|
HC ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$415.21
|
|
| Hospital Charge Code |
1682004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.72 |
| Max. Negotiated Rate |
$386.15 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Aetna Medicare |
$132.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$238.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.15
|
| Rate for Payer: Cash Price |
$249.13
|
| Rate for Payer: Centivo All Commercial |
$225.87
|
| Rate for Payer: Cigna All Commercial |
$358.33
|
| Rate for Payer: CORVEL All Commercial |
$386.15
|
| Rate for Payer: Coventry All Commercial |
$365.38
|
| Rate for Payer: Encore All Commercial |
$382.20
|
| Rate for Payer: Frontpath All Commercial |
$381.99
|
| Rate for Payer: Humana ChoiceCare |
$358.62
|
| Rate for Payer: Humana Medicare |
$132.87
|
| Rate for Payer: Lucent All Commercial |
$225.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.69
|
| Rate for Payer: PHCS All Commercial |
$311.41
|
| Rate for Payer: PHP All Commercial |
$314.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.93
|
| Rate for Payer: Sagamore Health Network All Products |
$320.54
|
| Rate for Payer: Signature Care EPO |
$344.62
|
| Rate for Payer: Signature Care PPO |
$365.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.93
|
| Rate for Payer: United Healthcare Commercial |
$327.19
|
| Rate for Payer: United Healthcare Medicare |
$132.87
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$340.68
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
1620605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$316.83 |
| Rate for Payer: Aetna Commercial |
$287.53
|
| Rate for Payer: Aetna Medicare |
$109.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$195.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$212.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.92
|
| Rate for Payer: Cash Price |
$204.41
|
| Rate for Payer: Cash Price |
$204.41
|
| Rate for Payer: Centivo All Commercial |
$185.33
|
| Rate for Payer: Cigna All Commercial |
$294.01
|
| Rate for Payer: CORVEL All Commercial |
$316.83
|
| Rate for Payer: Coventry All Commercial |
$299.80
|
| Rate for Payer: Encore All Commercial |
$313.60
|
| Rate for Payer: Frontpath All Commercial |
$313.43
|
| Rate for Payer: Humana ChoiceCare |
$294.25
|
| Rate for Payer: Humana Medicare |
$109.02
|
| Rate for Payer: Lucent All Commercial |
$185.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.61
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$255.51
|
| Rate for Payer: PHP All Commercial |
$258.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.87
|
| Rate for Payer: Sagamore Health Network All Products |
$263.00
|
| Rate for Payer: Signature Care EPO |
$282.76
|
| Rate for Payer: Signature Care PPO |
$299.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$289.58
|
| Rate for Payer: United Healthcare Commercial |
$268.46
|
| Rate for Payer: United Healthcare Medicare |
$109.02
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$340.68
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
1620605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.51 |
| Max. Negotiated Rate |
$316.83 |
| Rate for Payer: Aetna Commercial |
$294.35
|
| Rate for Payer: Cash Price |
$204.41
|
| Rate for Payer: Cigna All Commercial |
$294.01
|
| Rate for Payer: CORVEL All Commercial |
$316.83
|
| Rate for Payer: Coventry All Commercial |
$299.80
|
| Rate for Payer: Encore All Commercial |
$313.60
|
| Rate for Payer: Frontpath All Commercial |
$313.43
|
| Rate for Payer: Humana ChoiceCare |
$294.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.61
|
| Rate for Payer: PHCS All Commercial |
$255.51
|
| Rate for Payer: PHP All Commercial |
$258.37
|
| Rate for Payer: Sagamore Health Network All Products |
$263.00
|
| Rate for Payer: Signature Care EPO |
$282.76
|
| Rate for Payer: Signature Care PPO |
$299.80
|
| Rate for Payer: United Healthcare Commercial |
$268.46
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
IP
|
$528.36
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
1620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.27 |
| Max. Negotiated Rate |
$491.37 |
| Rate for Payer: Aetna Commercial |
$456.50
|
| Rate for Payer: Cash Price |
$317.02
|
| Rate for Payer: Cigna All Commercial |
$455.97
|
| Rate for Payer: CORVEL All Commercial |
$491.37
|
| Rate for Payer: Coventry All Commercial |
$464.96
|
| Rate for Payer: Encore All Commercial |
$486.36
|
| Rate for Payer: Frontpath All Commercial |
$486.09
|
| Rate for Payer: Humana ChoiceCare |
$456.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.52
|
| Rate for Payer: PHCS All Commercial |
$396.27
|
| Rate for Payer: PHP All Commercial |
$400.71
|
| Rate for Payer: Sagamore Health Network All Products |
$407.89
|
| Rate for Payer: Signature Care EPO |
$438.54
|
| Rate for Payer: Signature Care PPO |
$464.96
|
| Rate for Payer: United Healthcare Commercial |
$416.35
