO |
$862.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$833.00
|
| Rate for Payer: United Healthcare Commercial |
$772.24
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
|
|
HC ACU FRAGMENT PLATE 2.7MM
|
Facility
OP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.20 |
| Max. Negotiated Rate |
$1,233.47 |
| Rate for Payer: Aetna Commercial |
$1,130.96
|
| Rate for Payer: Aetna Medicare |
$442.20
|
| Rate for Payer: Anthem Exchange |
$769.56
|
| Rate for Payer: Anthem Medicare |
$442.20
|
| Rate for Payer: Anthem PPO |
$769.56
|
| Rate for Payer: Anthem Traditional |
$837.63
|
| Rate for Payer: Caresource Just 4 Me |
$508.53
|
| Rate for Payer: Caresource Medicare |
$486.42
|
| Rate for Payer: Centivo/Paragon All Products |
$683.40
|
| Rate for Payer: Cigna All Products |
$1,156.42
|
| Rate for Payer: Coventry/First Health All Products |
$1,179.20
|
| Rate for Payer: Encore All Products |
$1,233.47
|
| Rate for Payer: Frontpath All Products |
$1,232.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.36
|
| Rate for Payer: Humana Medicare |
$683.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$683.40
|
| Rate for Payer: Lutheran Preferred All Products |
$1,206.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,005.00
|
| Rate for Payer: PHP All Products |
$1,016.26
|
| Rate for Payer: Plain Church Group Ministry All Products |
$522.60
|
| Rate for Payer: Sagamore All Products |
$1,034.48
|
| Rate for Payer: Self Pay/Cash Rate |
$830.80
|
| Rate for Payer: Signature Care EPO |
$1,112.20
|
| Rate for Payer: Signature Care PPO |
$1,179.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,139.00
|
| Rate for Payer: United Healthcare Commercial |
$1,055.92
|
| Rate for Payer: United Healthcare Medicare |
$442.20
|
|
|
HC ACU FRAGMENT PLATE 2.7MM
|
Facility
IP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.80 |
| Max. Negotiated Rate |
$1,233.47 |
| Rate for Payer: Aetna Commercial |
$1,157.76
|
| Rate for Payer: Cigna All Products |
$1,156.42
|
| Rate for Payer: Coventry/First Health All Products |
$1,179.20
|
| Rate for Payer: Encore All Products |
$1,233.47
|
| Rate for Payer: Frontpath All Products |
$1,232.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.36
|
| Rate for Payer: Lutheran Preferred All Products |
$1,206.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,005.00
|
| Rate for Payer: PHP All Products |
$1,016.26
|
| Rate for Payer: Sagamore All Products |
$1,034.48
|
| Rate for Payer: Self Pay/Cash Rate |
$830.80
|
| Rate for Payer: Signature Care EPO |
$1,112.20
|
| Rate for Payer: Signature Care PPO |
$1,179.20
|
| Rate for Payer: United Healthcare Commercial |
$1,055.92
|
|
|
HC ACU GUIDEWIRE 2.0X9 ST
|
Facility
IP
|
$86.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
|
|
HC ACU GUIDEWIRE 2.0X9 ST
|
Facility
OP
|
$86.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$72.92
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Anthem Exchange |
$49.62
|
| Rate for Payer: Anthem Medicare |
$28.51
|
| Rate for Payer: Anthem PPO |
$49.62
|
| Rate for Payer: Anthem Traditional |
$54.01
|
| Rate for Payer: Caresource Just 4 Me |
$32.79
|
| Rate for Payer: Caresource Medicare |
$31.36
|
| Rate for Payer: Centivo/Paragon All Products |
$44.06
|
| Rate for Payer: Cigna All Products |
$74.56
|
| Rate for Payer: Coventry/First Health All Products |
$76.03
|
| Rate for Payer: Encore All Products |
$79.53
|
| Rate for Payer: Frontpath All Products |
$79.49
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Humana Medicare |
$44.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$44.06
|
| Rate for Payer: Lutheran Preferred All Products |
$77.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.80
|
| Rate for Payer: PHP All Products |
$65.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$33.70
|
| Rate for Payer: Sagamore All Products |
$66.70
|
| Rate for Payer: Self Pay/Cash Rate |
$53.57
|
| Rate for Payer: Signature Care EPO |
$71.71
|
| Rate for Payer: Signature Care PPO |
$76.03
|
| Rate for Payer: Three Rivers Preferred All Products |
$73.44
|
| Rate for Payer: United Healthcare Commercial |
$68.08
|
| Rate for Payer: United Healthcare Medicare |
$28.51
|
|
