|
HC ACU POST LAT FIB PLATE 3-H R
|
Facility
OP
|
$2,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602777
|
|
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 4-H L
|
Facility
IP
|
$2,165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$1,992.88 |
| Rate for Payer: Aetna Commercial |
$1,870.56
|
| Rate for Payer: Cigna All Products |
$1,868.39
|
| Rate for Payer: Coventry/First Health All Products |
$1,905.20
|
| Rate for Payer: Encore All Products |
$1,992.88
|
| Rate for Payer: Frontpath All Products |
$1,991.80
|
| Rate for Payer: Humana ChoiceCare |
$1,869.91
|
| Rate for Payer: Lutheran Preferred All Products |
$1,948.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,623.75
|
| Rate for Payer: PHP All Products |
$1,641.94
|
| Rate for Payer: Sagamore All Products |
$1,671.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,342.30
|
| Rate for Payer: Signature Care EPO |
$1,796.95
|
| Rate for Payer: Signature Care PPO |
$1,905.20
|
| Rate for Payer: United Healthcare Commercial |
$1,706.02
|
|
|
HC ACU POST LAT FIB PLATE 4-H L
|
Facility
OP
|
$2,165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.45 |
| Max. Negotiated Rate |
$1,992.88 |
| Rate for Payer: Aetna Commercial |
$1,827.26
|
| Rate for Payer: Aetna Medicare |
$714.45
|
| Rate for Payer: Anthem Exchange |
$1,243.36
|
| Rate for Payer: Anthem Medicare |
$714.45
|
| Rate for Payer: Anthem PPO |
$1,243.36
|
| Rate for Payer: Anthem Traditional |
$1,353.34
|
| Rate for Payer: Caresource Just 4 Me |
$821.62
|
| Rate for Payer: Caresource Medicare |
$785.89
|
| Rate for Payer: Centivo/Paragon All Products |
$1,104.15
|
| Rate for Payer: Cigna All Products |
$1,868.39
|
| Rate for Payer: Coventry/First Health All Products |
$1,905.20
|
| Rate for Payer: Encore All Products |
$1,992.88
|
| Rate for Payer: Frontpath All Products |
$1,991.80
|
| Rate for Payer: Humana ChoiceCare |
$1,869.91
|
| Rate for Payer: Humana Medicare |
$1,104.15
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,104.15
|
| Rate for Payer: Lutheran Preferred All Products |
$1,948.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,623.75
|
| Rate for Payer: PHP All Products |
$1,641.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$844.35
|
| Rate for Payer: Sagamore All Products |
$1,671.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,342.30
|
| Rate for Payer: Signature Care EPO |
$1,796.95
|
| Rate for Payer: Signature Care PPO |
$1,905.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,840.25
|
| Rate for Payer: United Healthcare Commercial |
$1,706.02
|
| Rate for Payer: United Healthcare Medicare |
$714.45
|
|
|
HC ACU POST LAT FIB PLATE 4-H R
|
Facility
IP
|
$2,165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$1,992.88 |
| Rate for Payer: Aetna Commercial |
$1,870.56
|
| Rate for Payer: Cigna All Products |
$1,868.39
|
| Rate for Payer: Coventry/First Health All Products |
$1,905.20
|
| Rate for Payer: Encore All Products |
$1,992.88
|
| Rate for Payer: Frontpath All Products |
$1,991.80
|
| Rate for Payer: Humana ChoiceCare |
$1,869.91
|
| Rate for Payer: Lutheran Preferred All Products |
$1,948.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,623.75
|
| Rate for Payer: PHP All Products |
$1,641.94
|
| Rate for Payer: Sagamore All Products |
$1,671.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,342.30
|
| Rate for Payer: Signature Care EPO |
$1,796.95
|
| Rate for Payer: Signature Care PPO |
$1,905.20
|
| Rate for Payer: United Healthcare Commercial |
$1,706.02
|
|
|
HC ACU POST LAT FIB PLATE 4-H R
|
Facility
OP
|
$2,165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.45 |
| Max. Negotiated Rate |
$1,992.88 |
| Rate for Payer: Aetna Commercial |
$1,827.26
