|
HC ACU ONE-THIRD TUB PLATE 8-H
|
Facility
OP
|
$610.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$561.50 |
| Rate for Payer: Aetna Commercial |
$514.84
|
| Rate for Payer: Aetna Medicare |
$201.30
|
| Rate for Payer: Anthem Exchange |
$350.32
|
| Rate for Payer: Anthem Medicare |
$201.30
|
| Rate for Payer: Anthem PPO |
$350.32
|
| Rate for Payer: Anthem Traditional |
$381.31
|
| Rate for Payer: Caresource Just 4 Me |
$231.50
|
| Rate for Payer: Caresource Medicare |
$221.43
|
| Rate for Payer: Centivo/Paragon All Products |
$311.10
|
| Rate for Payer: Cigna All Products |
$526.43
|
| Rate for Payer: Coventry/First Health All Products |
$536.80
|
| Rate for Payer: Encore All Products |
$561.50
|
| Rate for Payer: Frontpath All Products |
$561.20
|
| Rate for Payer: Humana ChoiceCare |
$526.86
|
| Rate for Payer: Humana Medicare |
$311.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$311.10
|
| Rate for Payer: Lutheran Preferred All Products |
$549.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$457.50
|
| Rate for Payer: PHP All Products |
$462.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$237.90
|
| Rate for Payer: Sagamore All Products |
$470.92
|
| Rate for Payer: Self Pay/Cash Rate |
$378.20
|
| Rate for Payer: Signature Care EPO |
$506.30
|
| Rate for Payer: Signature Care PPO |
$536.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$518.50
|
| Rate for Payer: United Healthcare Commercial |
$480.68
|
| Rate for Payer: United Healthcare Medicare |
$201.30
|
|
|
HC ACU ONE-THIRD TUB PLATE 8-H
|
Facility
IP
|
$610.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$561.50 |
| Rate for Payer: Aetna Commercial |
$527.04
|
| Rate for Payer: Cigna All Products |
$526.43
|
| Rate for Payer: Coventry/First Health All Products |
$536.80
|
| Rate for Payer: Encore All Products |
$561.50
|
| Rate for Payer: Frontpath All Products |
$561.20
|
| Rate for Payer: Humana ChoiceCare |
$526.86
|
| Rate for Payer: Lutheran Preferred All Products |
$549.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$457.50
|
| Rate for Payer: PHP All Products |
$462.62
|
| Rate for Payer: Sagamore All Products |
$470.92
|
| Rate for Payer: Self Pay/Cash Rate |
$378.20
|
| Rate for Payer: Signature Care EPO |
$506.30
|
| Rate for Payer: Signature Care PPO |
$536.80
|
| Rate for Payer: United Healthcare Commercial |
$480.68
|
|
|
HC ACU PLATE LP CLAVICL 8 H
|
Facility
IP
|
$1,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.72 |
| Max. Negotiated Rate |
$1,754.47 |
| Rate for Payer: Aetna Commercial |
$1,646.78
|
| Rate for Payer: Cigna All Products |
$1,644.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,677.28
|
| Rate for Payer: Encore All Products |
$1,754.47
|
| Rate for Payer: Frontpath All Products |
$1,753.52
|
| Rate for Payer: Humana ChoiceCare |
$1,646.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,715.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,429.50
|
| Rate for Payer: PHP All Products |
$1,445.51
|
| Rate for Payer: Sagamore All Products |
$1,471.43
|
| Rate for Payer: Self Pay/Cash Rate |
$1,181.72
|
| Rate for Payer: Signature Care EPO |
$1,581.98
|
| Rate for Payer: Signature Care PPO |
$1,677.28
|
| Rate for Payer: United Healthcare Commercial |
$1,501.93
|
|
|
HC ACU PLATE LP CLAVICL 8 H
|
Facility
OP
|
$1,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.98 |
| Max. Negotiated Rate |
$1,754.47 |
| Rate for Payer: Aetna Commercial |
$1,608.66
|
| Rate for Payer: Aetna Medicare |
$628.98
|
| Rate for Payer: Anthem Exchange |
$1,094.62
|
| Rate for Payer: Anthem Medicare |
$628.98
|
| Rate for Payer: Anthem PPO |
$1,094.62
|
| Rate for Payer: Anthem Traditional |
$1,191.44
|
| Rate for Payer: Caresource Just 4 Me |
$723.33
|
| Rate for Payer: Caresource Medicare |
$691.88
|
| Rate for Payer: Centivo/Paragon All Products |
$972.06
|
| Rate for Payer: Cigna All Products |
$1,644.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,677.28
|
| Rate for Payer: Encore All Products |
