|
HC ACU SCREW 3.5X30 NL LP HEX
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.88 |
| Max. Negotiated Rate |
$298.24 |
| Rate for Payer: Aetna Commercial |
$279.94
|
| Rate for Payer: Cigna All Products |
$279.61
|
| Rate for Payer: Coventry/First Health All Products |
$285.12
|
| Rate for Payer: Encore All Products |
$298.24
|
| Rate for Payer: Frontpath All Products |
$298.08
|
| Rate for Payer: Humana ChoiceCare |
$279.84
|
| Rate for Payer: Lutheran Preferred All Products |
$291.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$243.00
|
| Rate for Payer: PHP All Products |
$245.72
|
| Rate for Payer: Sagamore All Products |
$250.13
|
| Rate for Payer: Self Pay/Cash Rate |
$200.88
|
| Rate for Payer: Signature Care EPO |
$268.92
|
| Rate for Payer: Signature Care PPO |
$285.12
|
| Rate for Payer: United Healthcare Commercial |
$255.31
|
|
|
HC ACU SCREW 3.5X30 NL LP HEX
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$298.24 |
| Rate for Payer: Signature Care PPO |
$285.12
|
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: Anthem Exchange |
$186.07
|
| Rate for Payer: Anthem Medicare |
$106.92
|
| Rate for Payer: Anthem PPO |
$186.07
|
| Rate for Payer: Anthem Traditional |
$202.53
|
| Rate for Payer: Caresource Just 4 Me |
$122.96
|
| Rate for Payer: Caresource Medicare |
$117.61
|
| Rate for Payer: Centivo/Paragon All Products |
$165.24
|
| Rate for Payer: Cigna All Products |
$279.61
|
| Rate for Payer: Coventry/First Health All Products |
$285.12
|
| Rate for Payer: Encore All Products |
$298.24
|
| Rate for Payer: Frontpath All Products |
$298.08
|
| Rate for Payer: Humana ChoiceCare |
$279.84
|
| Rate for Payer: Humana Medicare |
$165.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$165.24
|
| Rate for Payer: Lutheran Preferred All Products |
$291.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$243.00
|
| Rate for Payer: PHP All Products |
$245.72
|
| Rate for Payer: Plain Church Group Ministry All Products |
$126.36
|
| Rate for Payer: Sagamore All Products |
$250.13
|
| Rate for Payer: Self Pay/Cash Rate |
$200.88
|
| Rate for Payer: Signature Care EPO |
$268.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$275.40
|
| Rate for Payer: United Healthcare Commercial |
$255.31
|
| Rate for Payer: United Healthcare Medicare |
$106.92
|
|
|
HC ACU SCREW 3.5X32 NL LP HEX
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.88 |
| Max. Negotiated Rate |
$298.24 |
| Rate for Payer: Aetna Commercial |
$279.94
|
| Rate for Payer: Cigna All Products |
$279.61
|
| Rate for Payer: Coventry/First Health All Products |
$285.12
|
| Rate for Payer: Encore All Products |
$298.24
|
| Rate for Payer: Frontpath All Products |
$298.08
|
| Rate for Payer: Humana ChoiceCare |
$279.84
|
| Rate for Payer: Lutheran Preferred All Products |
$291.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$243.00
|
| Rate for Payer: PHP All Products |
$245.72
|
| Rate for Payer: Sagamore All Products |
$250.13
|
| Rate for Payer: Self Pay/Cash Rate |
$200.88
|
| Rate for Payer: Signature Care EPO |
$268.92
|
| Rate for Payer: Signature Care PPO |
$285.12
|
| Rate for Payer: United Healthcare Commercial |
$255.31
|
|
|
HC ACU SCREW 3.5X32 NL LP HEX
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$298.24 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: Anthem Exchange |
$186.07
|
| Rate for Payer: Anthem Medicare |
$106.92
|
| Rate for Payer: Anthem PPO |
$186.07
|
| Rate for Payer: Anthem Traditional |
$202.53
|
| Rate for Payer: Caresource Just 4 Me |
$122.96
|
| Rate for Payer: Caresource Medicare |
$117.61
|
| Rate for Payer: Centivo/Paragon All Products |
$165.24
|
| Rate for Payer: Cigna All Products |
$279.61
|
| Rate for Payer: Coventry/First Health All Products |