|
| Rate for Payer: Aetna Medicare |
$714.45
|
| Rate for Payer: Anthem Exchange |
$1,243.36
|
| Rate for Payer: Anthem Medicare |
$714.45
|
| Rate for Payer: Anthem PPO |
$1,243.36
|
| Rate for Payer: Anthem Traditional |
$1,353.34
|
| Rate for Payer: Caresource Just 4 Me |
$821.62
|
| Rate for Payer: Caresource Medicare |
$785.89
|
| Rate for Payer: Centivo/Paragon All Products |
$1,104.15
|
| Rate for Payer: Cigna All Products |
$1,868.39
|
| Rate for Payer: Coventry/First Health All Products |
$1,905.20
|
| Rate for Payer: Encore All Products |
$1,992.88
|
| Rate for Payer: Frontpath All Products |
$1,991.80
|
| Rate for Payer: Humana ChoiceCare |
$1,869.91
|
| Rate for Payer: Humana Medicare |
$1,104.15
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,104.15
|
| Rate for Payer: Lutheran Preferred All Products |
$1,948.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,623.75
|
| Rate for Payer: PHP All Products |
$1,641.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$844.35
|
| Rate for Payer: Sagamore All Products |
$1,671.38
|
| Rate for Payer: Self Pay/Cash Rate |
$1,342.30
|
| Rate for Payer: Signature Care EPO |
$1,796.95
|
| Rate for Payer: Signature Care PPO |
$1,905.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,840.25
|
| Rate for Payer: United Healthcare Commercial |
$1,706.02
|
| Rate for Payer: United Healthcare Medicare |
$714.45
|
|
|
HC ACU POST LAT FIB PLATE 5-H L
|
Facility
OP
|
$2,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602780
|
|
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 POST LAT FIB PLATE 5-H L
|
Facility
IP
|
$2,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602780
|
|
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 POST LAT FIB PLATE 5-H R
|
Facility
IP
|
$2,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602781
|
|
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 POST LAT FIB PLATE 5-H R
|
Facility
OP
|
$2,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602781
|
|
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 POST LAT FIB PLATE 6-H L
|
Facility
IP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602782
|
|
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 POST LAT FIB PLATE 6-H L
|
Facility
OP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602782
|
|
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 POST LAT FIB PLATE 6-H R
|
Facility
OP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602783
|
|
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 POST LAT FIB PLATE 6-H R
|
Facility
IP
|
$2,215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602783
|
|
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 POST LAT FIB PLATE 7-H L
|
Facility
OP
|
$2,240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602784
|
|
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 POST LAT FIB PLATE 7-H L
|
Facility
IP
|
$2,240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602784
|
|
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 POST LAT FIB PLATE 7-H R
|
Facility
IP
|
$1,730.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$1,592.46 |
| Rate for Payer: Aetna Commercial |
$1,494.72
|
| Rate for Payer: Cigna All Products |
$1,492.99
|
| Rate for Payer: Coventry/First Health All Products |
$1,522.40
|
| Rate for Payer: Encore All Products |
$1,592.46
|
| Rate for Payer: Frontpath All Products |
$1,591.60
|
| Rate for Payer: Humana ChoiceCare |
$1,494.20
|
| Rate for Payer: Lutheran Preferred All Products |
$1,557.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,297.50
|
| Rate for Payer: PHP All Products |
$1,312.03
|
| Rate for Payer: Sagamore All Products |
$1,335.56
|
| Rate for Payer: Self Pay/Cash Rate |
$1,072.60
|
