|
HC INTRAOCULAR LENS ZKB00
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602541
|
|
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 ZKB00
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602541
|
|
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 ZLB00
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602542
|
|
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 ZLB00
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602542
|
|
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 ZMB00
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602543
|
|
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 ZMB00
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602543
|
|
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 ZXR00
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602544
|
|
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 ZXR00
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41602544
|
|
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 ZXT100
|
Facility
OP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603285
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,205.82 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,083.98
|
| Rate for Payer: Aetna Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,098.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,284.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,386.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,326.40
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Centivo All Commercial |
$1,863.54
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Humana Medicare |
$1,863.54
|
| Rate for Payer: Lucent All Commercial |
$1,863.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,425.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,105.90
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
| Rate for Payer: United Healthcare Medicare |
$1,205.82
|
|
|
HC INTRAOCULAR LENS ZXT100
|
Facility
IP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603285
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,740.50 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,157.06
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
|
|
HC INTRAOCULAR LENS ZXT150
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603060
|
|
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 ZXT150
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603060
|
|
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 ZXT225
|
Facility
OP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603066
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,205.82 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,083.98
|
| Rate for Payer: Aetna Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,098.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,284.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,386.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,326.40
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Centivo All Commercial |
$1,863.54
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Humana Medicare |
$1,863.54
|
| Rate for Payer: Lucent All Commercial |
$1,863.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,425.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,105.90
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
| Rate for Payer: United Healthcare Medicare |
$1,205.82
|
|
|
HC INTRAOCULAR LENS ZXT225
|
Facility
IP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603066
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,740.50 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,157.06
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
|
|
HC INTRAOCULAR LENS ZXT300
|
Facility
OP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603286
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,205.82 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,083.98
|
| Rate for Payer: Aetna Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,098.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,284.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,386.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,326.40
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Centivo All Commercial |
$1,863.54
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Humana Medicare |
$1,863.54
|
| Rate for Payer: Lucent All Commercial |
$1,863.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,425.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,105.90
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
| Rate for Payer: United Healthcare Medicare |
$1,205.82
|
|
|
HC INTRAOCULAR LENS ZXT300
|
Facility
IP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603286
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,740.50 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,157.06
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
|
|
HC INTRAOCULAR LENS ZXT375
|
Facility
IP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603287
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,740.50 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,157.06
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
|
|
HC INTRAOCULAR LENS ZXT375
|
Facility
OP
|
$3,654.00
|
|
|
Service Code
|
CPT V2787
|
| Hospital Charge Code |
41603287
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,205.82 |
| Max. Negotiated Rate |
$3,398.22 |
| Rate for Payer: Aetna Commercial |
$3,083.98
|
| Rate for Payer: Aetna Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,205.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,098.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,284.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,041.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,386.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,326.40
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Centivo All Commercial |
$1,863.54
|
| Rate for Payer: Cigna All Commercial |
$3,153.40
|
| Rate for Payer: CORVEL All Commercial |
$3,398.22
|
| Rate for Payer: Coventry All Commercial |
$3,215.52
|
| Rate for Payer: Encore All Commercial |
$3,363.51
|
| Rate for Payer: Frontpath All Commercial |
$3,361.68
|
| Rate for Payer: Humana ChoiceCare |
$3,155.96
|
| Rate for Payer: Humana Medicare |
$1,863.54
|
| Rate for Payer: Lucent All Commercial |
$1,863.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,288.60
|
| Rate for Payer: Managed Health Services Medicaid |
$2,041.77
|
| Rate for Payer: MDWise Medicaid |
$2,041.77
|
| Rate for Payer: PHCS All Commercial |
$2,740.50
|
| Rate for Payer: PHP All Commercial |
$2,771.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,425.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2,820.89
|
| Rate for Payer: Signature Care EPO |
$3,032.82
|
| Rate for Payer: Signature Care PPO |
$3,215.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,105.90
