|
HC S FEM COMP 3 CR TRI CEM R
|
Facility
|
OP
|
$7,784.71
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,239.78 |
| Rate for Payer: Aetna Commercial |
$6,570.30
|
| Rate for Payer: Aetna Medicare |
$2,491.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,413.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,470.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,866.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,864.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,740.22
|
| Rate for Payer: Cash Price |
$4,670.83
|
| Rate for Payer: Cash Price |
$4,670.83
|
| Rate for Payer: Centivo All Commercial |
$4,234.88
|
| Rate for Payer: Cigna All Commercial |
$6,718.20
|
| Rate for Payer: CORVEL All Commercial |
$7,239.78
|
| Rate for Payer: Coventry All Commercial |
$6,850.54
|
| Rate for Payer: Encore All Commercial |
$7,165.83
|
| Rate for Payer: Frontpath All Commercial |
$7,161.93
|
| Rate for Payer: Humana ChoiceCare |
$6,723.65
|
| Rate for Payer: Humana Medicare |
$2,491.11
|
| Rate for Payer: Lucent All Commercial |
$4,234.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,006.24
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,838.53
|
| Rate for Payer: PHP All Commercial |
$5,903.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,036.04
|
| Rate for Payer: Sagamore Health Network All Products |
$6,009.80
|
| Rate for Payer: Signature Care EPO |
$6,461.31
|
| Rate for Payer: Signature Care PPO |
$6,850.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,617.00
|
| Rate for Payer: United Healthcare Commercial |
$6,134.35
|
| Rate for Payer: United Healthcare Medicare |
$2,491.11
|
|
|
HC S FEM COMP 3 CR TRI R
|
Facility
|
OP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,034.17
|
| Rate for Payer: Aetna Medicare |
$3,425.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,318.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,147.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,691.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,939.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,767.80
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Centivo All Commercial |
$5,822.97
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Humana Medicare |
$3,425.28
|
| Rate for Payer: Lucent All Commercial |
$5,822.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,174.56
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,098.39
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
| Rate for Payer: United Healthcare Medicare |
$3,425.28
|
|
|
HC S FEM COMP 3 CR TRI R
|
Facility
|
IP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,027.99 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,248.25
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
|
|
HC S FEM COMP 5 CR TRI R
|
Facility
|
OP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,034.17
|
| Rate for Payer: Aetna Medicare |
$3,425.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,318.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,147.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,691.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,939.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,767.80
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Centivo All Commercial |
$5,822.97
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Humana Medicare |
$3,425.28
|
| Rate for Payer: Lucent All Commercial |
$5,822.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,174.56
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,098.39
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
| Rate for Payer: United Healthcare Medicare |
$3,425.28
|
|
|
HC S FEM COMP 5 CR TRI R
|
Facility
|
IP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,027.99 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,248.25
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
|
|
HC S FEM COMP 8 CR TRI R
|
Facility
|
OP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,034.17
|
| Rate for Payer: Aetna Medicare |
$3,425.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,318.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,147.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,691.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,939.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,767.80
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Centivo All Commercial |
$5,822.97
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Humana Medicare |
$3,425.28
|
| Rate for Payer: Lucent All Commercial |
$5,822.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,174.56
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,098.39
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
| Rate for Payer: United Healthcare Medicare |
$3,425.28
|
|
|
HC S FEM COMP 8 CR TRI R
|
Facility
|
IP
|
$10,703.99
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,027.99 |
| Max. Negotiated Rate |
$9,954.71 |
| Rate for Payer: Aetna Commercial |
$9,248.25
|
| Rate for Payer: Cash Price |
$6,422.39
|
| Rate for Payer: Cigna All Commercial |
$9,237.54
|
| Rate for Payer: CORVEL All Commercial |
$9,954.71
|
| Rate for Payer: Coventry All Commercial |
$9,419.51
|
| Rate for Payer: Encore All Commercial |
$9,853.02
|
| Rate for Payer: Frontpath All Commercial |
$9,847.67
|
| Rate for Payer: Humana ChoiceCare |
$9,245.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,633.59
|
| Rate for Payer: PHCS All Commercial |
$8,027.99
|
| Rate for Payer: PHP All Commercial |
$8,117.91
|
| Rate for Payer: Sagamore Health Network All Products |
$8,263.48
|
| Rate for Payer: Signature Care EPO |
$8,884.31
|
| Rate for Payer: Signature Care PPO |
$9,419.51
|
| Rate for Payer: United Healthcare Commercial |
$8,434.74
|
|
|
HC S FEM HEAD V40 36X-2.5
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,845.80 |
| Rate for Payer: Aetna Commercial |
$2,582.64
|
| Rate for Payer: Aetna Medicare |
$979.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$948.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,757.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,912.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,126.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,077.12
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Centivo All Commercial |
$1,664.64
|
| Rate for Payer: Cigna All Commercial |
$2,640.78
|