$1,754.47
|
| Rate for Payer: Frontpath All Products |
$1,753.52
|
| Rate for Payer: Humana ChoiceCare |
$1,646.21
|
| Rate for Payer: Humana Medicare |
$972.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$972.06
|
| Rate for Payer: Lutheran Preferred All Products |
$1,715.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,429.50
|
| Rate for Payer: PHP All Products |
$1,445.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$743.34
|
| Rate for Payer: Sagamore All Products |
$1,471.43
|
| Rate for Payer: Self Pay/Cash Rate |
$1,181.72
|
| Rate for Payer: Signature Care EPO |
$1,581.98
|
| Rate for Payer: Signature Care PPO |
$1,677.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,501.93
|
| Rate for Payer: United Healthcare Medicare |
$628.98
|
|
|
HC ACU PLATE POLARUS 3 6-H L
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.46 |
| Max. Negotiated Rate |
$2,082.17 |
| Rate for Payer: Aetna Commercial |
$1,909.13
|
| Rate for Payer: Aetna Medicare |
$746.46
|
| Rate for Payer: Anthem Exchange |
$1,299.07
|
| Rate for Payer: Anthem Medicare |
$746.46
|
| Rate for Payer: Anthem PPO |
$1,299.07
|
| Rate for Payer: Anthem Traditional |
$1,413.98
|
| Rate for Payer: Caresource Just 4 Me |
$858.43
|
| Rate for Payer: Caresource Medicare |
$821.11
|
| Rate for Payer: Centivo/Paragon All Products |
$1,153.62
|
| Rate for Payer: Cigna All Products |
$1,952.11
|
| Rate for Payer: Coventry/First Health All Products |
$1,990.56
|
| Rate for Payer: Encore All Products |
$2,082.17
|
| Rate for Payer: Frontpath All Products |
$2,081.04
|
| Rate for Payer: Humana ChoiceCare |
$1,953.69
|
| Rate for Payer: Humana Medicare |
$1,153.62
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,153.62
|
| Rate for Payer: Lutheran Preferred All Products |
$2,035.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,696.50
|
| Rate for Payer: PHP All Products |
$1,715.50
|
| Rate for Payer: Plain Church Group Ministry All Products |
$882.18
|
| Rate for Payer: Sagamore All Products |
$1,746.26
|
| Rate for Payer: Self Pay/Cash Rate |
$1,402.44
|
| Rate for Payer: Signature Care EPO |
$1,877.46
|
| Rate for Payer: Signature Care PPO |
$1,990.56
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,922.70
|
| Rate for Payer: United Healthcare Commercial |
$1,782.46
|
| Rate for Payer: United Healthcare Medicare |
$746.46
|
|
|
HC ACU PLATE POLARUS 3 6-H L
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.44 |
| Max. Negotiated Rate |
$2,082.17 |
| Rate for Payer: Aetna Commercial |
$1,954.37
|
| Rate for Payer: Cigna All Products |
$1,952.11
|
| Rate for Payer: Coventry/First Health All Products |
$1,990.56
|
| Rate for Payer: Encore All Products |
$2,082.17
|
| Rate for Payer: Frontpath All Products |
$2,081.04
|
| Rate for Payer: Humana ChoiceCare |
$1,953.69
|
| Rate for Payer: Lutheran Preferred All Products |
$2,035.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,696.50
|
| Rate for Payer: PHP All Products |
$1,715.50
|
| Rate for Payer: Sagamore All Products |
$1,746.26
|
| Rate for Payer: Self Pay/Cash Rate |
$1,402.44
|
| Rate for Payer: Signature Care EPO |
$1,877.46
|
| Rate for Payer: Signature Care PPO |
$1,990.56
|
| Rate for Payer: United Healthcare Commercial |
$1,782.46
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H L
|
Facility
IP
|
$1,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.72 |
| Max. Negotiated Rate |
$1,754.47 |
| Rate for Payer: Aetna Commercial |
$1,646.78
|
| Rate for Payer: Cigna All Products |
$1,644.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,677.28
|
| Rate for Payer: Encore All Products |
$1,754.47
|
| Rate for Payer: Frontpath All Products |
$1,753.52
|
| Rate for Payer: Humana ChoiceCare |
$1,646.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,715.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,429.50
|
| Rate for Payer: PHP All Products |
$1,445.51
|
| Rate for Payer: Sagamore All Products |
$1,471.43
|
| Rate for Payer: Self Pay/Cash Rate |
$1,181.72
|