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
OP
|
$528.36
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
1620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.79 |
| Max. Negotiated Rate |
$491.37 |
| Rate for Payer: Aetna Commercial |
$445.94
|
| Rate for Payer: Aetna Medicare |
$169.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$166.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$163.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$303.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$330.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$166.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.98
|
| Rate for Payer: Cash Price |
$317.02
|
| Rate for Payer: Cash Price |
$317.02
|
| Rate for Payer: Centivo All Commercial |
$287.43
|
| Rate for Payer: Cigna All Commercial |
$455.97
|
| Rate for Payer: CORVEL All Commercial |
$491.37
|
| Rate for Payer: Coventry All Commercial |
$464.96
|
| Rate for Payer: Encore All Commercial |
$486.36
|
| Rate for Payer: Frontpath All Commercial |
$486.09
|
| Rate for Payer: Humana ChoiceCare |
$456.34
|
| Rate for Payer: Humana Medicare |
$169.08
|
| Rate for Payer: Lucent All Commercial |
$287.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.52
|
| Rate for Payer: Managed Health Services Medicaid |
$166.20
|
| Rate for Payer: MDWise Medicaid |
$166.20
|
| Rate for Payer: PHCS All Commercial |
$396.27
|
| Rate for Payer: PHP All Commercial |
$400.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.06
|
| Rate for Payer: Sagamore Health Network All Products |
$407.89
|
| Rate for Payer: Signature Care EPO |
$438.54
|
| Rate for Payer: Signature Care PPO |
$464.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$449.11
|
| Rate for Payer: United Healthcare Commercial |
$416.35
|
| Rate for Payer: United Healthcare Medicare |
$169.08
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$378.42
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1660610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna Commercial |
$319.39
|
| Rate for Payer: Aetna Medicare |
$121.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$217.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$236.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$227.05
|
| Rate for Payer: Cash Price |
$227.05
|
| Rate for Payer: Centivo All Commercial |
$205.86
|
| Rate for Payer: Cigna All Commercial |
$326.58
|
| Rate for Payer: CORVEL All Commercial |
$351.93
|
| Rate for Payer: Coventry All Commercial |
$333.01
|
| Rate for Payer: Encore All Commercial |
$348.34
|
| Rate for Payer: Frontpath All Commercial |
$348.15
|
| Rate for Payer: Humana ChoiceCare |
$326.84
|
| Rate for Payer: Humana Medicare |
$121.09
|
| Rate for Payer: Lucent All Commercial |
$205.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.58
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$283.81
|
| Rate for Payer: PHP All Commercial |
$286.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.58
|
| Rate for Payer: Sagamore Health Network All Products |
$292.14
|
| Rate for Payer: Signature Care EPO |
$314.09
|
| Rate for Payer: Signature Care PPO |
$333.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$321.66
|
| Rate for Payer: United Healthcare Commercial |
$298.19
|
| Rate for Payer: United Healthcare Medicare |
$121.09
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$378.42
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1620610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna Commercial |
$319.39
|
| Rate for Payer: Aetna Medicare |
$121.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$217.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$236.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$227.05
|
| Rate for Payer: Cash Price |
$227.05
|
| Rate for Payer: Centivo All Commercial |
$205.86
|
| Rate for Payer: Cigna All Commercial |
$326.58
|
| Rate for Payer: CORVEL All Commercial |
$351.93
|
| Rate for Payer: Coventry All Commercial |
$333.01
|
| Rate for Payer: Encore All Commercial |
$348.34
|
| Rate for Payer: Frontpath All Commercial |
$348.15
|
| Rate for Payer: Humana ChoiceCare |
$326.84
|
| Rate for Payer: Humana Medicare |
$121.09
|
| Rate for Payer: Lucent All Commercial |
$205.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.58
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$283.81
|
| Rate for Payer: PHP All Commercial |
$286.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.58
|
| Rate for Payer: Sagamore Health Network All Products |
$292.14
|
| Rate for Payer: Signature Care EPO |
$314.09
|
| Rate for Payer: Signature Care PPO |
$333.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$321.66
|
| Rate for Payer: United Healthcare Commercial |
$298.19
|
| Rate for Payer: United Healthcare Medicare |
$121.09
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$378.42
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1620610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.81 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna Commercial |
