|
HC ACU HOOK PLATE 2-H
|
Facility
OP
|
$1,665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.45 |
| Max. Negotiated Rate |
$1,532.63 |
| Rate for Payer: Aetna Commercial |
$1,405.26
|
| Rate for Payer: Aetna Medicare |
$549.45
|
| Rate for Payer: Anthem Exchange |
$956.21
|
| Rate for Payer: Anthem Medicare |
$549.45
|
| Rate for Payer: Anthem PPO |
$956.21
|
| Rate for Payer: Anthem Traditional |
$1,040.79
|
| Rate for Payer: Caresource Just 4 Me |
$631.87
|
| Rate for Payer: Caresource Medicare |
$604.39
|
| Rate for Payer: Centivo/Paragon All Products |
$849.15
|
| Rate for Payer: Cigna All Products |
$1,436.89
|
| Rate for Payer: Coventry/First Health All Products |
$1,465.20
|
| Rate for Payer: Encore All Products |
$1,532.63
|
| Rate for Payer: Frontpath All Products |
$1,531.80
|
| Rate for Payer: Humana ChoiceCare |
$1,438.06
|
| Rate for Payer: Humana Medicare |
$849.15
|
| Rate for Payer: Lucent/Coldwater Veneers |
$849.15
|
| Rate for Payer: Lutheran Preferred All Products |
$1,498.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,248.75
|
| Rate for Payer: PHP All Products |
$1,262.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$649.35
|
| Rate for Payer: Sagamore All Products |
$1,285.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,032.30
|
| Rate for Payer: Signature Care EPO |
$1,381.95
|
| Rate for Payer: Signature Care PPO |
$1,465.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,415.25
|
| Rate for Payer: United Healthcare Commercial |
$1,312.02
|
| Rate for Payer: United Healthcare Medicare |
$549.45
|
|
|
HC ACU HOOK PLATE 2-H
|
Facility
IP
|
$1,665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.30 |
| Max. Negotiated Rate |
$1,532.63 |
| Rate for Payer: Aetna Commercial |
$1,438.56
|
| Rate for Payer: Cigna All Products |
$1,436.89
|
| Rate for Payer: Coventry/First Health All Products |
$1,465.20
|
| Rate for Payer: Encore All Products |
$1,532.63
|
| Rate for Payer: Frontpath All Products |
$1,531.80
|
| Rate for Payer: Humana ChoiceCare |
$1,438.06
|
| Rate for Payer: Lutheran Preferred All Products |
$1,498.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,248.75
|
| Rate for Payer: PHP All Products |
$1,262.74
|
| Rate for Payer: Sagamore All Products |
$1,285.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,032.30
|
| Rate for Payer: Signature Care EPO |
$1,381.95
|
| Rate for Payer: Signature Care PPO |
$1,465.20
|
| Rate for Payer: United Healthcare Commercial |
$1,312.02
|
|
|
HC ACU HOOK PLATE 3-H
|
Facility
IP
|
$1,715.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,063.30 |
| Max. Negotiated Rate |
$1,578.66 |
| Rate for Payer: Aetna Commercial |
$1,481.76
|
| Rate for Payer: Cigna All Products |
$1,480.05
|
| Rate for Payer: Coventry/First Health All Products |
$1,509.20
|
| Rate for Payer: Encore All Products |
$1,578.66
|
| Rate for Payer: Frontpath All Products |
$1,577.80
|
| Rate for Payer: Humana ChoiceCare |
$1,481.25
|
| Rate for Payer: Lutheran Preferred All Products |
$1,543.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,286.25
|
| Rate for Payer: PHP All Products |
$1,300.66
|
| Rate for Payer: Sagamore All Products |
$1,323.98
|
| Rate for Payer: Self Pay/Cash Rate |
$1,063.30
|
| Rate for Payer: Signature Care EPO |
$1,423.45
|
| Rate for Payer: Signature Care PPO |
$1,509.20
|
| Rate for Payer: United Healthcare Commercial |
$1,351.42
|
|
|
HC ACU HOOK PLATE 3-H
|
Facility
OP
|
$1,715.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.95 |
| Max. Negotiated Rate |
$1,578.66 |
| Rate for Payer: Aetna Commercial |
$1,447.46
|
| Rate for Payer: Aetna Medicare |
$565.95
|
| Rate for Payer: Anthem Exchange |
$984.92
|
| Rate for Payer: Anthem Medicare |
$565.95
|
| Rate for Payer: Anthem PPO |
$984.92
|
| Rate for Payer: Anthem Traditional |
$1,072.05
|
| Rate for Payer: Caresource Just 4 Me |
$650.84
|