$285.12
|
| Rate for Payer: Encore All Products |
$298.24
|
| Rate for Payer: Frontpath All Products |
$298.08
|
| Rate for Payer: Humana ChoiceCare |
$279.84
|
| Rate for Payer: Humana Medicare |
$165.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$165.24
|
| Rate for Payer: Lutheran Preferred All Products |
$291.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$243.00
|
| Rate for Payer: PHP All Products |
$245.72
|
| Rate for Payer: Plain Church Group Ministry All Products |
$126.36
|
| Rate for Payer: Sagamore All Products |
$250.13
|
| Rate for Payer: Self Pay/Cash Rate |
$200.88
|
| Rate for Payer: Signature Care EPO |
$268.92
|
| Rate for Payer: Signature Care PPO |
$285.12
|
| Rate for Payer: Three Rivers Preferred All Products |
$275.40
|
| Rate for Payer: United Healthcare Commercial |
$255.31
|
| Rate for Payer: United Healthcare Medicare |
$106.92
|
|
|
HC ACU SCREW 3.5X36 NL LP HEX
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.88 |
| Max. Negotiated Rate |
$298.24 |
| Rate for Payer: Aetna Commercial |
$279.94
|
| Rate for Payer: Cigna All Products |
$279.61
|
| Rate for Payer: Coventry/First Health All Products |
$285.12
|
| Rate for Payer: Encore All Products |
$298.24
|
| Rate for Payer: Frontpath All Products |
$298.08
|
| Rate for Payer: Humana ChoiceCare |
$279.84
|
| Rate for Payer: Lutheran Preferred All Products |
$291.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$243.00
|
| Rate for Payer: PHP All Products |
$245.72
|
| Rate for Payer: Sagamore All Products |
$250.13
|
| Rate for Payer: Self Pay/Cash Rate |
$200.88
|
| Rate for Payer: Signature Care EPO |
$268.92
|
| Rate for Payer: Signature Care PPO |
$285.12
|
| Rate for Payer: United Healthcare Commercial |
$255.31
|
|
|
HC ACU SCREW 3.5X36 NL LP HEX
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$298.24 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: Anthem Exchange |
$186.07
|
| Rate for Payer: Anthem Medicare |
$106.92
|
| Rate for Payer: Anthem PPO |
$186.07
|
| Rate for Payer: Anthem Traditional |
$202.53
|
| Rate for Payer: Caresource Just 4 Me |
$122.96
|
| Rate for Payer: Caresource Medicare |
$117.61
|
| Rate for Payer: Centivo/Paragon All Products |
$165.24
|
| Rate for Payer: Cigna All Products |
$279.61
|
| Rate for Payer: Coventry/First Health All Products |
$285.12
|
| Rate for Payer: Encore All Products |
$298.24
|
| Rate for Payer: Frontpath All Products |
$298.08
|
| Rate for Payer: Humana ChoiceCare |
$279.84
|
| Rate for Payer: Humana Medicare |
$165.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$165.24
|
| Rate for Payer: Lutheran Preferred All Products |
$291.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$243.00
|
| Rate for Payer: PHP All Products |
$245.72
|
| Rate for Payer: Plain Church Group Ministry All Products |
$126.36
|
| Rate for Payer: Sagamore All Products |
$250.13
|
| Rate for Payer: Self Pay/Cash Rate |
$200.88
|
| Rate for Payer: Signature Care EPO |
$268.92
|
| Rate for Payer: Signature Care PPO |
$285.12
|
| Rate for Payer: Three Rivers Preferred All Products |
$275.40
|
| Rate for Payer: United Healthcare Commercial |
$255.31
|
| Rate for Payer: United Healthcare Medicare |
$106.92
|
|
|
HC ACU SCREW 3.5X8 HEX NON-LOCK
|
Facility
OP
|
$313.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$288.30 |
| Rate for Payer: Aetna Commercial |
$264.34
|
| Rate for Payer: Aetna Medicare |
$103.36
|
| Rate for Payer: Anthem Exchange |
$179.87
|
| Rate for Payer: Anthem Medicare |
$103.36
|
| Rate for Payer: Anthem PPO |
$179.87
|
| Rate for Payer: Anthem Traditional |
$195.78
|
| Rate for Payer: Caresource Just 4 Me |
$118.86
|
| Rate for Payer: Caresource Medicare |
$113.69
|