$326.95
|
| Rate for Payer: Cash Price |
$227.05
|
| Rate for Payer: Cigna All Commercial |
$326.58
|
| Rate for Payer: CORVEL All Commercial |
$351.93
|
| Rate for Payer: Coventry All Commercial |
$333.01
|
| Rate for Payer: Encore All Commercial |
$348.34
|
| Rate for Payer: Frontpath All Commercial |
$348.15
|
| Rate for Payer: Humana ChoiceCare |
$326.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.58
|
| Rate for Payer: PHCS All Commercial |
$283.81
|
| Rate for Payer: PHP All Commercial |
$286.99
|
| Rate for Payer: Sagamore Health Network All Products |
$292.14
|
| Rate for Payer: Signature Care EPO |
$314.09
|
| Rate for Payer: Signature Care PPO |
$333.01
|
| Rate for Payer: United Healthcare Commercial |
$298.19
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$378.42
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1660610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.81 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna Commercial |
$326.95
|
| Rate for Payer: Cash Price |
$227.05
|
| Rate for Payer: Cigna All Commercial |
$326.58
|
| Rate for Payer: CORVEL All Commercial |
$351.93
|
| Rate for Payer: Coventry All Commercial |
$333.01
|
| Rate for Payer: Encore All Commercial |
$348.34
|
| Rate for Payer: Frontpath All Commercial |
$348.15
|
| Rate for Payer: Humana ChoiceCare |
$326.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$340.58
|
| Rate for Payer: PHCS All Commercial |
$283.81
|
| Rate for Payer: PHP All Commercial |
$286.99
|
| Rate for Payer: Sagamore Health Network All Products |
$292.14
|
| Rate for Payer: Signature Care EPO |
$314.09
|
| Rate for Payer: Signature Care PPO |
$333.01
|
| Rate for Payer: United Healthcare Commercial |
$298.19
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$415.14
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
1660611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$386.08 |
| Rate for Payer: Aetna Commercial |
$350.38
|
| Rate for Payer: Aetna Medicare |
$132.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$166.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$238.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$166.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.13
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Centivo All Commercial |
$225.84
|
| Rate for Payer: Cigna All Commercial |
$358.27
|
| Rate for Payer: CORVEL All Commercial |
$386.08
|
| Rate for Payer: Coventry All Commercial |
$365.32
|
| Rate for Payer: Encore All Commercial |
$382.14
|
| Rate for Payer: Frontpath All Commercial |
$381.93
|
| Rate for Payer: Humana ChoiceCare |
$358.56
|
| Rate for Payer: Humana Medicare |
$132.84
|
| Rate for Payer: Lucent All Commercial |
$225.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.63
|
| Rate for Payer: Managed Health Services Medicaid |
$166.20
|
| Rate for Payer: MDWise Medicaid |
$166.20
|
| Rate for Payer: PHCS All Commercial |
$311.36
|
| Rate for Payer: PHP All Commercial |
$314.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.90
|
| Rate for Payer: Sagamore Health Network All Products |
$320.49
|
| Rate for Payer: Signature Care EPO |
$344.57
|
| Rate for Payer: Signature Care PPO |
$365.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.87
|
| Rate for Payer: United Healthcare Commercial |
$327.13
|
| Rate for Payer: United Healthcare Medicare |
$132.84
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$415.14
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
1620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.36 |
| Max. Negotiated Rate |
$386.08 |
| Rate for Payer: Aetna Commercial |
$358.68
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cigna All Commercial |
$358.27
|
| Rate for Payer: CORVEL All Commercial |
$386.08
|
| Rate for Payer: Coventry All Commercial |
$365.32
|
| Rate for Payer: Encore All Commercial |
$382.14
|
| Rate for Payer: Frontpath All Commercial |
$381.93
|
| Rate for Payer: Humana ChoiceCare |
$358.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.63
|
| Rate for Payer: PHCS All Commercial |
$311.36
|
| Rate for Payer: PHP All Commercial |
$314.84
|
| Rate for Payer: Sagamore Health Network All Products |
$320.49
|
| Rate for Payer: Signature Care EPO |
$344.57
|
| Rate for Payer: Signature Care PPO |
$365.32
|
| Rate for Payer: United Healthcare Commercial |
$327.13
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$415.14
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
1660611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.36 |
| Max. Negotiated Rate |
$386.08 |
| Rate for Payer: Aetna Commercial |
$358.68
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cigna All Commercial |
$358.27
|
| Rate for Payer: CORVEL All Commercial |
$386.08
|
| Rate for Payer: Coventry All Commercial |
$365.32
|
| Rate for Payer: Encore All Commercial |
$382.14
|
| Rate for Payer: Frontpath All Commercial |
$381.93
|
| Rate for Payer: Humana ChoiceCare |