| Rate for Payer: Caresource Medicare |
$622.54
|
| Rate for Payer: Centivo/Paragon All Products |
$874.65
|
| Rate for Payer: Cigna All Products |
$1,480.05
|
| Rate for Payer: Coventry/First Health All Products |
$1,509.20
|
| Rate for Payer: Encore All Products |
$1,578.66
|
| Rate for Payer: Frontpath All Products |
$1,577.80
|
| Rate for Payer: Humana ChoiceCare |
$1,481.25
|
| Rate for Payer: Humana Medicare |
$874.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$874.65
|
| Rate for Payer: Lutheran Preferred All Products |
$1,543.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,286.25
|
| Rate for Payer: PHP All Products |
$1,300.66
|
| Rate for Payer: Plain Church Group Ministry All Products |
$668.85
|
| Rate for Payer: Sagamore All Products |
$1,323.98
|
| Rate for Payer: Self Pay/Cash Rate |
$1,063.30
|
| Rate for Payer: Signature Care EPO |
$1,423.45
|
| Rate for Payer: Signature Care PPO |
$1,509.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,457.75
|
| Rate for Payer: United Healthcare Commercial |
$1,351.42
|
| Rate for Payer: United Healthcare Medicare |
$565.95
|
|
|
HC ACUITY PRO LEAD DELIV SYS
|
Facility
OP
|
$3,093.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,020.94 |
| Max. Negotiated Rate |
$2,847.80 |
| Rate for Payer: Aetna Commercial |
$2,611.12
|
| Rate for Payer: Aetna Medicare |
$1,020.94
|
| Rate for Payer: Anthem Exchange |
$1,776.74
|
| Rate for Payer: Anthem Medicare |
$1,020.94
|
| Rate for Payer: Anthem PPO |
$1,776.74
|
| Rate for Payer: Anthem Traditional |
$1,933.90
|
| Rate for Payer: Caresource Just 4 Me |
$1,174.08
|
| Rate for Payer: Caresource Medicare |
$1,123.03
|
| Rate for Payer: Centivo/Paragon All Products |
$1,577.81
|
| Rate for Payer: Cigna All Products |
$2,669.91
|
| Rate for Payer: Coventry/First Health All Products |
$2,722.50
|
| Rate for Payer: Encore All Products |
$2,847.80
|
| Rate for Payer: Frontpath All Products |
$2,846.25
|
| Rate for Payer: Humana ChoiceCare |
$2,672.07
|
| Rate for Payer: Humana Medicare |
$1,577.81
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,577.81
|
| Rate for Payer: Lutheran Preferred All Products |
$2,784.38
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,320.31
|
| Rate for Payer: PHP All Products |
$2,346.30
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,206.56
|
| Rate for Payer: Sagamore All Products |
$2,388.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,918.12
|
| Rate for Payer: Signature Care EPO |
$2,567.81
|
| Rate for Payer: Signature Care PPO |
$2,722.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,629.69
|
| Rate for Payer: United Healthcare Commercial |
$2,437.88
|
| Rate for Payer: United Healthcare Medicare |
$1,020.94
|
|
|
HC ACUITY PRO LEAD DELIV SYS
|
Facility
IP
|
$3,093.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,918.12 |
| Max. Negotiated Rate |
$2,847.80 |
| Rate for Payer: Aetna Commercial |
$2,673.00
|
| Rate for Payer: Cigna All Products |
$2,669.91
|
| Rate for Payer: Coventry/First Health All Products |
$2,722.50
|
| Rate for Payer: Encore All Products |
$2,847.80
|
| Rate for Payer: Frontpath All Products |
$2,846.25
|
| Rate for Payer: Humana ChoiceCare |
$2,672.07
|
| Rate for Payer: Lutheran Preferred All Products |
$2,784.38
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,320.31
|
| Rate for Payer: PHP All Products |
$2,346.30
|
| Rate for Payer: Sagamore All Products |
$2,388.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,918.12
|
| Rate for Payer: Signature Care EPO |
$2,567.81
|
| Rate for Payer: Signature Care PPO |
$2,722.50
|
| Rate for Payer: United Healthcare Commercial |
$2,437.88
|
|
|
HC ACU LAT FIBULA PLATE 4-H L
|
Facility
OP
|
$1,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.12 |
| Max. Negotiated Rate |
$1,531.71 |
| Rate for Payer: Aetna Commercial |
$1,404.42
|
| Rate for Payer: Aetna Medicare |
