|
HC INTRADERMAL TB TEST-ED
|
Facility
OP
|
$56.01
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
01296580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$52.09 |
| Rate for Payer: Aetna Commercial |
$47.27
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$15.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.33
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Centivo All Commercial |
$28.56
|
| Rate for Payer: Cigna All Commercial |
$48.34
|
| Rate for Payer: CORVEL All Commercial |
$52.09
|
| Rate for Payer: Coventry All Commercial |
$49.29
|
| Rate for Payer: Encore All Commercial |
$51.56
|
| Rate for Payer: Frontpath All Commercial |
$51.53
|
| Rate for Payer: Humana ChoiceCare |
$48.37
|
| Rate for Payer: Humana Medicare |
$28.56
|
| Rate for Payer: Lucent All Commercial |
$28.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.41
|
| Rate for Payer: Managed Health Services Medicaid |
$15.17
|
| Rate for Payer: MDWise Medicaid |
$15.17
|
| Rate for Payer: PHCS All Commercial |
$42.01
|
| Rate for Payer: PHP All Commercial |
$42.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.84
|
| Rate for Payer: Sagamore Health Network All Products |
$43.24
|
| Rate for Payer: Signature Care EPO |
$46.49
|
| Rate for Payer: Signature Care PPO |
$49.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.61
|
| Rate for Payer: United Healthcare Commercial |
$44.13
|
| Rate for Payer: United Healthcare Medicare |
$18.48
|
|
|
HC INTRADUCER TAUT 7.5 FR X 3.5 IN
|
Facility
OP
|
$421.57
|
|
| Hospital Charge Code |
41601923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$392.06 |
| Rate for Payer: Aetna Commercial |
$355.81
|
| Rate for Payer: Aetna Medicare |
$139.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$242.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.03
|
| Rate for Payer: Cash Price |
$261.37
|
| Rate for Payer: Cash Price |
$261.37
|
| Rate for Payer: Centivo All Commercial |
$215.00
|
| Rate for Payer: Cigna All Commercial |
$363.81
|
| Rate for Payer: CORVEL All Commercial |
$392.06
|
| Rate for Payer: Coventry All Commercial |
$370.98
|
| Rate for Payer: Encore All Commercial |
$388.06
|
| Rate for Payer: Frontpath All Commercial |
$387.84
|
| Rate for Payer: Humana ChoiceCare |
$364.11
|
| Rate for Payer: Humana Medicare |
$215.00
|
| Rate for Payer: Lucent All Commercial |
$215.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$316.18
|
| Rate for Payer: PHP All Commercial |
$319.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.41
|
| Rate for Payer: Sagamore Health Network All Products |
$325.45
|
| Rate for Payer: Signature Care EPO |
$349.90
|
| Rate for Payer: Signature Care PPO |
$370.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$358.33
|
| Rate for Payer: United Healthcare Commercial |
$332.20
|
| Rate for Payer: United Healthcare Medicare |
$139.12
|
|
|
HC INTRADUCER TAUT 7.5 FR X 3.5 IN
|
Facility
IP
|
$421.57
|
|
| Hospital Charge Code |
41601923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.18 |
| Max. Negotiated Rate |
$392.06 |
| Rate for Payer: Aetna Commercial |
$364.24
|
| Rate for Payer: Cash Price |
$261.37
|
| Rate for Payer: Cigna All Commercial |
$363.81
|
| Rate for Payer: CORVEL All Commercial |
$392.06
|
| Rate for Payer: Coventry All Commercial |
$370.98
|
| Rate for Payer: Encore All Commercial |
$388.06
|
| Rate for Payer: Frontpath All Commercial |
$387.84
|
| Rate for Payer: Humana ChoiceCare |
$364.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.41
|
| Rate for Payer: PHCS All Commercial |
$316.18
|
| Rate for Payer: PHP All Commercial |
$319.72
|
| Rate for Payer: Sagamore Health Network All Products |
$325.45
|
| Rate for Payer: Signature Care EPO |
$349.90
|
| Rate for Payer: Signature Care PPO |
$370.98
|
| Rate for Payer: United Healthcare Commercial |
$332.20
|
|
|
HC INTRAOCULAR LENS AR40M
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602548
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$844.00
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$574.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$625.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$379.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Centivo All Commercial |
$510.00
|
| Rate for Payer: Cigna All Commercial |
$863.00
|
| Rate for Payer: CORVEL All Commercial |
$930.00
|
| Rate for Payer: Coventry All Commercial |
$880.00
|
| Rate for Payer: Encore All Commercial |
$920.50
|
| Rate for Payer: Frontpath All Commercial |
$920.00
|
| Rate for Payer: Humana ChoiceCare |
$863.70
|
| Rate for Payer: Humana Medicare |
$510.00
|
| Rate for Payer: Lucent All Commercial |
$510.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$750.00
|
| Rate for Payer: PHP All Commercial |
$758.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.00
|
| Rate for Payer: Sagamore Health Network All Products |
$772.00
|
| Rate for Payer: Signature Care EPO |
$830.00