| Rate for Payer: Signature Care EPO |
$1,581.98
|
| Rate for Payer: Signature Care PPO |
$1,677.28
|
| Rate for Payer: United Healthcare Commercial |
$1,501.93
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H L
|
Facility
OP
|
$1,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.98 |
| Max. Negotiated Rate |
$1,754.47 |
| Rate for Payer: Aetna Commercial |
$1,608.66
|
| Rate for Payer: Aetna Medicare |
$628.98
|
| Rate for Payer: Anthem Exchange |
$1,094.62
|
| Rate for Payer: Anthem Medicare |
$628.98
|
| Rate for Payer: Anthem PPO |
$1,094.62
|
| Rate for Payer: Anthem Traditional |
$1,191.44
|
| Rate for Payer: Caresource Just 4 Me |
$723.33
|
| Rate for Payer: Caresource Medicare |
$691.88
|
| Rate for Payer: Centivo/Paragon All Products |
$972.06
|
| Rate for Payer: Cigna All Products |
$1,644.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,677.28
|
| Rate for Payer: Encore All Products |
$1,754.47
|
| Rate for Payer: Frontpath All Products |
$1,753.52
|
| Rate for Payer: Humana ChoiceCare |
$1,646.21
|
| Rate for Payer: Humana Medicare |
$972.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$972.06
|
| Rate for Payer: Lutheran Preferred All Products |
$1,715.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,429.50
|
| Rate for Payer: PHP All Products |
$1,445.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$743.34
|
| Rate for Payer: Sagamore All Products |
$1,471.43
|
| Rate for Payer: Self Pay/Cash Rate |
$1,181.72
|
| Rate for Payer: Signature Care EPO |
$1,581.98
|
| Rate for Payer: Signature Care PPO |
$1,677.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,501.93
|
| Rate for Payer: United Healthcare Medicare |
$628.98
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H R
|
Facility
IP
|
$1,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.72 |
| Max. Negotiated Rate |
$1,754.47 |
| Rate for Payer: Aetna Commercial |
$1,646.78
|
| Rate for Payer: Cigna All Products |
$1,644.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,677.28
|
| Rate for Payer: Encore All Products |
$1,754.47
|
| Rate for Payer: Frontpath All Products |
$1,753.52
|
| Rate for Payer: Humana ChoiceCare |
$1,646.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,715.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,429.50
|
| Rate for Payer: PHP All Products |
$1,445.51
|
| Rate for Payer: Sagamore All Products |
$1,471.43
|
| Rate for Payer: Self Pay/Cash Rate |
$1,181.72
|
| Rate for Payer: Signature Care EPO |
$1,581.98
|
| Rate for Payer: Signature Care PPO |
$1,677.28
|
| Rate for Payer: United Healthcare Commercial |
$1,501.93
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H R
|
Facility
OP
|
$1,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.98 |
| Max. Negotiated Rate |
$1,754.47 |
| Rate for Payer: Aetna Commercial |
$1,608.66
|
| Rate for Payer: Aetna Medicare |
$628.98
|
| Rate for Payer: Anthem Exchange |
$1,094.62
|
| Rate for Payer: Anthem Medicare |
$628.98
|
| Rate for Payer: Anthem PPO |
$1,094.62
|
| Rate for Payer: Anthem Traditional |
$1,191.44
|
| Rate for Payer: Caresource Just 4 Me |
$723.33
|
| Rate for Payer: Caresource Medicare |
$691.88
|
| Rate for Payer: Centivo/Paragon All Products |
$972.06
|
| Rate for Payer: Cigna All Products |
$1,644.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,677.28
|
| Rate for Payer: Encore All Products |
$1,754.47
|
| Rate for Payer: Frontpath All Products |
$1,753.52
|
| Rate for Payer: Humana ChoiceCare |
$1,646.21
|
| Rate for Payer: Humana Medicare |
$972.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$972.06
|
| Rate for Payer: Lutheran Preferred All Products |
$1,715.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,429.50
|
| Rate for Payer: PHP All Products |
$1,445.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$743.34
|
| Rate for Payer: Sagamore All Products |
$1,471.43
|
| Rate for Payer: Self Pay/Cash Rate |
$1,181.72
|
| Rate for Payer: Signature Care EPO |
$1,581.98
|
| Rate for Payer: Signature Care PPO |