$549.12
|
| Rate for Payer: Anthem Exchange |
$955.64
|
| Rate for Payer: Anthem Medicare |
$549.12
|
| Rate for Payer: Anthem PPO |
$955.64
|
| Rate for Payer: Anthem Traditional |
$1,040.17
|
| Rate for Payer: Caresource Just 4 Me |
$631.49
|
| Rate for Payer: Caresource Medicare |
$604.03
|
| Rate for Payer: Centivo/Paragon All Products |
$848.64
|
| Rate for Payer: Cigna All Products |
$1,436.03
|
| Rate for Payer: Coventry/First Health All Products |
$1,464.32
|
| Rate for Payer: Encore All Products |
$1,531.71
|
| Rate for Payer: Frontpath All Products |
$1,530.88
|
| Rate for Payer: Humana ChoiceCare |
$1,437.20
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent/Coldwater Veneers |
$848.64
|
| Rate for Payer: Lutheran Preferred All Products |
$1,497.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,248.00
|
| Rate for Payer: PHP All Products |
$1,261.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$648.96
|
| Rate for Payer: Sagamore All Products |
$1,284.61
|
| Rate for Payer: Self Pay/Cash Rate |
$1,031.68
|
| Rate for Payer: Signature Care EPO |
$1,381.12
|
| Rate for Payer: Signature Care PPO |
$1,464.32
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,414.40
|
| Rate for Payer: United Healthcare Commercial |
$1,311.23
|
| Rate for Payer: United Healthcare Medicare |
$549.12
|
|
|
HC ACU LAT FIBULA PLATE 4-H L
|
Facility
IP
|
$1,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.68 |
| Max. Negotiated Rate |
$1,531.71 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Cigna All Products |
$1,436.03
|
| Rate for Payer: Coventry/First Health All Products |
$1,464.32
|
| Rate for Payer: Encore All Products |
$1,531.71
|
| Rate for Payer: Frontpath All Products |
$1,530.88
|
| Rate for Payer: Humana ChoiceCare |
$1,437.20
|
| Rate for Payer: Lutheran Preferred All Products |
$1,497.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,248.00
|
| Rate for Payer: PHP All Products |
$1,261.98
|
| Rate for Payer: Sagamore All Products |
$1,284.61
|
| Rate for Payer: Self Pay/Cash Rate |
$1,031.68
|
| Rate for Payer: Signature Care EPO |
$1,381.12
|
| Rate for Payer: Signature Care PPO |
$1,464.32
|
| Rate for Payer: United Healthcare Commercial |
$1,311.23
|
|
|
HC ACU LAT FIBULA PLATE 4-H R
|
Facility
OP
|
$1,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.12 |
| Max. Negotiated Rate |
$1,531.71 |
| Rate for Payer: Aetna Commercial |
$1,404.42
|
| Rate for Payer: Aetna Medicare |
$549.12
|
| Rate for Payer: Anthem Exchange |
$955.64
|
| Rate for Payer: Anthem Medicare |
$549.12
|
| Rate for Payer: Anthem PPO |
$955.64
|
| Rate for Payer: Anthem Traditional |
$1,040.17
|
| Rate for Payer: Caresource Just 4 Me |
$631.49
|
| Rate for Payer: Caresource Medicare |
$604.03
|
| Rate for Payer: Centivo/Paragon All Products |
$848.64
|
| Rate for Payer: Cigna All Products |
$1,436.03
|
| Rate for Payer: Coventry/First Health All Products |
$1,464.32
|
| Rate for Payer: Encore All Products |
$1,531.71
|
| Rate for Payer: Frontpath All Products |
$1,530.88
|
| Rate for Payer: Humana ChoiceCare |
$1,437.20
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent/Coldwater Veneers |
$848.64
|
| Rate for Payer: Lutheran Preferred All Products |
$1,497.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,248.00
|
| Rate for Payer: PHP All Products |
$1,261.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$648.96
|
| Rate for Payer: Sagamore All Products |
$1,284.61
|
| Rate for Payer: Self Pay/Cash Rate |
$1,031.68
|
| Rate for Payer: Signature Care EPO |
$1,381.12
|
| Rate for Payer: Signature Care PPO |
$1,464.32
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,414.40
|
| Rate for Payer: United Healthcare Commercial |
$1,311.23
|
| Rate for Payer: United Healthcare Medicare |
$549.12
|
|
|
HC ACU LAT FIBULA PLATE 4-H R
|
Facility
IP
|
$1,664.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.68 |
