|
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
|
|
|
HC ACU L FRAG PLATE 2.7MM LEFT
|
Facility
OP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602806
|
|
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 L FRAG PLATE 2.7MM LEFT
|
Facility
IP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602806
|
|
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 L FRAG PLATE 2.7MM RIGHT
|
Facility
OP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602807
|
|
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 L FRAG PLATE 2.7MM RIGHT
|
Facility
IP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602807
|
|
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 LOCK PEG HOOK PLATE 2-H
|
Facility
OP
|
$1,665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602795
|
|
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 LOCK PEG HOOK PLATE 2-H
|
Facility
IP
|
$1,665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602795
|
|
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 LOCK PEG HOOK PLATE 3-H
|
Facility
OP
|
$1,715.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602796
|
|
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 ACU LOCK PEG HOOK PLATE 3-H
|
Facility
IP
|
$1,715.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602796
|
|
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 MED ANTI-GLIDE PLATE 4-H
|
Facility
IP
|
$1,540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.80 |
| Max. Negotiated Rate |
$1,417.57 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Cigna All Products |
$1,329.02
|
| Rate for Payer: Coventry/First Health All Products |
$1,355.20
|
| Rate for Payer: Encore All Products |
$1,417.57
|
| Rate for Payer: Frontpath All Products |
$1,416.80
|
| Rate for Payer: Humana ChoiceCare |
$1,330.10
|
| Rate for Payer: Lutheran Preferred All Products |
$1,386.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,155.00
|
| Rate for Payer: PHP All Products |
$1,167.94
|
| Rate for Payer: Sagamore All Products |
$1,188.88
|
| Rate for Payer: Self Pay/Cash Rate |
$954.80
|
| Rate for Payer: Signature Care EPO |
$1,278.20
|
| Rate for Payer: Signature Care PPO |
$1,355.20
|
| Rate for Payer: United Healthcare Commercial |
$1,213.52
|
|
|
HC ACU MED ANTI-GLIDE PLATE 4-H
|
Facility
OP
|
$1,540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.20 |
| Max. Negotiated Rate |
$1,417.57 |
| Rate for Payer: Aetna Commercial |
$1,299.76
|
| Rate for Payer: Aetna Medicare |
$508.20
|
| Rate for Payer: Anthem Exchange |
$884.42
|
| Rate for Payer: Anthem Medicare |
$508.20
|
| Rate for Payer: Anthem PPO |
$884.42
|
| Rate for Payer: Anthem Traditional |
$962.65
|
| Rate for Payer: Caresource Just 4 Me |
$584.43
|
| Rate for Payer: Caresource Medicare |
$559.02
|
| Rate for Payer: Centivo/Paragon All Products |
$785.40
|
| Rate for Payer: Cigna All Products |
$1,329.02
|
| Rate for Payer: Coventry/First Health All Products |
$1,355.20
|
| Rate for Payer: Encore All Products |
$1,417.57
|
| Rate for Payer: Frontpath All Products |
$1,416.80
|
| Rate for Payer: Humana ChoiceCare |
$1,330.10
|
| Rate for Payer: Humana Medicare |
$785.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$785.40
|
| Rate for Payer: Lutheran Preferred All Products |
$1,386.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,155.00
|
| Rate for Payer: PHP All Products |
$1,167.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$600.60
|
| Rate for Payer: Sagamore All Products |
$1,188.88
|
| Rate for Payer: Self Pay/Cash Rate |
$954.80
|
| Rate for Payer: Signature Care EPO |
$1,278.20
|
| Rate for Payer: Signature Care PPO |
$1,355.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,309.00
|