$1,677.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,620.10
|
| Rate for Payer: United Healthcare Commercial |
$1,501.93
|
| Rate for Payer: United Healthcare Medicare |
$628.98
|
|
|
HC ACU PLATE PROF CLAVICLE 8-H L
|
Facility
OP
|
$1,941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.53 |
| Max. Negotiated Rate |
$1,786.69 |
| Rate for Payer: Aetna Commercial |
$1,638.20
|
| Rate for Payer: Aetna Medicare |
$640.53
|
| Rate for Payer: Anthem Exchange |
$1,114.72
|
| Rate for Payer: Anthem Medicare |
$640.53
|
| Rate for Payer: Anthem PPO |
$1,114.72
|
| Rate for Payer: Anthem Traditional |
$1,213.32
|
| Rate for Payer: Caresource Just 4 Me |
$736.61
|
| Rate for Payer: Caresource Medicare |
$704.58
|
| Rate for Payer: Centivo/Paragon All Products |
$989.91
|
| Rate for Payer: Cigna All Products |
$1,675.08
|
| Rate for Payer: Coventry/First Health All Products |
$1,708.08
|
| Rate for Payer: Encore All Products |
$1,786.69
|
| Rate for Payer: Frontpath All Products |
$1,785.72
|
| Rate for Payer: Humana ChoiceCare |
$1,676.44
|
| Rate for Payer: Humana Medicare |
$989.91
|
| Rate for Payer: Lucent/Coldwater Veneers |
$989.91
|
| Rate for Payer: Lutheran Preferred All Products |
$1,746.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,455.75
|
| Rate for Payer: PHP All Products |
$1,472.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$756.99
|
| Rate for Payer: Sagamore All Products |
$1,498.45
|
| Rate for Payer: Self Pay/Cash Rate |
$1,203.42
|
| Rate for Payer: Signature Care EPO |
$1,611.03
|
| Rate for Payer: Signature Care PPO |
$1,708.08
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,649.85
|
| Rate for Payer: United Healthcare Commercial |
$1,529.51
|
| Rate for Payer: United Healthcare Medicare |
$640.53
|
|
|
HC ACU PLATE PROF CLAVICLE 8-H L
|
Facility
IP
|
$1,941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.42 |
| Max. Negotiated Rate |
$1,786.69 |
| Rate for Payer: Aetna Commercial |
$1,677.02
|
| Rate for Payer: Cigna All Products |
$1,675.08
|
| Rate for Payer: Coventry/First Health All Products |
$1,708.08
|
| Rate for Payer: Encore All Products |
$1,786.69
|
| Rate for Payer: Frontpath All Products |
$1,785.72
|
| Rate for Payer: Humana ChoiceCare |
$1,676.44
|
| Rate for Payer: Lutheran Preferred All Products |
$1,746.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,455.75
|
| Rate for Payer: PHP All Products |
$1,472.05
|
| Rate for Payer: Sagamore All Products |
$1,498.45
|
| Rate for Payer: Self Pay/Cash Rate |
$1,203.42
|
| Rate for Payer: Signature Care EPO |
$1,611.03
|
| Rate for Payer: Signature Care PPO |
$1,708.08
|
| Rate for Payer: United Healthcare Commercial |
$1,529.51
|
|
|
HC ACU PLATE RAD HEAD 3-H LOCK SM
|
Facility
IP
|
$1,956.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.72 |
| Max. Negotiated Rate |
$1,800.50 |
| Rate for Payer: Aetna Commercial |
$1,689.98
|
| Rate for Payer: Cigna All Products |
$1,688.03
|
| Rate for Payer: Coventry/First Health All Products |
$1,721.28
|
| Rate for Payer: Encore All Products |
$1,800.50
|
| Rate for Payer: Frontpath All Products |
$1,799.52
|
| Rate for Payer: Humana ChoiceCare |
$1,689.40
|
| Rate for Payer: Lutheran Preferred All Products |
$1,760.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,467.00
|
| Rate for Payer: PHP All Products |
$1,483.43
|
| Rate for Payer: Sagamore All Products |
$1,510.03
|
| Rate for Payer: Self Pay/Cash Rate |
$1,212.72
|
| Rate for Payer: Signature Care EPO |
$1,623.48
|
| Rate for Payer: Signature Care PPO |
$1,721.28
|
| Rate for Payer: United Healthcare Commercial |
$1,541.33
|
|
|
HC ACU PLATE RAD HEAD 3-H LOCK SM
|
Facility
OP
|
$1,956.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.48 |
| Max. Negotiated Rate |
$1,800.50 |
| Rate for Payer: Aetna Commercial |
$1,650.86
|
| Rate for Payer: Aetna Medicare |
$645.48
|
| Rate for Payer: Anthem Exchange |
$1,123.33
|
| Rate for Payer: Anthem Medicare |
$645.48
|
| Rate for Payer: Anthem PPO |