| Max. Negotiated Rate |
$1,531.71 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Cigna All Products |
$1,436.03
|
| Rate for Payer: Coventry/First Health All Products |
$1,464.32
|
| Rate for Payer: Encore All Products |
$1,531.71
|
| Rate for Payer: Frontpath All Products |
$1,530.88
|
| Rate for Payer: Humana ChoiceCare |
$1,437.20
|
| Rate for Payer: Lutheran Preferred All Products |
$1,497.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,248.00
|
| Rate for Payer: PHP All Products |
$1,261.98
|
| Rate for Payer: Sagamore All Products |
$1,284.61
|
| Rate for Payer: Self Pay/Cash Rate |
$1,031.68
|
| Rate for Payer: Signature Care EPO |
$1,381.12
|
| Rate for Payer: Signature Care PPO |
$1,464.32
|
| Rate for Payer: United Healthcare Commercial |
$1,311.23
|
|
|
HC ACU LAT FIBULA PLATE 5-H L
|
Facility
OP
|
$1,681.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.73 |
| Max. Negotiated Rate |
$1,547.36 |
| Rate for Payer: Aetna Commercial |
$1,418.76
|
| Rate for Payer: Aetna Medicare |
$554.73
|
| Rate for Payer: Anthem Exchange |
$965.40
|
| Rate for Payer: Anthem Medicare |
$554.73
|
| Rate for Payer: Anthem PPO |
$965.40
|
| Rate for Payer: Anthem Traditional |
$1,050.79
|
| Rate for Payer: Caresource Just 4 Me |
$637.94
|
| Rate for Payer: Caresource Medicare |
$610.20
|
| Rate for Payer: Centivo/Paragon All Products |
$857.31
|
| Rate for Payer: Cigna All Products |
$1,450.70
|
| Rate for Payer: Coventry/First Health All Products |
$1,479.28
|
| Rate for Payer: Encore All Products |
$1,547.36
|
| Rate for Payer: Frontpath All Products |
$1,546.52
|
| Rate for Payer: Humana ChoiceCare |
$1,451.88
|
| Rate for Payer: Humana Medicare |
$857.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$857.31
|
| Rate for Payer: Lutheran Preferred All Products |
$1,512.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,260.75
|
| Rate for Payer: PHP All Products |
$1,274.87
|
| Rate for Payer: Plain Church Group Ministry All Products |
$655.59
|
| Rate for Payer: Sagamore All Products |
$1,297.73
|
| Rate for Payer: Self Pay/Cash Rate |
$1,042.22
|
| Rate for Payer: Signature Care EPO |
$1,395.23
|
| Rate for Payer: Signature Care PPO |
$1,479.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,428.85
|
| Rate for Payer: United Healthcare Commercial |
$1,324.63
|
| Rate for Payer: United Healthcare Medicare |
$554.73
|
|
|
HC ACU LAT FIBULA PLATE 5-H L
|
Facility
IP
|
$1,681.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.22 |
| Max. Negotiated Rate |
$1,547.36 |
| Rate for Payer: Aetna Commercial |
$1,452.38
|
| Rate for Payer: Cigna All Products |
$1,450.70
|
| Rate for Payer: Coventry/First Health All Products |
$1,479.28
|
| Rate for Payer: Encore All Products |
$1,547.36
|
| Rate for Payer: Frontpath All Products |
$1,546.52
|
| Rate for Payer: Humana ChoiceCare |
$1,451.88
|
| Rate for Payer: Lutheran Preferred All Products |
$1,512.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,260.75
|
| Rate for Payer: PHP All Products |
$1,274.87
|
| Rate for Payer: Sagamore All Products |
$1,297.73
|
| Rate for Payer: Self Pay/Cash Rate |
$1,042.22
|
| Rate for Payer: Signature Care EPO |
$1,395.23
|
| Rate for Payer: Signature Care PPO |
$1,479.28
|
| Rate for Payer: United Healthcare Commercial |
$1,324.63
|
|
|
HC ACU LAT FIBULA PLATE 5-H R
|
Facility
OP
|
$1,681.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.73 |
| Max. Negotiated Rate |
$1,547.36 |
| Rate for Payer: Aetna Commercial |
$1,418.76
|
| Rate for Payer: Aetna Medicare |
$554.73
|
| Rate for Payer: Anthem Exchange |
$965.40
|
| Rate for Payer: Anthem Medicare |
$554.73
|
| Rate for Payer: Anthem PPO |
$965.40
|
| Rate for Payer: Anthem Traditional |
$1,050.79
|
| Rate for Payer: Caresource Just 4 Me |
$637.94
|
| Rate for Payer: Caresource Medicare |
$610.20
|
| Rate for Payer: Centivo/Paragon All Products |