| Rate for Payer: United Healthcare Commercial |
$1,213.52
|
| Rate for Payer: United Healthcare Medicare |
$508.20
|
|
|
HC ACU ONE-THIRD TUB PLATE 10-H
|
Facility
OP
|
$464.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$427.48 |
| Rate for Payer: Aetna Commercial |
$391.95
|
| Rate for Payer: Aetna Medicare |
$153.25
|
| Rate for Payer: Anthem Exchange |
$266.70
|
| Rate for Payer: Anthem Medicare |
$153.25
|
| Rate for Payer: Anthem PPO |
$266.70
|
| Rate for Payer: Anthem Traditional |
$290.30
|
| Rate for Payer: Caresource Just 4 Me |
$176.24
|
| Rate for Payer: Caresource Medicare |
$168.58
|
| Rate for Payer: Centivo/Paragon All Products |
$236.84
|
| Rate for Payer: Cigna All Products |
$400.78
|
| Rate for Payer: Coventry/First Health All Products |
$408.67
|
| Rate for Payer: Encore All Products |
$427.48
|
| Rate for Payer: Frontpath All Products |
$427.25
|
| Rate for Payer: Humana ChoiceCare |
$401.10
|
| Rate for Payer: Humana Medicare |
$236.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$236.84
|
| Rate for Payer: Lutheran Preferred All Products |
$417.96
|
| Rate for Payer: PHCS/Multiplan All Products |
$348.30
|
| Rate for Payer: PHP All Products |
$352.20
|
| Rate for Payer: Plain Church Group Ministry All Products |
$181.12
|
| Rate for Payer: Sagamore All Products |
$358.52
|
| Rate for Payer: Self Pay/Cash Rate |
$287.93
|
| Rate for Payer: Signature Care EPO |
$385.45
|
| Rate for Payer: Signature Care PPO |
$408.67
|
| Rate for Payer: Three Rivers Preferred All Products |
$394.74
|
| Rate for Payer: United Healthcare Commercial |
$365.95
|
| Rate for Payer: United Healthcare Medicare |
$153.25
|
|
|
HC ACU ONE-THIRD TUB PLATE 10-H
|
Facility
IP
|
$464.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.93 |
| Max. Negotiated Rate |
$427.48 |
| Rate for Payer: Aetna Commercial |
$401.24
|
| Rate for Payer: Cigna All Products |
$400.78
|
| Rate for Payer: Coventry/First Health All Products |
$408.67
|
| Rate for Payer: Encore All Products |
$427.48
|
| Rate for Payer: Frontpath All Products |
$427.25
|
| Rate for Payer: Humana ChoiceCare |
$401.10
|
| Rate for Payer: Lutheran Preferred All Products |
$417.96
|
| Rate for Payer: PHCS/Multiplan All Products |
$348.30
|
| Rate for Payer: PHP All Products |
$352.20
|
| Rate for Payer: Sagamore All Products |
$358.52
|
| Rate for Payer: Self Pay/Cash Rate |
$287.93
|
| Rate for Payer: Signature Care EPO |
$385.45
|
| Rate for Payer: Signature Care PPO |
$408.67
|
| Rate for Payer: United Healthcare Commercial |
$365.95
|
|
|
HC ACU ONE-THIRD TUB PLATE 12-H
|
Facility
IP
|
$650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$598.33 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Cigna All Products |
$560.95
|
| Rate for Payer: Coventry/First Health All Products |
$572.00
|
| Rate for Payer: Encore All Products |
$598.33
|
| Rate for Payer: Frontpath All Products |
$598.00
|
| Rate for Payer: Humana ChoiceCare |
$561.40
|
| Rate for Payer: Lutheran Preferred All Products |
$585.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$487.50
|
| Rate for Payer: PHP All Products |
$492.96
|
| Rate for Payer: Sagamore All Products |
$501.80
|
| Rate for Payer: Self Pay/Cash Rate |
$403.00
|
| Rate for Payer: Signature Care EPO |
$539.50
|
| Rate for Payer: Signature Care PPO |
$572.00
|
| Rate for Payer: United Healthcare Commercial |
$512.20
|
|
|
HC ACU ONE-THIRD TUB PLATE 12-H
|
Facility
OP
|
$650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$598.33 |
| Rate for Payer: Aetna Commercial |
$548.60
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: Anthem Exchange |
$373.30
|
| Rate for Payer: Anthem Medicare |
$214.50
|
| Rate for Payer: Anthem PPO |