| Rate for Payer: Centivo/Paragon All Products |
$159.73
|
| Rate for Payer: Cigna All Products |
$270.29
|
| Rate for Payer: Coventry/First Health All Products |
$275.62
|
| Rate for Payer: Encore All Products |
$288.30
|
| Rate for Payer: Frontpath All Products |
$288.14
|
| Rate for Payer: Humana ChoiceCare |
$270.51
|
| Rate for Payer: Humana Medicare |
$159.73
|
| Rate for Payer: Lucent/Coldwater Veneers |
$159.73
|
| Rate for Payer: Lutheran Preferred All Products |
$281.88
|
| Rate for Payer: PHCS/Multiplan All Products |
$234.90
|
| Rate for Payer: PHP All Products |
$237.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$122.15
|
| Rate for Payer: Sagamore All Products |
$241.79
|
| Rate for Payer: Self Pay/Cash Rate |
$194.18
|
| Rate for Payer: Signature Care EPO |
$259.96
|
| Rate for Payer: Signature Care PPO |
$275.62
|
| Rate for Payer: Three Rivers Preferred All Products |
$266.22
|
| Rate for Payer: United Healthcare Commercial |
$246.80
|
| Rate for Payer: United Healthcare Medicare |
$103.36
|
|
|
HC ACU SCREW 3.5X8 HEX NON-LOCK
|
Facility
IP
|
$313.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.18 |
| Max. Negotiated Rate |
$288.30 |
| Rate for Payer: Aetna Commercial |
$270.60
|
| Rate for Payer: Cigna All Products |
$270.29
|
| Rate for Payer: Coventry/First Health All Products |
$275.62
|
| Rate for Payer: Encore All Products |
$288.30
|
| Rate for Payer: Frontpath All Products |
$288.14
|
| Rate for Payer: Humana ChoiceCare |
$270.51
|
| Rate for Payer: Lutheran Preferred All Products |
$281.88
|
| Rate for Payer: PHCS/Multiplan All Products |
$234.90
|
| Rate for Payer: PHP All Products |
$237.53
|
| Rate for Payer: Sagamore All Products |
$241.79
|
| Rate for Payer: Self Pay/Cash Rate |
$194.18
|
| Rate for Payer: Signature Care EPO |
$259.96
|
| Rate for Payer: Signature Care PPO |
$275.62
|
| Rate for Payer: United Healthcare Commercial |
$246.80
|
|
|
HC ACU SCREW 4.3X34 LP HEX
|
Facility
IP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$441.68
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
|
|
HC ACU SCREW 4.3X34 LP HEX
|
Facility
OP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$431.45
|
| Rate for Payer: Aetna Medicare |
$168.70
|
| Rate for Payer: Anthem Exchange |
$293.58
|
| Rate for Payer: Anthem Medicare |
$168.70
|
| Rate for Payer: Anthem PPO |
$293.58
|
| Rate for Payer: Anthem Traditional |
$319.55
|
| Rate for Payer: Caresource Just 4 Me |
$194.00
|
| Rate for Payer: Caresource Medicare |
$185.57
|
| Rate for Payer: Centivo/Paragon All Products |
$260.71
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Humana Medicare |
$260.71
|
| Rate for Payer: Lucent/Coldwater Veneers |
$260.71
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$199.37
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$434.52
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
| Rate for Payer: United Healthcare Medicare |
$168.70
|
|
|
HC ACU SCREW 4.3X36 LP HEX
|
Facility
OP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$431.45
|
| Rate for Payer: Aetna Medicare |
$168.70
|
| Rate for Payer: Anthem Exchange |
$293.58
|
| Rate for Payer: Anthem Medicare |
$168.70
|
| Rate for Payer: Anthem PPO |
$293.58
|
| Rate for Payer: Anthem Traditional |
$319.55
|
| Rate for Payer: Caresource Just 4 Me |
$194.00
|
| Rate for Payer: Caresource Medicare |
$185.57
|
| Rate for Payer: Centivo/Paragon All Products |
$260.71
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Humana Medicare |
$260.71
|
| Rate for Payer: Lucent/Coldwater Veneers |
$260.71
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$199.37
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$434.52
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