$358.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.63
|
| Rate for Payer: PHCS All Commercial |
$311.36
|
| Rate for Payer: PHP All Commercial |
$314.84
|
| Rate for Payer: Sagamore Health Network All Products |
$320.49
|
| Rate for Payer: Signature Care EPO |
$344.57
|
| Rate for Payer: Signature Care PPO |
$365.32
|
| Rate for Payer: United Healthcare Commercial |
$327.13
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$415.14
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
1620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$386.08 |
| Rate for Payer: Aetna Commercial |
$350.38
|
| Rate for Payer: Aetna Medicare |
$132.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$166.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$238.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$166.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.13
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Centivo All Commercial |
$225.84
|
| Rate for Payer: Cigna All Commercial |
$358.27
|
| Rate for Payer: CORVEL All Commercial |
$386.08
|
| Rate for Payer: Coventry All Commercial |
$365.32
|
| Rate for Payer: Encore All Commercial |
$382.14
|
| Rate for Payer: Frontpath All Commercial |
$381.93
|
| Rate for Payer: Humana ChoiceCare |
$358.56
|
| Rate for Payer: Humana Medicare |
$132.84
|
| Rate for Payer: Lucent All Commercial |
$225.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.63
|
| Rate for Payer: Managed Health Services Medicaid |
$166.20
|
| Rate for Payer: MDWise Medicaid |
$166.20
|
| Rate for Payer: PHCS All Commercial |
$311.36
|
| Rate for Payer: PHP All Commercial |
$314.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.90
|
| Rate for Payer: Sagamore Health Network All Products |
$320.49
|
| Rate for Payer: Signature Care EPO |
$344.57
|
| Rate for Payer: Signature Care PPO |
$365.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.87
|
| Rate for Payer: United Healthcare Commercial |
$327.13
|
| Rate for Payer: United Healthcare Medicare |
$132.84
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$321.30
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
1660600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$271.18
|
| Rate for Payer: Aetna Medicare |
$102.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$184.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.10
|
| Rate for Payer: Cash Price |
$192.78
|
| Rate for Payer: Cash Price |
$192.78
|
| Rate for Payer: Centivo All Commercial |
$174.79
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Humana Medicare |
$102.82
|
| Rate for Payer: Lucent All Commercial |
$174.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$240.97
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.31
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$273.11
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
| Rate for Payer: United Healthcare Medicare |
$102.82
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$321.30
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
1620600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$271.18
|
| Rate for Payer: Aetna Medicare |
$102.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$184.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.10
|
| Rate for Payer: Cash Price |
$192.78
|
| Rate for Payer: Cash Price |
$192.78
|
| Rate for Payer: Centivo All Commercial |
$174.79
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Humana Medicare |
$102.82
|
| Rate for Payer: Lucent All Commercial |
$174.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$240.97
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.31
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$273.11
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
| Rate for Payer: United Healthcare Medicare |
$102.82
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$321.30
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
1660600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.97 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$192.78
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: PHCS All Commercial |
$240.97
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$321.30
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
1620600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.97 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$192.78
|
| Rate for Payer: Cigna All Commercial |
$277.28
|
| Rate for Payer: CORVEL All Commercial |
$298.81
|
| Rate for Payer: Coventry All Commercial |
$282.74
|
| Rate for Payer: Encore All Commercial |
$295.76
|
| Rate for Payer: Frontpath All Commercial |
$295.60
|
| Rate for Payer: Humana ChoiceCare |
$277.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$289.17
|
| Rate for Payer: PHCS All Commercial |
$240.97
|
| Rate for Payer: PHP All Commercial |
$243.67
|
| Rate for Payer: Sagamore Health Network All Products |
$248.04
|
| Rate for Payer: Signature Care EPO |
$266.68
|