| Rate for Payer: Signature Care EPO |
$1,435.90
|
| Rate for Payer: Signature Care PPO |
$1,522.40
|
| Rate for Payer: United Healthcare Commercial |
$1,363.24
|
|
|
HC ACU POST LAT FIB PLATE 7-H R
|
Facility
OP
|
$1,730.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.90 |
| Max. Negotiated Rate |
$1,592.46 |
| Rate for Payer: Aetna Commercial |
$1,460.12
|
| Rate for Payer: Aetna Medicare |
$570.90
|
| Rate for Payer: Anthem Exchange |
$993.54
|
| Rate for Payer: Anthem Medicare |
$570.90
|
| Rate for Payer: Anthem PPO |
$993.54
|
| Rate for Payer: Anthem Traditional |
$1,081.42
|
| Rate for Payer: Caresource Just 4 Me |
$656.53
|
| Rate for Payer: Caresource Medicare |
$627.99
|
| Rate for Payer: Centivo/Paragon All Products |
$882.30
|
| Rate for Payer: Cigna All Products |
$1,492.99
|
| Rate for Payer: Coventry/First Health All Products |
$1,522.40
|
| Rate for Payer: Encore All Products |
$1,592.46
|
| Rate for Payer: Frontpath All Products |
$1,591.60
|
| Rate for Payer: Humana ChoiceCare |
$1,494.20
|
| Rate for Payer: Humana Medicare |
$882.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$882.30
|
| Rate for Payer: Lutheran Preferred All Products |
$1,557.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,297.50
|
| Rate for Payer: PHP All Products |
$1,312.03
|
| Rate for Payer: Plain Church Group Ministry All Products |
$674.70
|
| Rate for Payer: Sagamore All Products |
$1,335.56
|
| Rate for Payer: Self Pay/Cash Rate |
$1,072.60
|
| Rate for Payer: Signature Care EPO |
$1,435.90
|
| Rate for Payer: Signature Care PPO |
$1,522.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,470.50
|
| Rate for Payer: United Healthcare Commercial |
$1,363.24
|
| Rate for Payer: United Healthcare Medicare |
$570.90
|
|
|
HC ACU POST MED DIS TIB PLT 3H L
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602790
|
|
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 MED DIS TIB PLT 3H L
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602790
|
|
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 MED DIS TIB PLT 3H R
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602791
|
|
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 MED DIS TIB PLT 3H R
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,693.72 |
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| 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: 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 RADIAL HEAD 22.0 LEFT
|
Facility
OP
|
$3,965.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.45 |
| Max. Negotiated Rate |
$3,649.78 |
| Rate for Payer: Aetna Commercial |
$3,346.46
|
| Rate for Payer: Aetna Medicare |
$1,308.45
|
| Rate for Payer: Anthem Exchange |
$2,277.10
|
| Rate for Payer: Anthem Medicare |
$1,308.45
|
| Rate for Payer: Anthem PPO |
$2,277.10
|
| Rate for Payer: Anthem Traditional |
$2,478.52
|
| Rate for Payer: Caresource Just 4 Me |
$1,504.72
|
| Rate for Payer: Caresource Medicare |
$1,439.29
|
| Rate for Payer: Centivo/Paragon All Products |
$2,022.15
|
| Rate for Payer: Cigna All Products |
$3,421.80
|
| Rate for Payer: Coventry/First Health All Products |
$3,489.20
|
| Rate for Payer: Encore All Products |
$3,649.78
|
| Rate for Payer: Frontpath All Products |
$3,647.80
|
| Rate for Payer: Humana ChoiceCare |
$3,424.57
|
| Rate for Payer: Humana Medicare |
$2,022.15
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,022.15
|
| Rate for Payer: Lutheran Preferred All Products |
$3,568.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,973.75
|
| Rate for Payer: PHP All Products |
$3,007.06
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,546.35
|
| Rate for Payer: Sagamore All Products |
$3,060.98
|
| Rate for Payer: Self Pay/Cash Rate |