$857.31
|
| Rate for Payer: Cigna All Products |
$1,450.70
|
| Rate for Payer: Coventry/First Health All Products |
$1,479.28
|
| Rate for Payer: Encore All Products |
$1,547.36
|
| Rate for Payer: Frontpath All Products |
$1,546.52
|
| Rate for Payer: Humana ChoiceCare |
$1,451.88
|
| Rate for Payer: Humana Medicare |
$857.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$857.31
|
| Rate for Payer: Lutheran Preferred All Products |
$1,512.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,260.75
|
| Rate for Payer: PHP All Products |
$1,274.87
|
| Rate for Payer: Plain Church Group Ministry All Products |
$655.59
|
| Rate for Payer: Sagamore All Products |
$1,297.73
|
| Rate for Payer: Self Pay/Cash Rate |
$1,042.22
|
| Rate for Payer: Signature Care EPO |
$1,395.23
|
| Rate for Payer: Signature Care PPO |
$1,479.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,428.85
|
| Rate for Payer: United Healthcare Commercial |
$1,324.63
|
| Rate for Payer: United Healthcare Medicare |
$554.73
|
|
|
HC ACU LAT FIBULA PLATE 5-H R
|
Facility
IP
|
$1,681.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.22 |
| Max. Negotiated Rate |
$1,547.36 |
| Rate for Payer: Aetna Commercial |
$1,452.38
|
| Rate for Payer: Cigna All Products |
$1,450.70
|
| Rate for Payer: Coventry/First Health All Products |
$1,479.28
|
| Rate for Payer: Encore All Products |
$1,547.36
|
| Rate for Payer: Frontpath All Products |
$1,546.52
|
| Rate for Payer: Humana ChoiceCare |
$1,451.88
|
| Rate for Payer: Lutheran Preferred All Products |
$1,512.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,260.75
|
| Rate for Payer: PHP All Products |
$1,274.87
|
| Rate for Payer: Sagamore All Products |
$1,297.73
|
| Rate for Payer: Self Pay/Cash Rate |
$1,042.22
|
| Rate for Payer: Signature Care EPO |
$1,395.23
|
| Rate for Payer: Signature Care PPO |
$1,479.28
|
| Rate for Payer: United Healthcare Commercial |
$1,324.63
|
|
|
HC ACU LAT FIBULA PLATE 6-H L
|
Facility
OP
|
$2,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.70 |
| Max. Negotiated Rate |
$2,015.89 |
| Rate for Payer: Aetna Commercial |
$1,848.36
|
| Rate for Payer: Aetna Medicare |
$722.70
|
| Rate for Payer: Anthem Exchange |
$1,257.72
|
| Rate for Payer: Anthem Medicare |
$722.70
|
| Rate for Payer: Anthem PPO |
$1,257.72
|
| Rate for Payer: Anthem Traditional |
$1,368.97
|
| Rate for Payer: Caresource Just 4 Me |
$831.11
|
| Rate for Payer: Caresource Medicare |
$794.97
|
| Rate for Payer: Centivo/Paragon All Products |
$1,116.90
|
| Rate for Payer: Cigna All Products |
$1,889.97
|
| Rate for Payer: Coventry/First Health All Products |
$1,927.20
|
| Rate for Payer: Encore All Products |
$2,015.89
|
| Rate for Payer: Frontpath All Products |
$2,014.80
|
| Rate for Payer: Humana ChoiceCare |
$1,891.50
|
| Rate for Payer: Humana Medicare |
$1,116.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,116.90
|
| Rate for Payer: Lutheran Preferred All Products |
$1,971.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,642.50
|
| Rate for Payer: PHP All Products |
$1,660.90
|
| Rate for Payer: Plain Church Group Ministry All Products |
$854.10
|
| Rate for Payer: Sagamore All Products |
$1,690.68
|
| Rate for Payer: Self Pay/Cash Rate |
$1,357.80
|
| Rate for Payer: Signature Care EPO |
$1,817.70
|
| Rate for Payer: Signature Care PPO |
$1,927.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,861.50
|
| Rate for Payer: United Healthcare Commercial |
$1,725.72
|
| Rate for Payer: United Healthcare Medicare |
$722.70
|
|
|
HC ACU LAT FIBULA PLATE 6-H L
|
Facility
IP
|
$2,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,357.80 |
| Max. Negotiated Rate |
$2,015.89 |
| Rate for Payer: Aetna Commercial |
$1,892.16
|
| Rate for Payer: Cigna All Products |
$1,889.97
|
| Rate for Payer: Coventry/First Health All Products |
$1,927.20
|