|
| Rate for Payer: United Healthcare Commercial |
$2,879.35
|
| Rate for Payer: United Healthcare Medicare |
$1,205.82
|
|
|
HC INTRAOP-FLUORO > 1 HR W/IMAGE
|
Facility
OP
|
$2,038.98
|
|
| Hospital Charge Code |
01610008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$672.86 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.15
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Centivo All Commercial |
$1,039.88
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$1,039.88
|
| Rate for Payer: Lucent All Commercial |
$1,039.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$672.86
|
|
|
HC INTRAOP-FLUORO > 1 HR W/IMAGE
|
Facility
IP
|
$2,038.98
|
|
| Hospital Charge Code |
01610008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC INTRAOP-FLUORO < 1 HR W/IMAGE
|
Facility
OP
|
$1,796.56
|
|
| Hospital Charge Code |
01610006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$592.86 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,516.29
|
| Rate for Payer: Aetna Medicare |
$592.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$592.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,031.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,123.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$681.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$652.15
|
| Rate for Payer: Cash Price |
$1,113.87
|
| Rate for Payer: Centivo All Commercial |
$916.24
|
| Rate for Payer: Cigna All Commercial |
$1,550.43
|
| Rate for Payer: CORVEL All Commercial |
$1,670.80
|
| Rate for Payer: Coventry All Commercial |
$1,580.97
|
| Rate for Payer: Encore All Commercial |
$1,653.73
|
| Rate for Payer: Frontpath All Commercial |
$1,652.83
|
| Rate for Payer: Humana ChoiceCare |
$1,551.69
|
| Rate for Payer: Humana Medicare |
$916.24
|
| Rate for Payer: Lucent All Commercial |
$916.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,616.90
|
| Rate for Payer: PHCS All Commercial |
$1,347.42
|
| Rate for Payer: PHP All Commercial |
$1,362.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$700.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,386.94
|
| Rate for Payer: Signature Care EPO |
$1,491.14
|
| Rate for Payer: Signature Care PPO |
$1,580.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,527.07
|
| Rate for Payer: United Healthcare Commercial |
$1,415.69
|
| Rate for Payer: United Healthcare Medicare |
$592.86
|
|
|
HC INTRAOP-FLUORO < 1 HR W/IMAGE
|
Facility
IP
|
$1,796.56
|
|
| Hospital Charge Code |
01610006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,347.42 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,552.22
|
| Rate for Payer: Cash Price |
$1,113.87
|
| Rate for Payer: Cigna All Commercial |
$1,550.43
|
| Rate for Payer: CORVEL All Commercial |
$1,670.80
|
| Rate for Payer: Coventry All Commercial |
$1,580.97
|
| Rate for Payer: Encore All Commercial |
$1,653.73
|
| Rate for Payer: Frontpath All Commercial |
$1,652.83
|
| Rate for Payer: Humana ChoiceCare |
$1,551.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,616.90
|
| Rate for Payer: PHCS All Commercial |
$1,347.42
|
| Rate for Payer: PHP All Commercial |
$1,362.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,386.94
|
| Rate for Payer: Signature Care EPO |
$1,491.14
|
| Rate for Payer: Signature Care PPO |
$1,580.97
|
| Rate for Payer: United Healthcare Commercial |
$1,415.69
|
|
|
HC INTRAOP-FLUORO <1 HR W/O IMAGE
|
Facility
IP
|
$1,254.41
|
|
| Hospital Charge Code |
01610005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$940.80 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Aetna Commercial |
$1,083.81
|
| Rate for Payer: Cash Price |
$777.73
|
| Rate for Payer: Cigna All Commercial |
$1,082.55
|
| Rate for Payer: CORVEL All Commercial |
$1,166.60
|
| Rate for Payer: Coventry All Commercial |
$1,103.88
|
| Rate for Payer: Encore All Commercial |
$1,154.68
|
| Rate for Payer: Frontpath All Commercial |
$1,154.05
|
| Rate for Payer: Humana ChoiceCare |
$1,083.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,128.97
|
| Rate for Payer: PHCS All Commercial |
$940.80
|
| Rate for Payer: PHP All Commercial |
$951.34
|
| Rate for Payer: Sagamore Health Network All Products |
$968.40
|
| Rate for Payer: Signature Care EPO |
$1,041.16
|
| Rate for Payer: Signature Care PPO |
$1,103.88
|
| Rate for Payer: United Healthcare Commercial |
$988.47
|
|
|
HC INTRAOP-FLUORO <1 HR W/O IMAGE
|
Facility
OP
|
$1,254.41
|
|
| Hospital Charge Code |
01610005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Aetna Commercial |
$1,058.72
|
| Rate for Payer: Aetna Medicare |
$413.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$413.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$784.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.35
|
| Rate for Payer: Cash Price |
$777.73
|
| Rate for Payer: Centivo All Commercial |
$639.75
|
| Rate for Payer: Cigna All Commercial |
$1,082.55
|
| Rate for Payer: CORVEL All Commercial |
$1,166.60
|
| Rate for Payer: Coventry All Commercial |
$1,103.88
|
| Rate for Payer: Encore All Commercial |
$1,154.68
|
| Rate for Payer: Frontpath All Commercial |
$1,154.05
|
| Rate for Payer: Humana ChoiceCare |
$1,083.43
|
| Rate for Payer: Humana Medicare |
$639.75
|
| Rate for Payer: Lucent All Commercial |
$639.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,128.97
|
| Rate for Payer: PHCS All Commercial |
$940.80
|
| Rate for Payer: PHP All Commercial |
$951.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$489.22
|
| Rate for Payer: Sagamore Health Network All Products |
$968.40
|
| Rate for Payer: Signature Care EPO |
$1,041.16
|
| Rate for Payer: Signature Care PPO |
$1,103.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,066.25
|
| Rate for Payer: United Healthcare Commercial |
$988.47
|
| Rate for Payer: United Healthcare Medicare |
$413.95
|
|
|
HC INTRAOP-FLUORO >1 HR W/O IMAGE
|
Facility
IP
|
$1,672.55
|
|
| Hospital Charge Code |
01610007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,254.41 |
| Max. Negotiated Rate |
$1,555.47 |
| Rate for Payer: Aetna Commercial |
$1,445.08
|
| Rate for Payer: Cash Price |
$1,036.98
|
| Rate for Payer: Cigna All Commercial |
$1,443.41
|
| Rate for Payer: CORVEL All Commercial |
$1,555.47
|
| Rate for Payer: Coventry All Commercial |
$1,471.84
|
| Rate for Payer: Encore All Commercial |
$1,539.58
|
| Rate for Payer: Frontpath All Commercial |
$1,538.74
|
| Rate for Payer: Humana ChoiceCare |
$1,444.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,505.29
|
| Rate for Payer: PHCS All Commercial |
$1,254.41
|
| Rate for Payer: PHP All Commercial |
$1,268.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,291.20
|
| Rate for Payer: Signature Care EPO |
$1,388.21
|
| Rate for Payer: Signature Care PPO |
$1,471.84
|
| Rate for Payer: United Healthcare Commercial |
$1,317.97
|
|