|
| Rate for Payer: Signature Care PPO |
$880.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$850.00
|
| Rate for Payer: United Healthcare Commercial |
$788.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
|
|
HC INTRAOCULAR LENS AR40M
|
Facility
IP
|
$1,000.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602548
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$864.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna All Commercial |
$863.00
|
| Rate for Payer: CORVEL All Commercial |
$930.00
|
| Rate for Payer: Coventry All Commercial |
$880.00
|
| Rate for Payer: Encore All Commercial |
$920.50
|
| Rate for Payer: Frontpath All Commercial |
$920.00
|
| Rate for Payer: Humana ChoiceCare |
$863.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: PHCS All Commercial |
$750.00
|
| Rate for Payer: PHP All Commercial |
$758.40
|
| Rate for Payer: Sagamore Health Network All Products |
$772.00
|
| Rate for Payer: Signature Care EPO |
$830.00
|
| Rate for Payer: Signature Care PPO |
$880.00
|
| Rate for Payer: United Healthcare Commercial |
$788.00
|
|
|
HC INTRAOCULAR LENS AU00T0
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602546
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOCULAR LENS AU00T0
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602546
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC INTRAOCULAR LENS DIB00
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41607822
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC INTRAOCULAR LENS DIB00
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41607822
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC INTRAOCULAR LENS DXB00
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41607823
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC INTRAOCULAR LENS DXB00
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41607823
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOCULAR LENS ISERT250
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41603599
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC INTRAOCULAR LENS ISERT250
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41603599
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC INTRAOCULAR LENS ISERT251
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602545
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC INTRAOCULAR LENS ISERT251
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602545
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC INTRAOCULAR LENS LI61A0
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41607441
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC INTRAOCULAR LENS LI61A0
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41607441
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOCULAR LENS MA60AC
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41603067
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
|
|
HC INTRAOCULAR LENS MA60AC
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41603067
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$675.20
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$264.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.40
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$690.40
|
| Rate for Payer: CORVEL All Commercial |
$744.00
|
| Rate for Payer: Coventry All Commercial |
$704.00
|
| Rate for Payer: Encore All Commercial |
$736.40
|
| Rate for Payer: Frontpath All Commercial |
$736.00
|
| Rate for Payer: Humana ChoiceCare |
$690.96
|
| Rate for Payer: Humana Medicare |
$408.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: PHP All Commercial |
$606.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.00
|
| Rate for Payer: Sagamore Health Network All Products |
$617.60
|
| Rate for Payer: Signature Care EPO |
$664.00
|
| Rate for Payer: Signature Care PPO |
$704.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$630.40
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
|
|
HC INTRAOCULAR LENS MN6AD1
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602540
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,497.50 |
| Max. Negotiated Rate |
$3,096.90 |
| Rate for Payer: Aetna Commercial |
$2,877.12
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna All Commercial |
$2,873.79
|
| Rate for Payer: CORVEL All Commercial |
$3,096.90
|
| Rate for Payer: Coventry All Commercial |
$2,930.40
|
| Rate for Payer: Encore All Commercial |
$3,065.26
|
| Rate for Payer: Frontpath All Commercial |
$3,063.60
|
| Rate for Payer: Humana ChoiceCare |
$2,876.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,997.00
|
| Rate for Payer: PHCS All Commercial |
$2,497.50
|
| Rate for Payer: PHP All Commercial |
$2,525.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,570.76
|
| Rate for Payer: Signature Care EPO |
$2,763.90
|
| Rate for Payer: Signature Care PPO |
$2,930.40
|
| Rate for Payer: United Healthcare Commercial |
$2,624.04
|
|
|