| Rate for Payer: United Healthcare Medicare |
$168.70
|
|
|
HC ACU SCREW 4.3X36 LP HEX
|
Facility
IP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$441.68
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
|
|
HC ACU SCREW 4.3X38 LP HEX
|
Facility
OP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$431.45
|
| Rate for Payer: Aetna Medicare |
$168.70
|
| Rate for Payer: Anthem Exchange |
$293.58
|
| Rate for Payer: Anthem Medicare |
$168.70
|
| Rate for Payer: Anthem PPO |
$293.58
|
| Rate for Payer: Anthem Traditional |
$319.55
|
| Rate for Payer: Caresource Just 4 Me |
$194.00
|
| Rate for Payer: Caresource Medicare |
$185.57
|
| Rate for Payer: Centivo/Paragon All Products |
$260.71
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Humana Medicare |
$260.71
|
| Rate for Payer: Lucent/Coldwater Veneers |
$260.71
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$199.37
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$434.52
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
| Rate for Payer: United Healthcare Medicare |
$168.70
|
|
|
HC ACU SCREW 4.3X38 LP HEX
|
Facility
IP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$441.68
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
|
|
HC ACU SCREW 4.3X46 LP HEX
|
Facility
OP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$431.45
|
| Rate for Payer: Aetna Medicare |
$168.70
|
| Rate for Payer: Anthem Exchange |
$293.58
|
| Rate for Payer: Anthem Medicare |
$168.70
|
| Rate for Payer: Anthem PPO |
$293.58
|
| Rate for Payer: Anthem Traditional |
$319.55
|
| Rate for Payer: Caresource Just 4 Me |
$194.00
|
| Rate for Payer: Caresource Medicare |
$185.57
|
| Rate for Payer: Centivo/Paragon All Products |
$260.71
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Humana Medicare |
$260.71
|
| Rate for Payer: Lucent/Coldwater Veneers |
$260.71
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$199.37
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$434.52
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
| Rate for Payer: United Healthcare Medicare |
$168.70
|
|
|
HC ACU SCREW 4.3X46 LP HEX
|
Facility
IP
|
$511.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$470.56 |
| Rate for Payer: Aetna Commercial |
$441.68
|
| Rate for Payer: Cigna All Products |
$441.17
|
| Rate for Payer: Coventry/First Health All Products |
$449.86
|
| Rate for Payer: Encore All Products |
$470.56
|
| Rate for Payer: Frontpath All Products |
$470.30
|
| Rate for Payer: Humana ChoiceCare |
$441.52
|
| Rate for Payer: Lutheran Preferred All Products |
$460.08
|
| Rate for Payer: PHCS/Multiplan All Products |
$383.40
|
| Rate for Payer: PHP All Products |
$387.69
|
| Rate for Payer: Sagamore All Products |
$394.65
|
| Rate for Payer: Self Pay/Cash Rate |
$316.94
|
| Rate for Payer: Signature Care EPO |
$424.30
|
| Rate for Payer: Signature Care PPO |
$449.86
|
| Rate for Payer: United Healthcare Commercial |
$402.83
|
|
|
HC ACUTE CARE ROOM
|
Facility
OP
|
$1,612.00
|
|
| Hospital Charge Code |
10010051
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$531.96 |
| Max. Negotiated Rate |
$1,483.85 |
| Rate for Payer: Aetna Commercial |
$1,360.53
|
| Rate for Payer: Aetna Medicare |
$531.96
|
| Rate for Payer: Anthem Exchange |
$925.77
|
| Rate for Payer: Anthem Medicare |
$531.96
|
| Rate for Payer: Anthem PPO |
$925.77
|
| Rate for Payer: Anthem Traditional |
$1,007.66
|
| Rate for Payer: Caresource Just 4 Me |
$611.75
|
| Rate for Payer: Caresource Medicare |
$585.16
|
| Rate for Payer: Centivo/Paragon All Products |
$822.12
|
| Rate for Payer: Cigna All Products |
$1,391.16
|
| Rate for Payer: Coventry/First Health All Products |
$1,418.56
|
| Rate for Payer: Encore All Products |
$1,483.85
|
| Rate for Payer: Frontpath All Products |