| Rate for Payer: Encore All Products |
$2,015.89
|
| Rate for Payer: Frontpath All Products |
$2,014.80
|
| Rate for Payer: Humana ChoiceCare |
$1,891.50
|
| Rate for Payer: Lutheran Preferred All Products |
$1,971.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,642.50
|
| Rate for Payer: PHP All Products |
$1,660.90
|
| Rate for Payer: Sagamore All Products |
$1,690.68
|
| Rate for Payer: Self Pay/Cash Rate |
$1,357.80
|
| Rate for Payer: Signature Care EPO |
$1,817.70
|
| Rate for Payer: Signature Care PPO |
$1,927.20
|
| Rate for Payer: United Healthcare Commercial |
$1,725.72
|
|
|
HC ACU LAT FIBULA PLATE 6-H R
|
Facility
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.20 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Cigna All Products |
$1,389.43
|
| Rate for Payer: Coventry/First Health All Products |
$1,416.80
|
| Rate for Payer: Encore All Products |
$1,482.00
|
| Rate for Payer: Frontpath All Products |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Lutheran Preferred All Products |
$1,449.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,207.50
|
| Rate for Payer: PHP All Products |
$1,221.02
|
| Rate for Payer: Sagamore All Products |
$1,242.92
|
| Rate for Payer: Self Pay/Cash Rate |
$998.20
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
|
|
HC ACU LAT FIBULA PLATE 6-H R
|
Facility
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Signature Care PPO |
$1,416.80
|
| Rate for Payer: Aetna Commercial |
$1,358.84
|
| Rate for Payer: Aetna Medicare |
$531.30
|
| Rate for Payer: Anthem Exchange |
$924.62
|
| Rate for Payer: Anthem Medicare |
$531.30
|
| Rate for Payer: Anthem PPO |
$924.62
|
| Rate for Payer: Anthem Traditional |
$1,006.41
|
| Rate for Payer: Caresource Just 4 Me |
$611.00
|
| Rate for Payer: Caresource Medicare |
$584.43
|
| Rate for Payer: Centivo/Paragon All Products |
$821.10
|
| Rate for Payer: Cigna All Products |
$1,389.43
|
| Rate for Payer: Coventry/First Health All Products |
$1,416.80
|
| Rate for Payer: Encore All Products |
$1,482.00
|
| Rate for Payer: Frontpath All Products |
$1,481.20
|
| Rate for Payer: Humana ChoiceCare |
$1,390.56
|
| Rate for Payer: Humana Medicare |
$821.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$821.10
|
| Rate for Payer: Lutheran Preferred All Products |
$1,449.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,207.50
|
| Rate for Payer: PHP All Products |
$1,221.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$627.90
|
| Rate for Payer: Sagamore All Products |
$1,242.92
|
| Rate for Payer: Self Pay/Cash Rate |
$998.20
|
| Rate for Payer: Signature Care EPO |
$1,336.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,268.68
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
|
|
HC ACU LAT FIBULA PLATE 7-H L
|
Facility
IP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,373.30 |
| Max. Negotiated Rate |
$2,038.91 |
| Rate for Payer: Aetna Commercial |
$1,913.76
|
| Rate for Payer: Cigna All Products |
$1,911.55
|
| Rate for Payer: Coventry/First Health All Products |
$1,949.20
|
| Rate for Payer: Encore All Products |
$2,038.91
|
| Rate for Payer: Frontpath All Products |
$2,037.80
|
| Rate for Payer: Humana ChoiceCare |
$1,913.10
|
| Rate for Payer: Lutheran Preferred All Products |
$1,993.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,661.25
|
| Rate for Payer: PHP All Products |
$1,679.86
|
| Rate for Payer: Sagamore All Products |
$1,709.98
|
| Rate for Payer: Self Pay/Cash Rate |
$1,373.30
|
| Rate for Payer: Signature Care EPO |
$1,838.45
|
| Rate for Payer: Signature Care PPO |
$1,949.20
|
| Rate for Payer: United Healthcare Commercial |
$1,745.42
|
|
|
HC ACU LAT FIBULA PLATE 7-H L
|
Facility
OP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.95 |
| Max. Negotiated Rate |
$2,038.91 |
| Rate for Payer: Aetna Commercial |
$1,869.46
|
| Rate for Payer: Aetna Medicare |
$730.95
|
