|
HC INTRAOCULAR LENS PCB00
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602547
|
|
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 PCB00
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41602547
|
|
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 SA60WF
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41604353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$744.00 |
| 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 |
$524.16
|
| 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 |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| 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 SA60WF
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41604353
|
|
Hospital Revenue Code
|
278
|
| 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 SN60A
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41604004
|
|
Hospital Revenue Code
|
278
|
| 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 SN60A
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41604004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$744.00 |
| 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 |
$524.16
|
| 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 |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| 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 SN6AD1
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602539
|
|
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 SN6AD1
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602539
|
|
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 SN6AT3
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602524
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT3
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602524
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6AT4
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602525
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT4
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602525
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6AT5
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602526
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT5
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602526
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6AT6
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602527
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6AT6
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602527
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT7
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602528
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT7
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602528
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6AT8
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602529
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6AT8
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602529
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT9
|
Facility
OP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602530
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$2,041.77 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC INTRAOCULAR LENS SN6AT9
|
Facility
IP
|
$1,890.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41602530
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC INTRAOCULAR LENS SN6CWS
|
Facility
IP
|
$1,000.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41603453
|
|
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 SN6CWS
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
CPT V2632
|
| Hospital Charge Code |
41603453
|
|
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 SND1T3
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2788
|
| Hospital Charge Code |
41604377
|
|
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
|
|
