|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL
|
Facility
|
OP
|
$83.25
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
1617063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$70.26
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.30
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Centivo All Commercial |
$45.29
|
| Rate for Payer: Cigna All Commercial |
$71.84
|
| Rate for Payer: CORVEL All Commercial |
$77.42
|
| Rate for Payer: Coventry All Commercial |
$73.26
|
| Rate for Payer: Encore All Commercial |
$76.63
|
| Rate for Payer: Frontpath All Commercial |
$76.59
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Lucent All Commercial |
$45.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.92
|
| Rate for Payer: Managed Health Services Medicaid |
$18.53
|
| Rate for Payer: MDWise Medicaid |
$18.53
|
| Rate for Payer: PHCS All Commercial |
$62.44
|
| Rate for Payer: PHP All Commercial |
$63.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.47
|
| Rate for Payer: Sagamore Health Network All Products |
$64.27
|
| Rate for Payer: Signature Care EPO |
$69.10
|
| Rate for Payer: Signature Care PPO |
$73.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$65.60
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL
|
Facility
|
IP
|
$55.90
|
|
|
Service Code
|
CPT 77063 52
|
| Hospital Charge Code |
1617064
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$51.99 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: Cigna All Commercial |
$48.24
|
| Rate for Payer: CORVEL All Commercial |
$51.99
|
| Rate for Payer: Coventry All Commercial |
$49.19
|
| Rate for Payer: Encore All Commercial |
$51.46
|
| Rate for Payer: Frontpath All Commercial |
$51.43
|
| Rate for Payer: Humana ChoiceCare |
$48.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.31
|
| Rate for Payer: PHCS All Commercial |
$41.92
|
| Rate for Payer: PHP All Commercial |
$42.39
|
| Rate for Payer: Sagamore Health Network All Products |
$43.15
|
| Rate for Payer: Signature Care EPO |
$46.40
|
| Rate for Payer: Signature Care PPO |
$49.19
|
| Rate for Payer: United Healthcare Commercial |
$44.05
|
|
|
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL
|
Facility
|
OP
|
$55.90
|
|
|
Service Code
|
CPT 77063 52
|
| Hospital Charge Code |
1617064
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$51.99 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Aetna Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$32.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.68
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: Centivo All Commercial |
$30.41
|
| Rate for Payer: Cigna All Commercial |
$48.24
|
| Rate for Payer: CORVEL All Commercial |
$51.99
|
| Rate for Payer: Coventry All Commercial |
$49.19
|
| Rate for Payer: Encore All Commercial |
$51.46
|
| Rate for Payer: Frontpath All Commercial |
$51.43
|
| Rate for Payer: Humana ChoiceCare |
$48.28
|
| Rate for Payer: Humana Medicare |
$17.89
|
| Rate for Payer: Lucent All Commercial |
$30.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.31
|
| Rate for Payer: Managed Health Services Medicaid |
$18.53
|
| Rate for Payer: MDWise Medicaid |
$18.53
|
| Rate for Payer: PHCS All Commercial |
$41.92
|
| Rate for Payer: PHP All Commercial |
$42.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.80
|
| Rate for Payer: Sagamore Health Network All Products |
$43.15
|
| Rate for Payer: Signature Care EPO |
$46.40
|
| Rate for Payer: Signature Care PPO |
$49.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.52
|
| Rate for Payer: United Healthcare Commercial |
$44.05
|
| Rate for Payer: United Healthcare Medicare |
$17.89
|
|
|
HC SCREW CORTICAL 2.7MM 12MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 2.7MM 12MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.51
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
|
|
HC SCREW CORTICAL 2.7MM 16MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.51
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
|
|
HC SCREW CORTICAL 2.7MM 16MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 2.7MM 18MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.51
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
|
|
HC SCREW CORTICAL 2.7MM 18MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 2.7 MM 20 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.51
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
|
|
HC SCREW CORTICAL 2.7 MM 20 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 2.7 MM 8 MM
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC SCREW CORTICAL 2.7 MM 8 MM
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.51
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
|
|
HC SCREW LP LOCK TI 3.0 X 14 MM ACFS
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC SCREW LP LOCK TI 3.0 X 14 MM ACFS
|
Facility
|
OP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.80