| Rate for Payer: Signature Care PPO |
$282.74
|
| Rate for Payer: United Healthcare Commercial |
$253.18
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$367.20
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
1620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$341.50 |
| Rate for Payer: Aetna Commercial |
$317.26
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cigna All Commercial |
$316.89
|
| Rate for Payer: CORVEL All Commercial |
$341.50
|
| Rate for Payer: Coventry All Commercial |
$323.14
|
| Rate for Payer: Encore All Commercial |
$338.01
|
| Rate for Payer: Frontpath All Commercial |
$337.82
|
| Rate for Payer: Humana ChoiceCare |
$317.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.48
|
| Rate for Payer: PHCS All Commercial |
$275.40
|
| Rate for Payer: PHP All Commercial |
$278.48
|
| Rate for Payer: Sagamore Health Network All Products |
$283.48
|
| Rate for Payer: Signature Care EPO |
$304.78
|
| Rate for Payer: Signature Care PPO |
$323.14
|
| Rate for Payer: United Healthcare Commercial |
$289.35
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$367.20
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
1620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$341.50 |
| Rate for Payer: Aetna Commercial |
$309.92
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$166.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$210.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$166.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.25
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Centivo All Commercial |
$199.76
|
| Rate for Payer: Cigna All Commercial |
$316.89
|
| Rate for Payer: CORVEL All Commercial |
$341.50
|
| Rate for Payer: Coventry All Commercial |
$323.14
|
| Rate for Payer: Encore All Commercial |
$338.01
|
| Rate for Payer: Frontpath All Commercial |
$337.82
|
| Rate for Payer: Humana ChoiceCare |
$317.15
|
| Rate for Payer: Humana Medicare |
$117.50
|
| Rate for Payer: Lucent All Commercial |
$199.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.48
|
| Rate for Payer: Managed Health Services Medicaid |
$166.20
|
| Rate for Payer: MDWise Medicaid |
$166.20
|
| Rate for Payer: PHCS All Commercial |
$275.40
|
| Rate for Payer: PHP All Commercial |
$278.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.21
|
| Rate for Payer: Sagamore Health Network All Products |
$283.48
|
| Rate for Payer: Signature Care EPO |
$304.78
|
| Rate for Payer: Signature Care PPO |
$323.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$312.12
|
| Rate for Payer: United Healthcare Commercial |
$289.35
|
| Rate for Payer: United Healthcare Medicare |
$117.50
|
|
|
HC AR TIGERLINK 2
|
Facility
|
IP
|
$423.50
|
|
| Hospital Charge Code |
41606526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.62 |
| Max. Negotiated Rate |
$393.86 |
| Rate for Payer: Aetna Commercial |
$365.90
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna All Commercial |
$365.48
|
| Rate for Payer: CORVEL All Commercial |
$393.86
|
| Rate for Payer: Coventry All Commercial |
$372.68
|
| Rate for Payer: Encore All Commercial |
$389.83
|
| Rate for Payer: Frontpath All Commercial |
$389.62
|
| Rate for Payer: Humana ChoiceCare |
$365.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.15
|
| Rate for Payer: PHCS All Commercial |
$317.62
|
| Rate for Payer: PHP All Commercial |
$321.18
|
| Rate for Payer: Sagamore Health Network All Products |
$326.94
|
| Rate for Payer: Signature Care EPO |
$351.50
|
| Rate for Payer: Signature Care PPO |
$372.68
|
| Rate for Payer: United Healthcare Commercial |
$333.72
|
|
|
HC AR TIGERLINK 2
|
Facility
|
OP
|
$423.50
|
|
| Hospital Charge Code |
41606526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$393.86 |
| Rate for Payer: Aetna Commercial |
$357.43
|
| Rate for Payer: Aetna Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$243.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$264.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.07
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Centivo All Commercial |
$230.38
|
| Rate for Payer: Cigna All Commercial |
$365.48
|
| Rate for Payer: CORVEL All Commercial |
$393.86
|
| Rate for Payer: Coventry All Commercial |
$372.68
|
| Rate for Payer: Encore All Commercial |
$389.83
|
| Rate for Payer: Frontpath All Commercial |
$389.62
|
| Rate for Payer: Humana ChoiceCare |
$365.78
|
| Rate for Payer: Humana Medicare |
$135.52
|
| Rate for Payer: Lucent All Commercial |
$230.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.15
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$317.62
|
| Rate for Payer: PHP All Commercial |
$321.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.16
|
| Rate for Payer: Sagamore Health Network All Products |
$326.94
|
| Rate for Payer: Signature Care EPO |
$351.50
|
| Rate for Payer: Signature Care PPO |
$372.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$359.98
|
| Rate for Payer: United Healthcare Commercial |