$1,123.33
|
| Rate for Payer: Anthem Traditional |
$1,222.70
|
| Rate for Payer: Caresource Just 4 Me |
$742.30
|
| Rate for Payer: Caresource Medicare |
$710.03
|
| Rate for Payer: Centivo/Paragon All Products |
$997.56
|
| Rate for Payer: Cigna All Products |
$1,688.03
|
| Rate for Payer: Coventry/First Health All Products |
$1,721.28
|
| Rate for Payer: Encore All Products |
$1,800.50
|
| Rate for Payer: Frontpath All Products |
$1,799.52
|
| Rate for Payer: Humana ChoiceCare |
$1,689.40
|
| Rate for Payer: Humana Medicare |
$997.56
|
| Rate for Payer: Lucent/Coldwater Veneers |
$997.56
|
| Rate for Payer: Lutheran Preferred All Products |
$1,760.40
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,467.00
|
| Rate for Payer: PHP All Products |
$1,483.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$762.84
|
| Rate for Payer: Sagamore All Products |
$1,510.03
|
| Rate for Payer: Self Pay/Cash Rate |
$1,212.72
|
| Rate for Payer: Signature Care EPO |
$1,623.48
|
| Rate for Payer: Signature Care PPO |
$1,721.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,662.60
|
| Rate for Payer: United Healthcare Commercial |
$1,541.33
|
| Rate for Payer: United Healthcare Medicare |
$645.48
|
|
|
HC ACU POST LAT DIS TIB PLT 3H L
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.80 |
| Max. Negotiated Rate |
$1,693.72 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cigna All Products |
$1,587.92
|
| Rate for Payer: Coventry/First Health All Products |
$1,619.20
|
| Rate for Payer: Encore All Products |
$1,693.72
|
| Rate for Payer: Frontpath All Products |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,656.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,380.00
|
| Rate for Payer: PHP All Products |
$1,395.46
|
| Rate for Payer: Sagamore All Products |
$1,420.48
|
| Rate for Payer: Self Pay/Cash Rate |
$1,140.80
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC ACU POST LAT DIS TIB PLT 3H L
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,693.72 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Exchange |
$1,056.71
|
| Rate for Payer: Anthem Medicare |
$607.20
|
| Rate for Payer: Anthem PPO |
$1,056.71
|
| Rate for Payer: Anthem Traditional |
$1,150.18
|
| Rate for Payer: Caresource Just 4 Me |
$698.28
|
| Rate for Payer: Caresource Medicare |
$667.92
|
| Rate for Payer: Centivo/Paragon All Products |
$938.40
|
| Rate for Payer: Cigna All Products |
$1,587.92
|
| Rate for Payer: Coventry/First Health All Products |
$1,619.20
|
| Rate for Payer: Encore All Products |
$1,693.72
|
| Rate for Payer: Frontpath All Products |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$938.40
|
| Rate for Payer: Lutheran Preferred All Products |
$1,656.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,380.00
|
| Rate for Payer: PHP All Products |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$717.60
|
| Rate for Payer: Sagamore All Products |
$1,420.48
|
| Rate for Payer: Self Pay/Cash Rate |
$1,140.80
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC ACU POST LAT DIS TIB PLT 3H R
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.80 |
| Max. Negotiated Rate |
$1,693.72 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cigna All Products |
$1,587.92
|
| Rate for Payer: Coventry/First Health All Products |
$1,619.20
|
| Rate for Payer: Encore All Products |
$1,693.72
|
| Rate for Payer: Frontpath All Products |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,656.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,380.00
|
| Rate for Payer: PHP All Products |
$1,395.46
|
| Rate for Payer: Sagamore All Products |
$1,420.48
|
| Rate for Payer: Self Pay/Cash Rate |
$1,140.80
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC ACU POST LAT DIS TIB PLT 3H R
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,693.72 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Exchange |
$1,056.71
|
| Rate for Payer: Anthem Medicare |
$607.20
|
| Rate for Payer: Anthem PPO |
$1,056.71
|