| Rate for Payer: Anthem Exchange |
$1,272.07
|
| Rate for Payer: Anthem Medicare |
$730.95
|
| Rate for Payer: Anthem PPO |
$1,272.07
|
| Rate for Payer: Anthem Traditional |
$1,384.60
|
| Rate for Payer: Caresource Just 4 Me |
$840.59
|
| Rate for Payer: Caresource Medicare |
$804.04
|
| Rate for Payer: Centivo/Paragon All Products |
$1,129.65
|
| Rate for Payer: Cigna All Products |
$1,911.55
|
| Rate for Payer: Coventry/First Health All Products |
$1,949.20
|
| Rate for Payer: Encore All Products |
$2,038.91
|
| Rate for Payer: Frontpath All Products |
$2,037.80
|
| Rate for Payer: Humana ChoiceCare |
$1,913.10
|
| Rate for Payer: Humana Medicare |
$1,129.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,129.65
|
| Rate for Payer: Lutheran Preferred All Products |
$1,993.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,661.25
|
| Rate for Payer: PHP All Products |
$1,679.86
|
| Rate for Payer: Plain Church Group Ministry All Products |
$863.85
|
| Rate for Payer: Sagamore All Products |
$1,709.98
|
| Rate for Payer: Self Pay/Cash Rate |
$1,373.30
|
| Rate for Payer: Signature Care EPO |
$1,838.45
|
| Rate for Payer: Signature Care PPO |
$1,949.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$1,745.42
|
| Rate for Payer: United Healthcare Medicare |
$730.95
|
|
|
HC ACU LAT FIBULA PLATE 7-H R
|
Facility
IP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,373.30 |
| Max. Negotiated Rate |
$2,038.91 |
| Rate for Payer: Aetna Commercial |
$1,913.76
|
| Rate for Payer: Cigna All Products |
$1,911.55
|
| Rate for Payer: Coventry/First Health All Products |
$1,949.20
|
| Rate for Payer: Encore All Products |
$2,038.91
|
| Rate for Payer: Frontpath All Products |
$2,037.80
|
| Rate for Payer: Humana ChoiceCare |
$1,913.10
|
| Rate for Payer: Lutheran Preferred All Products |
$1,993.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,661.25
|
| Rate for Payer: PHP All Products |
$1,679.86
|
| Rate for Payer: Sagamore All Products |
$1,709.98
|
| Rate for Payer: Self Pay/Cash Rate |
$1,373.30
|
| Rate for Payer: Signature Care EPO |
$1,838.45
|
| Rate for Payer: Signature Care PPO |
$1,949.20
|
| Rate for Payer: United Healthcare Commercial |
$1,745.42
|
|
|
HC ACU LAT FIBULA PLATE 7-H R
|
Facility
OP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.95 |
| Max. Negotiated Rate |
$2,038.91 |
| Rate for Payer: Aetna Commercial |
$1,869.46
|
| Rate for Payer: Aetna Medicare |
$730.95
|
| Rate for Payer: Anthem Exchange |
$1,272.07
|
| Rate for Payer: Anthem Medicare |
$730.95
|
| Rate for Payer: Anthem PPO |
$1,272.07
|
| Rate for Payer: Anthem Traditional |
$1,384.60
|
| Rate for Payer: Caresource Just 4 Me |
$840.59
|
| Rate for Payer: Caresource Medicare |
$804.04
|
| Rate for Payer: Centivo/Paragon All Products |
$1,129.65
|
| Rate for Payer: Cigna All Products |
$1,911.55
|
| Rate for Payer: Coventry/First Health All Products |
$1,949.20
|
| Rate for Payer: Encore All Products |
$2,038.91
|
| Rate for Payer: Frontpath All Products |
$2,037.80
|
| Rate for Payer: Humana ChoiceCare |
$1,913.10
|
| Rate for Payer: Humana Medicare |
$1,129.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,129.65
|
| Rate for Payer: Lutheran Preferred All Products |
$1,993.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,661.25
|
| Rate for Payer: PHP All Products |
$1,679.86
|
| Rate for Payer: Plain Church Group Ministry All Products |
$863.85
|
| Rate for Payer: Sagamore All Products |
$1,709.98
|
| Rate for Payer: Self Pay/Cash Rate |
$1,373.30
|
| Rate for Payer: Signature Care EPO |
$1,838.45
|
| Rate for Payer: Signature Care PPO |
$1,949.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$1,745.42
|
| Rate for Payer: United Healthcare Medicare |
$730.95
|
|
|
HC ACU LAT FIBULA PLATE 9-H L
|
Facility
OP
|
$2,240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$2,061.92 |
| Rate for Payer: Aetna Commercial |