$333.72
|
| Rate for Payer: United Healthcare Medicare |
$135.52
|
|
|
HC AR TIGHTROPE ABS 3H 11MM
|
Facility
|
OP
|
$2,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Aetna Commercial |
$1,936.98
|
| Rate for Payer: Aetna Medicare |
$734.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$711.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,318.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,434.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$844.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$807.84
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Centivo All Commercial |
$1,248.48
|
| Rate for Payer: Cigna All Commercial |
$1,980.59
|
| Rate for Payer: CORVEL All Commercial |
$2,134.35
|
| Rate for Payer: Coventry All Commercial |
$2,019.60
|
| Rate for Payer: Encore All Commercial |
$2,112.55
|
| Rate for Payer: Frontpath All Commercial |
$2,111.40
|
| Rate for Payer: Humana ChoiceCare |
$1,982.19
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Lucent All Commercial |
$1,248.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,065.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,721.25
|
| Rate for Payer: PHP All Commercial |
$1,740.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$895.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,771.74
|
| Rate for Payer: Signature Care EPO |
$1,904.85
|
| Rate for Payer: Signature Care PPO |
$2,019.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,950.75
|
| Rate for Payer: United Healthcare Commercial |
$1,808.46
|
| Rate for Payer: United Healthcare Medicare |
$734.40
|
|
|
HC AR TIGHTROPE ABS 3H 11MM
|
Facility
|
IP
|
$2,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.25 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Aetna Commercial |
$1,982.88
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna All Commercial |
$1,980.59
|
| Rate for Payer: CORVEL All Commercial |
$2,134.35
|
| Rate for Payer: Coventry All Commercial |
$2,019.60
|
| Rate for Payer: Encore All Commercial |
$2,112.55
|
| Rate for Payer: Frontpath All Commercial |
$2,111.40
|
| Rate for Payer: Humana ChoiceCare |
$1,982.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,065.50
|
| Rate for Payer: PHCS All Commercial |
$1,721.25
|
| Rate for Payer: PHP All Commercial |
$1,740.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,771.74
|
| Rate for Payer: Signature Care EPO |
$1,904.85
|
| Rate for Payer: Signature Care PPO |
$2,019.60
|
| Rate for Payer: United Healthcare Commercial |
$1,808.46
|
|
|
HC AR TIGHTROPE ABS II
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,259.90 |
| Rate for Payer: Aetna Commercial |
$2,050.92
|
| Rate for Payer: Aetna Medicare |
$777.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$753.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,395.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,518.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$894.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$855.36
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Centivo All Commercial |
$1,321.92
|
| Rate for Payer: Cigna All Commercial |
$2,097.09
|
| Rate for Payer: CORVEL All Commercial |
$2,259.90
|
| Rate for Payer: Coventry All Commercial |
$2,138.40
|
| Rate for Payer: Encore All Commercial |
$2,236.82
|
| Rate for Payer: Frontpath All Commercial |
$2,235.60
|
| Rate for Payer: Humana ChoiceCare |
$2,098.79
|
| Rate for Payer: Humana Medicare |
$777.60
|
| Rate for Payer: Lucent All Commercial |
$1,321.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,187.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,822.50
|
| Rate for Payer: PHP All Commercial |
$1,842.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$947.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,875.96
|
| Rate for Payer: Signature Care EPO |
$2,016.90
|
| Rate for Payer: Signature Care PPO |
$2,138.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,065.50
|
| Rate for Payer: United Healthcare Commercial |
$1,914.84
|
| Rate for Payer: United Healthcare Medicare |
$777.60
|
|
|
HC AR TIGHTROPE ABS II
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.50 |
| Max. Negotiated Rate |
$2,259.90 |
| Rate for Payer: Aetna Commercial |
$2,099.52
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna All Commercial |
$2,097.09
|
| Rate for Payer: CORVEL All Commercial |
$2,259.90
|
| Rate for Payer: Coventry All Commercial |
$2,138.40
|
| Rate for Payer: Encore All Commercial |
$2,236.82
|
| Rate for Payer: Frontpath All Commercial |
$2,235.60
|
| Rate for Payer: Humana ChoiceCare |
$2,098.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,187.00
|
| Rate for Payer: PHCS All Commercial |
$1,822.50
|
| Rate for Payer: PHP All Commercial |
$1,842.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,875.96
|
| Rate for Payer: Signature Care EPO |
$2,016.90
|
| Rate for Payer: Signature Care PPO |
$2,138.40
|
| Rate for Payer: United Healthcare Commercial |
$1,914.84
|
|