$373.30
|
| Rate for Payer: Anthem Traditional |
$406.31
|
| Rate for Payer: Caresource Just 4 Me |
$246.68
|
| Rate for Payer: Caresource Medicare |
$235.95
|
| Rate for Payer: Centivo/Paragon All Products |
$331.50
|
| Rate for Payer: Cigna All Products |
$560.95
|
| Rate for Payer: Coventry/First Health All Products |
$572.00
|
| Rate for Payer: Encore All Products |
$598.33
|
| Rate for Payer: Frontpath All Products |
$598.00
|
| Rate for Payer: Humana ChoiceCare |
$561.40
|
| Rate for Payer: Humana Medicare |
$331.50
|
| Rate for Payer: Lucent/Coldwater Veneers |
$331.50
|
| Rate for Payer: Lutheran Preferred All Products |
$585.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$487.50
|
| Rate for Payer: PHP All Products |
$492.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$253.50
|
| Rate for Payer: Sagamore All Products |
$501.80
|
| Rate for Payer: Self Pay/Cash Rate |
$403.00
|
| Rate for Payer: Signature Care EPO |
$539.50
|
| Rate for Payer: Signature Care PPO |
$572.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$552.50
|
| Rate for Payer: United Healthcare Commercial |
$512.20
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
|
|
HC ACU ONE-THIRD TUB PLATE 3-H
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.38 |
| Max. Negotiated Rate |
$447.36 |
| Rate for Payer: Aetna Commercial |
$410.18
|
| Rate for Payer: Aetna Medicare |
$160.38
|
| Rate for Payer: Anthem Exchange |
$279.11
|
| Rate for Payer: Anthem Medicare |
$160.38
|
| Rate for Payer: Anthem PPO |
$279.11
|
| Rate for Payer: Anthem Traditional |
$303.80
|
| Rate for Payer: Caresource Just 4 Me |
$184.44
|
| Rate for Payer: Caresource Medicare |
$176.42
|
| Rate for Payer: Centivo/Paragon All Products |
$247.86
|
| Rate for Payer: Cigna All Products |
$419.42
|
| Rate for Payer: Coventry/First Health All Products |
$427.68
|
| Rate for Payer: Encore All Products |
$447.36
|
| Rate for Payer: Frontpath All Products |
$447.12
|
| Rate for Payer: Humana ChoiceCare |
$419.76
|
| Rate for Payer: Humana Medicare |
$247.86
|
| Rate for Payer: Lucent/Coldwater Veneers |
$247.86
|
| Rate for Payer: Lutheran Preferred All Products |
$437.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$364.50
|
| Rate for Payer: PHP All Products |
$368.58
|
| Rate for Payer: Plain Church Group Ministry All Products |
$189.54
|
| Rate for Payer: Sagamore All Products |
$375.19
|
| Rate for Payer: Self Pay/Cash Rate |
$301.32
|
| Rate for Payer: Signature Care EPO |
$403.38
|
| Rate for Payer: Signature Care PPO |
$427.68
|
| Rate for Payer: Three Rivers Preferred All Products |
$413.10
|
| Rate for Payer: United Healthcare Commercial |
$382.97
|
| Rate for Payer: United Healthcare Medicare |
$160.38
|
|
|
HC ACU ONE-THIRD TUB PLATE 3-H
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.32 |
| Max. Negotiated Rate |
$447.36 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Cigna All Products |
$419.42
|
| Rate for Payer: Coventry/First Health All Products |
$427.68
|
| Rate for Payer: Encore All Products |
$447.36
|
| Rate for Payer: Frontpath All Products |
$447.12
|
| Rate for Payer: Humana ChoiceCare |
$419.76
|
| Rate for Payer: Lutheran Preferred All Products |
$437.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$364.50
|
| Rate for Payer: PHP All Products |
$368.58
|
| Rate for Payer: Sagamore All Products |
$375.19
|
| Rate for Payer: Self Pay/Cash Rate |
$301.32
|
| Rate for Payer: Signature Care EPO |
$403.38
|
| Rate for Payer: Signature Care PPO |
$427.68
|
| Rate for Payer: United Healthcare Commercial |
$382.97
|
|
|
HC ACU ONE-THIRD TUB PLATE 4-H
|
Facility
IP
|
$345.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.27 |