$2,458.30
|
| Rate for Payer: Signature Care EPO |
$3,290.95
|
| Rate for Payer: Signature Care PPO |
$3,489.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$3,370.25
|
| Rate for Payer: United Healthcare Commercial |
$3,124.42
|
| Rate for Payer: United Healthcare Medicare |
$1,308.45
|
|
|
HC ACU RADIAL HEAD 22.0 LEFT
|
Facility
IP
|
$3,965.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,458.30 |
| Max. Negotiated Rate |
$3,649.78 |
| Rate for Payer: Aetna Commercial |
$3,425.76
|
| Rate for Payer: Cigna All Products |
$3,421.80
|
| Rate for Payer: Coventry/First Health All Products |
$3,489.20
|
| Rate for Payer: Encore All Products |
$3,649.78
|
| Rate for Payer: Frontpath All Products |
$3,647.80
|
| Rate for Payer: Humana ChoiceCare |
$3,424.57
|
| Rate for Payer: Lutheran Preferred All Products |
$3,568.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,973.75
|
| Rate for Payer: PHP All Products |
$3,007.06
|
| Rate for Payer: Sagamore All Products |
$3,060.98
|
| Rate for Payer: Self Pay/Cash Rate |
$2,458.30
|
| Rate for Payer: Signature Care EPO |
$3,290.95
|
| Rate for Payer: Signature Care PPO |
$3,489.20
|
| Rate for Payer: United Healthcare Commercial |
$3,124.42
|
|
|
HC ACU RADIAL STEM 9.0X0.00
|
Facility
IP
|
$2,704.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,676.48 |
| Max. Negotiated Rate |
$2,489.03 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Cigna All Products |
$2,333.55
|
| Rate for Payer: Coventry/First Health All Products |
$2,379.52
|
| Rate for Payer: Encore All Products |
$2,489.03
|
| Rate for Payer: Frontpath All Products |
$2,487.68
|
| Rate for Payer: Humana ChoiceCare |
$2,335.44
|
| Rate for Payer: Lutheran Preferred All Products |
$2,433.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,028.00
|
| Rate for Payer: PHP All Products |
$2,050.71
|
| Rate for Payer: Sagamore All Products |
$2,087.49
|
| Rate for Payer: Self Pay/Cash Rate |
$1,676.48
|
| Rate for Payer: Signature Care EPO |
$2,244.32
|
| Rate for Payer: Signature Care PPO |
$2,379.52
|
| Rate for Payer: United Healthcare Commercial |
$2,130.75
|
|
|
HC ACU RADIAL STEM 9.0X0.00
|
Facility
OP
|
$2,704.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.32 |
| Max. Negotiated Rate |
$2,489.03 |
| Rate for Payer: Aetna Commercial |
$2,282.18
|
| Rate for Payer: Aetna Medicare |
$892.32
|
| Rate for Payer: Anthem Exchange |
$1,552.91
|
| Rate for Payer: Anthem Medicare |
$892.32
|
| Rate for Payer: Anthem PPO |
$1,552.91
|
| Rate for Payer: Anthem Traditional |
$1,690.27
|
| Rate for Payer: Caresource Just 4 Me |
$1,026.17
|
| Rate for Payer: Caresource Medicare |
$981.55
|
| Rate for Payer: Centivo/Paragon All Products |
$1,379.04
|
| Rate for Payer: Cigna All Products |
$2,333.55
|
| Rate for Payer: Coventry/First Health All Products |
$2,379.52
|
| Rate for Payer: Encore All Products |
$2,489.03
|
| Rate for Payer: Frontpath All Products |
$2,487.68
|
| Rate for Payer: Humana ChoiceCare |
$2,335.44
|
| Rate for Payer: Humana Medicare |
$1,379.04
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,379.04
|
| Rate for Payer: Lutheran Preferred All Products |
$2,433.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,028.00
|
| Rate for Payer: PHP All Products |
$2,050.71
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,054.56
|
| Rate for Payer: Sagamore All Products |
$2,087.49
|
| Rate for Payer: Self Pay/Cash Rate |
$1,676.48
|
| Rate for Payer: Signature Care EPO |
$2,244.32
|
| Rate for Payer: Signature Care PPO |
$2,379.52
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,298.40
|
| Rate for Payer: United Healthcare Commercial |
$2,130.75
|
| Rate for Payer: United Healthcare Medicare |
$892.32
|
|