$1,483.04
|
| Rate for Payer: Humana ChoiceCare |
$1,392.28
|
| Rate for Payer: Humana Medicare |
$822.12
|
| Rate for Payer: Lucent/Coldwater Veneers |
$822.12
|
| Rate for Payer: Lutheran Preferred All Products |
$1,450.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,209.00
|
| Rate for Payer: PHP All Products |
$1,222.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$628.68
|
| Rate for Payer: Sagamore All Products |
$1,244.46
|
| Rate for Payer: Self Pay/Cash Rate |
$999.44
|
| Rate for Payer: Signature Care EPO |
$1,337.96
|
| Rate for Payer: Signature Care PPO |
$1,418.56
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,370.20
|
| Rate for Payer: United Healthcare Commercial |
$1,270.26
|
| Rate for Payer: United Healthcare Medicare |
$531.96
|
|
|
HC ACUTE CARE ROOM
|
Facility
IP
|
$1,612.00
|
|
| Hospital Charge Code |
10010051
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$999.44 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Aetna Commercial |
$1,392.77
|
| Rate for Payer: Aetna Medicare |
$3,285.00
|
| Rate for Payer: Anthem Medicare |
$3,285.00
|
| Rate for Payer: Caresource Just 4 Me |
$3,777.75
|
| Rate for Payer: Caresource Medicare |
$3,613.50
|
| Rate for Payer: Centivo/Paragon All Products |
$5,584.50
|
| Rate for Payer: Cigna All Products |
$1,391.16
|
| Rate for Payer: Coventry/First Health All Products |
$1,418.56
|
| Rate for Payer: Encore All Products |
$1,483.85
|
| Rate for Payer: Frontpath All Products |
$1,483.04
|
| Rate for Payer: Humana ChoiceCare |
$1,392.28
|
| Rate for Payer: Humana Medicare |
$3,285.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$5,584.50
|
| Rate for Payer: Lutheran Preferred All Products |
$1,450.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,209.00
|
| Rate for Payer: PHP All Products |
$1,222.54
|
| Rate for Payer: Sagamore All Products |
$1,244.46
|
| Rate for Payer: Self Pay/Cash Rate |
$999.44
|
| Rate for Payer: Signature Care EPO |
$1,337.96
|
| Rate for Payer: Signature Care PPO |
$1,418.56
|
| Rate for Payer: United Healthcare Commercial |
$1,270.26
|
| Rate for Payer: United Healthcare Medicare |
$3,285.00
|
|
|
HC ACU T FRAG PLATE 2.7MM
|
Facility
IP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602808
|
|
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 T FRAG PLATE 2.7MM
|
Facility
OP
|
$1,340.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602808
|
|
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 VDR HEX EXT LINK SCREW
|
Facility
IP
|
$868.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.16 |
| Max. Negotiated Rate |
$798.99 |
| Rate for Payer: Aetna Commercial |
$749.95
|
| Rate for Payer: Cigna All Products |
$749.08
|
| Rate for Payer: Coventry/First Health All Products |
$763.84
|
| Rate for Payer: Encore All Products |
$798.99
|
| Rate for Payer: Frontpath All Products |
$798.56
|
| Rate for Payer: Humana ChoiceCare |
$749.69
|
| Rate for Payer: Lutheran Preferred All Products |
$781.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$651.00
|
| Rate for Payer: PHP All Products |
$658.29
|
| Rate for Payer: Sagamore All Products |
$670.10
|
| Rate for Payer: Self Pay/Cash Rate |
$538.16
|
| Rate for Payer: Signature Care EPO |
$720.44
|
| Rate for Payer: Signature Care PPO |
$763.84
|
| Rate for Payer: United Healthcare Commercial |
$683.98
|
|
|
HC ACU VDR HEX EXT LINK SCREW
|
Facility
OP
|
$868.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$798.99 |
| Rate for Payer: Aetna Commercial |
$732.59
|
| Rate for Payer: Aetna Medicare |
$286.44
|
| Rate for Payer: Anthem Exchange |
$498.49
|
| Rate for Payer: Anthem Medicare |
$286.44
|
| Rate for Payer: Anthem PPO |
$498.49
|
| Rate for Payer: Anthem Traditional |