| Max. Negotiated Rate |
$318.12 |
| Rate for Payer: Aetna Commercial |
$298.60
|
| Rate for Payer: Cigna All Products |
$298.25
|
| Rate for Payer: Coventry/First Health All Products |
$304.13
|
| Rate for Payer: Encore All Products |
$318.12
|
| Rate for Payer: Frontpath All Products |
$317.95
|
| Rate for Payer: Humana ChoiceCare |
$298.49
|
| Rate for Payer: Lutheran Preferred All Products |
$311.04
|
| Rate for Payer: PHCS/Multiplan All Products |
$259.20
|
| Rate for Payer: PHP All Products |
$262.10
|
| Rate for Payer: Sagamore All Products |
$266.80
|
| Rate for Payer: Self Pay/Cash Rate |
$214.27
|
| Rate for Payer: Signature Care EPO |
$286.85
|
| Rate for Payer: Signature Care PPO |
$304.13
|
| Rate for Payer: United Healthcare Commercial |
$272.33
|
|
|
HC ACU ONE-THIRD TUB PLATE 4-H
|
Facility
OP
|
$345.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.05 |
| Max. Negotiated Rate |
$318.12 |
| Rate for Payer: Aetna Commercial |
$291.69
|
| Rate for Payer: Aetna Medicare |
$114.05
|
| Rate for Payer: Anthem Exchange |
$198.48
|
| Rate for Payer: Anthem Medicare |
$114.05
|
| Rate for Payer: Anthem PPO |
$198.48
|
| Rate for Payer: Anthem Traditional |
$216.03
|
| Rate for Payer: Caresource Just 4 Me |
$131.16
|
| Rate for Payer: Caresource Medicare |
$125.45
|
| Rate for Payer: Centivo/Paragon All Products |
$176.26
|
| Rate for Payer: Cigna All Products |
$298.25
|
| Rate for Payer: Coventry/First Health All Products |
$304.13
|
| Rate for Payer: Encore All Products |
$318.12
|
| Rate for Payer: Frontpath All Products |
$317.95
|
| Rate for Payer: Humana ChoiceCare |
$298.49
|
| Rate for Payer: Humana Medicare |
$176.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$176.26
|
| Rate for Payer: Lutheran Preferred All Products |
$311.04
|
| Rate for Payer: PHCS/Multiplan All Products |
$259.20
|
| Rate for Payer: PHP All Products |
$262.10
|
| Rate for Payer: Plain Church Group Ministry All Products |
$134.78
|
| Rate for Payer: Sagamore All Products |
$266.80
|
| Rate for Payer: Self Pay/Cash Rate |
$214.27
|
| Rate for Payer: Signature Care EPO |
$286.85
|
| Rate for Payer: Signature Care PPO |
$304.13
|
| Rate for Payer: Three Rivers Preferred All Products |
$293.76
|
| Rate for Payer: United Healthcare Commercial |
$272.33
|
| Rate for Payer: United Healthcare Medicare |
$114.05
|
|
|
HC ACU ONE-THIRD TUB PLATE 5-H
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$506.27 |
| Rate for Payer: Aetna Commercial |
$464.20
|
| Rate for Payer: Aetna Medicare |
$181.50
|
| Rate for Payer: Anthem Exchange |
$315.87
|
| Rate for Payer: Anthem Medicare |
$181.50
|
| Rate for Payer: Anthem PPO |
$315.87
|
| Rate for Payer: Anthem Traditional |
$343.81
|
| Rate for Payer: Caresource Just 4 Me |
$208.72
|
| Rate for Payer: Caresource Medicare |
$199.65
|
| Rate for Payer: Centivo/Paragon All Products |
$280.50
|
| Rate for Payer: Cigna All Products |
$474.65
|
| Rate for Payer: Coventry/First Health All Products |
$484.00
|
| Rate for Payer: Encore All Products |
$506.27
|
| Rate for Payer: Frontpath All Products |
$506.00
|
| Rate for Payer: Humana ChoiceCare |
$475.04
|
| Rate for Payer: Humana Medicare |
$280.50
|
| Rate for Payer: Lucent/Coldwater Veneers |
$280.50
|
| Rate for Payer: Lutheran Preferred All Products |
$495.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$412.50
|
| Rate for Payer: PHP All Products |
$417.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$214.50
|
| Rate for Payer: Sagamore All Products |
$424.60
|
| Rate for Payer: Self Pay/Cash Rate |
$341.00
|
| Rate for Payer: Signature Care EPO |
$456.50
|
| Rate for Payer: Signature Care PPO |
$484.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$467.50