| Rate for Payer: Anthem Traditional |
$1,150.18
|
| Rate for Payer: Caresource Just 4 Me |
$698.28
|
| Rate for Payer: Caresource Medicare |
$667.92
|
| Rate for Payer: Centivo/Paragon All Products |
$938.40
|
| Rate for Payer: Cigna All Products |
$1,587.92
|
| Rate for Payer: Coventry/First Health All Products |
$1,619.20
|
| Rate for Payer: Encore All Products |
$1,693.72
|
| Rate for Payer: Frontpath All Products |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$938.40
|
| Rate for Payer: Lutheran Preferred All Products |
$1,656.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,380.00
|
| Rate for Payer: PHP All Products |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$717.60
|
| Rate for Payer: Sagamore All Products |
$1,420.48
|
| Rate for Payer: Self Pay/Cash Rate |
$1,140.80
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC ACU POST LAT DIS TIB PLT 4H L
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,171.80 |
| Max. Negotiated Rate |
$1,739.74 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cigna All Products |
$1,631.07
|
| Rate for Payer: Coventry/First Health All Products |
$1,663.20
|
| Rate for Payer: Encore All Products |
$1,739.74
|
| Rate for Payer: Frontpath All Products |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Products |
$1,701.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,417.50
|
| Rate for Payer: PHP All Products |
$1,433.38
|
| Rate for Payer: Sagamore All Products |
$1,459.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,171.80
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC ACU POST LAT DIS TIB PLT 4H L
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,739.74 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Exchange |
$1,085.43
|
| Rate for Payer: Anthem Medicare |
$623.70
|
| Rate for Payer: Anthem PPO |
$1,085.43
|
| Rate for Payer: Anthem Traditional |
$1,181.44
|
| Rate for Payer: Caresource Just 4 Me |
$717.25
|
| Rate for Payer: Caresource Medicare |
$686.07
|
| Rate for Payer: Centivo/Paragon All Products |
$963.90
|
| Rate for Payer: Cigna All Products |
$1,631.07
|
| Rate for Payer: Coventry/First Health All Products |
$1,663.20
|
| Rate for Payer: Encore All Products |
$1,739.74
|
| Rate for Payer: Frontpath All Products |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$963.90
|
| Rate for Payer: Lutheran Preferred All Products |
$1,701.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,417.50
|
| Rate for Payer: PHP All Products |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Products |
$737.10
|
| Rate for Payer: Sagamore All Products |
$1,459.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,171.80
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC ACU POST LAT DIS TIB PLT 4H R
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,171.80 |
| Max. Negotiated Rate |
$1,739.74 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cigna All Products |
$1,631.07
|
| Rate for Payer: Coventry/First Health All Products |
$1,663.20
|
| Rate for Payer: Encore All Products |
$1,739.74
|
| Rate for Payer: Frontpath All Products |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Products |
$1,701.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,417.50
|
| Rate for Payer: PHP All Products |
$1,433.38
|
| Rate for Payer: Sagamore All Products |
$1,459.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,171.80
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC ACU POST LAT DIS TIB PLT 4H R
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,739.74 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Exchange |
$1,085.43
|
| Rate for Payer: Anthem Medicare |
$623.70
|
| Rate for Payer: Anthem PPO |
$1,085.43
|
| Rate for Payer: Anthem Traditional |
$1,181.44
|
| Rate for Payer: Caresource Just 4 Me |
$717.25
|
| Rate for Payer: Caresource Medicare |
$686.07
|
| Rate for Payer: Centivo/Paragon All Products |
$963.90
|
| Rate for Payer: Cigna All Products |
$1,631.07
|
| Rate for Payer: Coventry/First Health All Products |