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Centivo All Commercial |
$523.60
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$308.00
|
| Rate for Payer: Lucent All Commercial |
$523.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$308.00
|
|
|
HC SCREW LP LOCK TI 3.0 X 16 MM ACFS
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC SCREW LP LOCK TI 3.0 X 16 MM ACFS
|
Facility
|
OP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.80
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Centivo All Commercial |
$523.60
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$308.00
|
| Rate for Payer: Lucent All Commercial |
$523.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$308.00
|
|
|
HC SCREW LP TI CORTICAL 3.0 X 16 MM ACFS
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP TI CORTICAL 3.0 X 16 MM ACFS
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$271.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$262.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.14
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Centivo All Commercial |
$460.77
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$271.04
|
| Rate for Payer: Lucent All Commercial |
$460.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$271.04
|
|
|
HC SCREW LP TI CORTICAL 3.0 X 18 MM ACFS
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SCREW LP TI CORTICAL 3.0 X 18 MM ACFS
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$271.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$262.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.14
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Centivo All Commercial |
$460.77
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$271.04
|
| Rate for Payer: Lucent All Commercial |
$460.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$271.04
|
|
|
HC SCREW LP TI CORTICAL 3.0 X 20 MM ACFS
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$714.87
|
| Rate for Payer: Aetna Medicare |
$271.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$262.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$529.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$311.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.14
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Centivo All Commercial |
$460.77
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Humana Medicare |
$271.04
|
| Rate for Payer: Lucent All Commercial |
$460.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.33
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
| Rate for Payer: United Healthcare Medicare |
$271.04
|
|
|
HC SCREW LP TI CORTICAL 3.0 X 20 MM ACFS
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$787.71 |
| Rate for Payer: Aetna Commercial |
$731.81
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna All Commercial |
$730.96
|
| Rate for Payer: CORVEL All Commercial |
$787.71
|
| Rate for Payer: Coventry All Commercial |
$745.36
|
| Rate for Payer: Encore All Commercial |
$779.66
|
| Rate for Payer: Frontpath All Commercial |
$779.24
|
| Rate for Payer: Humana ChoiceCare |
$731.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$762.30
|
| Rate for Payer: PHCS All Commercial |
$635.25
|
| Rate for Payer: PHP All Commercial |
$642.36
|
| Rate for Payer: Sagamore Health Network All Products |
$653.88
|
| Rate for Payer: Signature Care EPO |
$703.01
|
| Rate for Payer: Signature Care PPO |
$745.36
|
| Rate for Payer: United Healthcare Commercial |
$667.44
|
|
|
HC SEDIMENTATION RATE
|
Facility
|
OP
|
$53.55
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
63087809
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$45.20
|
| Rate for Payer: Aetna Medicare |
$17.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.85
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Centivo All Commercial |
$29.13
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Lucent All Commercial |
$29.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.52
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
| Rate for Payer: United Healthcare Medicare |
$17.14
|
|
|
HC SEDIMENTATION RATE
|
Facility
|
IP
|
$53.55
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
63087809
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cigna All Commercial |
$46.21
|
| Rate for Payer: CORVEL All Commercial |
$49.80
|
| Rate for Payer: Coventry All Commercial |
$47.12
|
| Rate for Payer: Encore All Commercial |
$49.29
|
| Rate for Payer: Frontpath All Commercial |
$49.27
|
| Rate for Payer: Humana ChoiceCare |
$46.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.20
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$40.61
|
| Rate for Payer: Sagamore Health Network All Products |
$41.34
|
| Rate for Payer: Signature Care EPO |
$44.45
|
| Rate for Payer: Signature Care PPO |
$47.12
|
| Rate for Payer: United Healthcare Commercial |
$42.20
|
|