|
| Rate for Payer: United Healthcare Commercial |
$433.40
|
| Rate for Payer: United Healthcare Medicare |
$181.50
|
|
|
HC ACU ONE-THIRD TUB PLATE 5-H
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$506.27 |
| Rate for Payer: Aetna Commercial |
$475.20
|
| Rate for Payer: Cigna All Products |
$474.65
|
| Rate for Payer: Coventry/First Health All Products |
$484.00
|
| Rate for Payer: Encore All Products |
$506.27
|
| Rate for Payer: Frontpath All Products |
$506.00
|
| Rate for Payer: Humana ChoiceCare |
$475.04
|
| Rate for Payer: Lutheran Preferred All Products |
$495.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$412.50
|
| Rate for Payer: PHP All Products |
$417.12
|
| Rate for Payer: Sagamore All Products |
$424.60
|
| Rate for Payer: Self Pay/Cash Rate |
$341.00
|
| Rate for Payer: Signature Care EPO |
$456.50
|
| Rate for Payer: Signature Care PPO |
$484.00
|
| Rate for Payer: United Healthcare Commercial |
$433.40
|
|
|
HC ACU ONE-THIRD TUB PLATE 6-H
|
Facility
IP
|
$570.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602800
|
|
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
|
|
|
HC ACU ONE-THIRD TUB PLATE 6-H
|
Facility
OP
|
$570.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602800
|
|
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 ONE-THIRD TUB PLATE 7-H
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.70 |
| Max. Negotiated Rate |
$543.10 |
| Rate for Payer: Aetna Commercial |
$497.96
|
| Rate for Payer: Aetna Medicare |
$194.70
|
| Rate for Payer: Anthem Exchange |
$338.84
|
| Rate for Payer: Anthem Medicare |
$194.70
|
| Rate for Payer: Anthem PPO |
$338.84
|
| Rate for Payer: Anthem Traditional |
$368.81
|
| Rate for Payer: Caresource Just 4 Me |
$223.91
|
| Rate for Payer: Caresource Medicare |
$214.17
|
| Rate for Payer: Centivo/Paragon All Products |
$300.90
|
| Rate for Payer: Cigna All Products |
$509.17
|
| Rate for Payer: Coventry/First Health All Products |
$519.20
|
| Rate for Payer: Encore All Products |
$543.10
|
| Rate for Payer: Frontpath All Products |
$542.80
|
| Rate for Payer: Humana ChoiceCare |
$509.58
|
| Rate for Payer: Humana Medicare |
$300.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$300.90
|
| Rate for Payer: Lutheran Preferred All Products |
$531.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$442.50
|
| Rate for Payer: PHP All Products |
$447.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$230.10
|
| Rate for Payer: Sagamore All Products |
$455.48
|
| Rate for Payer: Self Pay/Cash Rate |
$365.80
|
| Rate for Payer: Signature Care EPO |
$489.70
|
| Rate for Payer: Signature Care PPO |
$519.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$501.50
|
| Rate for Payer: United Healthcare Commercial |
$464.92
|
| Rate for Payer: United Healthcare Medicare |
$194.70
|
|
|
HC ACU ONE-THIRD TUB PLATE 7-H
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.80 |
| Max. Negotiated Rate |
$543.10 |
| Rate for Payer: Aetna Commercial |
$509.76
|
| Rate for Payer: Cigna All Products |
$509.17
|
| Rate for Payer: Coventry/First Health All Products |
$519.20
|
| Rate for Payer: Encore All Products |
$543.10
|
| Rate for Payer: Frontpath All Products |
$542.80
|
| Rate for Payer: Humana ChoiceCare |
$509.58
|
| Rate for Payer: Lutheran Preferred All Products |
$531.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$442.50
|
| Rate for Payer: PHP All Products |
$447.46
|
| Rate for Payer: Sagamore All Products |
$455.48
|
| Rate for Payer: Self Pay/Cash Rate |
$365.80
|
| Rate for Payer: Signature Care EPO |
$489.70
|
| Rate for Payer: Signature Care PPO |
$519.20
|
| Rate for Payer: United Healthcare Commercial |
$464.92
|
|