$542.59
|
| Rate for Payer: Caresource Just 4 Me |
$329.41
|
| Rate for Payer: Caresource Medicare |
$315.08
|
| Rate for Payer: Centivo/Paragon All Products |
$442.68
|
| Rate for Payer: Cigna All Products |
$749.08
|
| Rate for Payer: Coventry/First Health All Products |
$763.84
|
| Rate for Payer: Encore All Products |
$798.99
|
| Rate for Payer: Frontpath All Products |
$798.56
|
| Rate for Payer: Humana ChoiceCare |
$749.69
|
| Rate for Payer: Humana Medicare |
$442.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$442.68
|
| Rate for Payer: Lutheran Preferred All Products |
$781.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$651.00
|
| Rate for Payer: PHP All Products |
$658.29
|
| Rate for Payer: Plain Church Group Ministry All Products |
$338.52
|
| Rate for Payer: Sagamore All Products |
$670.10
|
| Rate for Payer: Self Pay/Cash Rate |
$538.16
|
| Rate for Payer: Signature Care EPO |
$720.44
|
| Rate for Payer: Signature Care PPO |
$763.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$737.80
|
| Rate for Payer: United Healthcare Commercial |
$683.98
|
| Rate for Payer: United Healthcare Medicare |
$286.44
|
|
|
HC ACU VDU PLATE LEFT LONG
|
Facility
OP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,924.32
|
| Rate for Payer: Aetna Medicare |
$752.40
|
| Rate for Payer: Anthem Exchange |
$1,309.40
|
| Rate for Payer: Anthem Medicare |
$752.40
|
| Rate for Payer: Anthem PPO |
$1,309.40
|
| Rate for Payer: Anthem Traditional |
$1,425.23
|
| Rate for Payer: Caresource Just 4 Me |
$865.26
|
| Rate for Payer: Caresource Medicare |
$827.64
|
| Rate for Payer: Centivo/Paragon All Products |
$1,162.80
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Humana Medicare |
$1,162.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,162.80
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$889.20
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,938.00
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare Medicare |
$752.40
|
|
|
HC ACU VDU PLATE LEFT LONG
|
Facility
IP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.60 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,969.92
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
|
|
HC ACU VDU PLATE LEFT STD
|
Facility
OP
|
$2,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$2,098.74 |
| Rate for Payer: Aetna Commercial |
$1,924.32
|
| Rate for Payer: Aetna Medicare |
$752.40
|
| Rate for Payer: Anthem Exchange |
$1,309.40
|
| Rate for Payer: Anthem Medicare |
$752.40
|
| Rate for Payer: Anthem PPO |
$1,309.40
|
| Rate for Payer: Anthem Traditional |
$1,425.23
|
| Rate for Payer: Caresource Just 4 Me |
$865.26
|
| Rate for Payer: Caresource Medicare |
$827.64
|
| Rate for Payer: Centivo/Paragon All Products |
$1,162.80
|
| Rate for Payer: Cigna All Products |
$1,967.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,006.40
|
| Rate for Payer: Encore All Products |
$2,098.74
|
| Rate for Payer: Frontpath All Products |
$2,097.60
|
| Rate for Payer: Humana ChoiceCare |
$1,969.24
|
| Rate for Payer: Humana Medicare |
$1,162.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,162.80
|
| Rate for Payer: Lutheran Preferred All Products |
$2,052.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,710.00
|
| Rate for Payer: PHP All Products |
$1,729.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$889.20
|
| Rate for Payer: Sagamore All Products |
$1,760.16
|
| Rate for Payer: Self Pay/Cash Rate |
$1,413.60
|
| Rate for Payer: Signature Care EPO |
$1,892.40
|
| Rate for Payer: Signature Care PPO |
$2,006.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,938.00
|
| Rate for Payer: United Healthcare Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare Medicare |
$752.40
|
|