$1,890.56
|
| Rate for Payer: Aetna Medicare |
$739.20
|
| Rate for Payer: Anthem Exchange |
$1,286.43
|
| Rate for Payer: Anthem Medicare |
$739.20
|
| Rate for Payer: Anthem PPO |
$1,286.43
|
| Rate for Payer: Anthem Traditional |
$1,400.22
|
| Rate for Payer: Caresource Just 4 Me |
$850.08
|
| Rate for Payer: Caresource Medicare |
$813.12
|
| Rate for Payer: Centivo/Paragon All Products |
$1,142.40
|
| Rate for Payer: Cigna All Products |
$1,933.12
|
| Rate for Payer: Coventry/First Health All Products |
$1,971.20
|
| Rate for Payer: Encore All Products |
$2,061.92
|
| Rate for Payer: Frontpath All Products |
$2,060.80
|
| Rate for Payer: Humana ChoiceCare |
$1,934.69
|
| Rate for Payer: Humana Medicare |
$1,142.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,142.40
|
| Rate for Payer: Lutheran Preferred All Products |
$2,016.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,680.00
|
| Rate for Payer: PHP All Products |
$1,698.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$873.60
|
| Rate for Payer: Sagamore All Products |
$1,729.28
|
| Rate for Payer: Self Pay/Cash Rate |
$1,388.80
|
| Rate for Payer: Signature Care EPO |
$1,859.20
|
| Rate for Payer: Signature Care PPO |
$1,971.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,904.00
|
| Rate for Payer: United Healthcare Commercial |
$1,765.12
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
|
|
HC ACU LAT FIBULA PLATE 9-H L
|
Facility
IP
|
$2,240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.80 |
| Max. Negotiated Rate |
$2,061.92 |
| Rate for Payer: Aetna Commercial |
$1,935.36
|
| Rate for Payer: Cigna All Products |
$1,933.12
|
| Rate for Payer: Coventry/First Health All Products |
$1,971.20
|
| Rate for Payer: Encore All Products |
$2,061.92
|
| Rate for Payer: Frontpath All Products |
$2,060.80
|
| Rate for Payer: Humana ChoiceCare |
$1,934.69
|
| Rate for Payer: Lutheran Preferred All Products |
$2,016.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,680.00
|
| Rate for Payer: PHP All Products |
$1,698.82
|
| Rate for Payer: Sagamore All Products |
$1,729.28
|
| Rate for Payer: Self Pay/Cash Rate |
$1,388.80
|
| Rate for Payer: Signature Care EPO |
$1,859.20
|
| Rate for Payer: Signature Care PPO |
$1,971.20
|
| Rate for Payer: United Healthcare Commercial |
$1,765.12
|
|
|
HC ACU LAT FIBULA PLATE 9-H R
|
Facility
OP
|
$2,240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$2,061.92 |
| Rate for Payer: Aetna Commercial |
$1,890.56
|
| Rate for Payer: Aetna Medicare |
$739.20
|
| Rate for Payer: Anthem Exchange |
$1,286.43
|
| Rate for Payer: Anthem Medicare |
$739.20
|
| Rate for Payer: Anthem PPO |
$1,286.43
|
| Rate for Payer: Anthem Traditional |
$1,400.22
|
| Rate for Payer: Caresource Just 4 Me |
$850.08
|
| Rate for Payer: Caresource Medicare |
$813.12
|
| Rate for Payer: Centivo/Paragon All Products |
$1,142.40
|
| Rate for Payer: Cigna All Products |
$1,933.12
|
| Rate for Payer: Coventry/First Health All Products |
$1,971.20
|
| Rate for Payer: Encore All Products |
$2,061.92
|
| Rate for Payer: Frontpath All Products |
$2,060.80
|
| Rate for Payer: Humana ChoiceCare |
$1,934.69
|
| Rate for Payer: Humana Medicare |
$1,142.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,142.40
|
| Rate for Payer: Lutheran Preferred All Products |
$2,016.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,680.00
|
| Rate for Payer: PHP All Products |
$1,698.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$873.60
|
| Rate for Payer: Sagamore All Products |
$1,729.28
|
| Rate for Payer: Self Pay/Cash Rate |
$1,388.80
|
| Rate for Payer: Signature Care EPO |
$1,859.20
|
| Rate for Payer: Signature Care PPO |
$1,971.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,904.00
|
| Rate for Payer: United Healthcare Commercial |
$1,765.12
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
|