HC INTRAOCULAR LENS MN6AD1
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602540
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,098.90 |
| Max. Negotiated Rate |
$3,096.90 |
| Rate for Payer: Aetna Commercial |
$2,810.52
|
| Rate for Payer: Aetna Medicare |
$1,098.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,098.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,912.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,081.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,263.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,208.79
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Centivo All Commercial |
$1,698.30
|
| Rate for Payer: Cigna All Commercial |
$2,873.79
|
| Rate for Payer: CORVEL All Commercial |
$3,096.90
|
| Rate for Payer: Coventry All Commercial |
$2,930.40
|
| Rate for Payer: Encore All Commercial |
$3,065.26
|
| Rate for Payer: Frontpath All Commercial |
$3,063.60
|
| Rate for Payer: Humana ChoiceCare |
$2,876.12
|
| Rate for Payer: Humana Medicare |
$1,698.30
|
| Rate for Payer: Lucent All Commercial |
$1,698.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,997.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$2,497.50
|
| Rate for Payer: PHP All Commercial |
$2,525.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,298.70
|
| Rate for Payer: Sagamore Health Network All Products |
$2,570.76
|
| Rate for Payer: Signature Care EPO |
$2,763.90
|
| Rate for Payer: Signature Care PPO |
$2,930.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,624.04
|
| Rate for Payer: United Healthcare Medicare |
$1,098.90
|
|
|
HC INTRAOCULAR LENS MTA4U0
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41604352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$346.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$603.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.15
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Centivo All Commercial |
$535.50
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$535.50
|
| Rate for Payer: Lucent All Commercial |
$535.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
|
|
HC INTRAOCULAR LENS MTA4U0
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41604352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC INTRAOCULAR LENS PANOPTIX-MF
|
Facility
OP
|
$3,870.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41606657
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,277.10 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna Commercial |
$3,266.28
|
| Rate for Payer: Aetna Medicare |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,222.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,419.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,468.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,404.81
|
| Rate for Payer: Cash Price |
$2,399.40
|
| Rate for Payer: Cash Price |
$2,399.40
|
| Rate for Payer: Centivo All Commercial |
$1,973.70
|
| Rate for Payer: Cigna All Commercial |
$3,339.81
|
| Rate for Payer: CORVEL All Commercial |
$3,599.10
|
| Rate for Payer: Coventry All Commercial |
$3,405.60
|
| Rate for Payer: Encore All Commercial |
$3,562.34
|
| Rate for Payer: Frontpath All Commercial |
$3,560.40
|
| Rate for Payer: Humana ChoiceCare |
$3,342.52
|
| Rate for Payer: Humana Medicare |
$1,973.70
|
| Rate for Payer: Lucent All Commercial |
$1,973.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,483.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$2,902.50
|
| Rate for Payer: PHP All Commercial |
$2,935.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,509.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,987.64
|
| Rate for Payer: Signature Care EPO |
$3,212.10
|
| Rate for Payer: Signature Care PPO |
$3,405.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,289.50
|
| Rate for Payer: United Healthcare Commercial |
$3,049.56
|
| Rate for Payer: United Healthcare Medicare |
$1,277.10
|
|
|
HC INTRAOCULAR LENS PANOPTIX-MF
|
Facility
IP
|
$3,870.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41606657
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,902.50 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Aetna Commercial |
$3,343.68
|
| Rate for Payer: Cash Price |
$2,399.40
|
| Rate for Payer: Cigna All Commercial |
$3,339.81
|
| Rate for Payer: CORVEL All Commercial |
$3,599.10
|
| Rate for Payer: Coventry All Commercial |
$3,405.60
|
| Rate for Payer: Encore All Commercial |
$3,562.34
|
| Rate for Payer: Frontpath All Commercial |
$3,560.40
|
| Rate for Payer: Humana ChoiceCare |
$3,342.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,483.00
|
| Rate for Payer: PHCS All Commercial |
$2,902.50
|
| Rate for Payer: PHP All Commercial |
$2,935.01
|
| Rate for Payer: Sagamore Health Network All Products |
$2,987.64
|
| Rate for Payer: Signature Care EPO |
$3,212.10
|
| Rate for Payer: Signature Care PPO |
$3,405.60
|
| Rate for Payer: United Healthcare Commercial |
$3,049.56
|
|