$1,663.20
|
| Rate for Payer: Encore All Products |
$1,739.74
|
| Rate for Payer: Frontpath All Products |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$963.90
|
| Rate for Payer: Lutheran Preferred All Products |
$1,701.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,417.50
|
| Rate for Payer: PHP All Products |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Products |
$737.10
|
| Rate for Payer: Sagamore All Products |
$1,459.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,171.80
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC ACU POST LAT FIB PLATE 3-H L
|
Facility
OP
|
$2,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$706.20 |
| Max. Negotiated Rate |
$1,969.87 |
| Rate for Payer: Aetna Commercial |
$1,806.16
|
| Rate for Payer: Aetna Medicare |
$706.20
|
| Rate for Payer: Anthem Exchange |
$1,229.00
|
| Rate for Payer: Anthem Medicare |
$706.20
|
| Rate for Payer: Anthem PPO |
$1,229.00
|
| Rate for Payer: Anthem Traditional |
$1,337.71
|
| Rate for Payer: Caresource Just 4 Me |
$812.13
|
| Rate for Payer: Caresource Medicare |
$776.82
|
| Rate for Payer: Centivo/Paragon All Products |
$1,091.40
|
| Rate for Payer: Cigna All Products |
$1,846.82
|
| Rate for Payer: Coventry/First Health All Products |
$1,883.20
|
| Rate for Payer: Encore All Products |
$1,969.87
|
| Rate for Payer: Frontpath All Products |
$1,968.80
|
| Rate for Payer: Humana ChoiceCare |
$1,848.32
|
| Rate for Payer: Humana Medicare |
$1,091.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,091.40
|
| Rate for Payer: Lutheran Preferred All Products |
$1,926.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,605.00
|
| Rate for Payer: PHP All Products |
$1,622.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$834.60
|
| Rate for Payer: Sagamore All Products |
$1,652.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,326.80
|
| Rate for Payer: Signature Care EPO |
$1,776.20
|
| Rate for Payer: Signature Care PPO |
$1,883.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,819.00
|
| Rate for Payer: United Healthcare Commercial |
$1,686.32
|
| Rate for Payer: United Healthcare Medicare |
$706.20
|
|
|
HC ACU POST LAT FIB PLATE 3-H L
|
Facility
IP
|
$2,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,326.80 |
| Max. Negotiated Rate |
$1,969.87 |
| Rate for Payer: Aetna Commercial |
$1,848.96
|
| Rate for Payer: Cigna All Products |
$1,846.82
|
| Rate for Payer: Coventry/First Health All Products |
$1,883.20
|
| Rate for Payer: Encore All Products |
$1,969.87
|
| Rate for Payer: Frontpath All Products |
$1,968.80
|
| Rate for Payer: Humana ChoiceCare |
$1,848.32
|
| Rate for Payer: Lutheran Preferred All Products |
$1,926.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,605.00
|
| Rate for Payer: PHP All Products |
$1,622.98
|
| Rate for Payer: Sagamore All Products |
$1,652.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,326.80
|
| Rate for Payer: Signature Care EPO |
$1,776.20
|
| Rate for Payer: Signature Care PPO |
$1,883.20
|
| Rate for Payer: United Healthcare Commercial |
$1,686.32
|
|
|
HC ACU POST LAT FIB PLATE 3-H R
|
Facility
IP
|
$2,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,326.80 |
| Max. Negotiated Rate |
$1,969.87 |
| Rate for Payer: Aetna Commercial |
$1,848.96
|
| Rate for Payer: Cigna All Products |
$1,846.82
|
| Rate for Payer: Coventry/First Health All Products |
$1,883.20
|
| Rate for Payer: Encore All Products |
$1,969.87
|
| Rate for Payer: Frontpath All Products |
$1,968.80
|
| Rate for Payer: Humana ChoiceCare |
$1,848.32
|
| Rate for Payer: Lutheran Preferred All Products |
$1,926.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,605.00
|
| Rate for Payer: PHP All Products |
$1,622.98
|
| Rate for Payer: Sagamore All Products |
$1,652.08
|
| Rate for Payer: Self Pay/Cash Rate |
$1,326.80
|
| Rate for Payer: Signature Care EPO |
$1,776.20
|
| Rate for Payer: Signature Care PPO |
$1,883.20
|
| Rate for Payer: United Healthcare Commercial |
$1,686.32
|
|