| Rate for Payer: CORVEL All Commercial |
$2,845.80
|
| Rate for Payer: Coventry All Commercial |
$2,692.80
|
| Rate for Payer: Encore All Commercial |
$2,816.73
|
| Rate for Payer: Frontpath All Commercial |
$2,815.20
|
| Rate for Payer: Humana ChoiceCare |
$2,642.92
|
| Rate for Payer: Humana Medicare |
$979.20
|
| Rate for Payer: Lucent All Commercial |
$1,664.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,754.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,295.00
|
| Rate for Payer: PHP All Commercial |
$2,320.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,193.40
|
| Rate for Payer: Sagamore Health Network All Products |
$2,362.32
|
| Rate for Payer: Signature Care EPO |
$2,539.80
|
| Rate for Payer: Signature Care PPO |
$2,692.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,601.00
|
| Rate for Payer: United Healthcare Commercial |
$2,411.28
|
| Rate for Payer: United Healthcare Medicare |
$979.20
|
|
|
HC S FEM HEAD V40 36X-2.5
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.00 |
| Max. Negotiated Rate |
$2,845.80 |
| Rate for Payer: Aetna Commercial |
$2,643.84
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cigna All Commercial |
$2,640.78
|
| Rate for Payer: CORVEL All Commercial |
$2,845.80
|
| Rate for Payer: Coventry All Commercial |
$2,692.80
|
| Rate for Payer: Encore All Commercial |
$2,816.73
|
| Rate for Payer: Frontpath All Commercial |
$2,815.20
|
| Rate for Payer: Humana ChoiceCare |
$2,642.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,754.00
|
| Rate for Payer: PHCS All Commercial |
$2,295.00
|
| Rate for Payer: PHP All Commercial |
$2,320.70
|
| Rate for Payer: Sagamore Health Network All Products |
$2,362.32
|
| Rate for Payer: Signature Care EPO |
$2,539.80
|
| Rate for Payer: Signature Care PPO |
$2,692.80
|
| Rate for Payer: United Healthcare Commercial |
$2,411.28
|
|
|
HC SGOT
|
Facility
|
IP
|
$48.25
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
63001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$41.69
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: PHCS All Commercial |
$36.19
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.05
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
|
|
HC SGOT
|
Facility
|
OP
|
$48.25
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
63001101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Aetna Medicare |
$15.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.98
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Centivo All Commercial |
$26.25
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Humana Medicare |
$15.44
|
| Rate for Payer: Lucent All Commercial |
$26.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$36.19
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.82
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.05
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.01
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
| Rate for Payer: United Healthcare Medicare |
$15.44
|
|
|
HC SGPT
|
Facility
|
OP
|
$48.25
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
63001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$40.72
|
| Rate for Payer: Aetna Medicare |
$15.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.98
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Centivo All Commercial |
$26.25
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Humana Medicare |
$15.44
|
| Rate for Payer: Lucent All Commercial |
$26.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: Managed Health Services Medicaid |
$5.30
|
| Rate for Payer: MDWise Medicaid |
$5.30
|
| Rate for Payer: PHCS All Commercial |
$36.19
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.82
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.05
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.01
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
| Rate for Payer: United Healthcare Medicare |
$15.44
|
|
|
HC SGPT
|
Facility
|
IP
|
$48.25
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
63001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna Commercial |
$41.69
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna All Commercial |
$41.64
|
| Rate for Payer: CORVEL All Commercial |
$44.87
|
| Rate for Payer: Coventry All Commercial |
$42.46
|
| Rate for Payer: Encore All Commercial |
$44.41
|
| Rate for Payer: Frontpath All Commercial |
$44.39
|
| Rate for Payer: Humana ChoiceCare |
$41.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.42
|
| Rate for Payer: PHCS All Commercial |
$36.19
|
| Rate for Payer: PHP All Commercial |
$36.59
|
| Rate for Payer: Sagamore Health Network All Products |
$37.25
|
| Rate for Payer: Signature Care EPO |
$40.05
|
| Rate for Payer: Signature Care PPO |
$42.46
|
| Rate for Payer: United Healthcare Commercial |
$38.02
|
|
|
HC SHAVER TOMCAT 4.0
|
Facility
|
OP
|
$403.69
|
|
| Hospital Charge Code |
41601202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$375.43 |
| Rate for Payer: Aetna Commercial |
$340.71
|
| Rate for Payer: Aetna Medicare |
$129.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$231.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.10
|
| Rate for Payer: Cash Price |
$242.21
|
| Rate for Payer: Cash Price |
$242.21
|
| Rate for Payer: Centivo All Commercial |
$219.61
|
| Rate for Payer: Cigna All Commercial |
$348.38
|
| Rate for Payer: CORVEL All Commercial |
$375.43
|
| Rate for Payer: Coventry All Commercial |
$355.25
|
| Rate for Payer: Encore All Commercial |
$371.60
|
| Rate for Payer: Frontpath All Commercial |
$371.39
|
| Rate for Payer: Humana ChoiceCare |
$348.67
|
| Rate for Payer: Humana Medicare |
$129.18
|
| Rate for Payer: Lucent All Commercial |
$219.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$302.77
|
| Rate for Payer: PHP All Commercial |
$306.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.44
|
| Rate for Payer: Sagamore Health Network All Products |
$311.65
|
| Rate for Payer: Signature Care EPO |
$335.06
|
| Rate for Payer: Signature Care PPO |
$355.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.14
|
| Rate for Payer: United Healthcare Commercial |
$318.11
|
| Rate for Payer: United Healthcare Medicare |
$129.18
|
|
|
HC SHAVER TOMCAT 4.0
|
Facility
|
IP
|
$403.69
|
|
| Hospital Charge Code |
41601202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.77 |
| Max. Negotiated Rate |
$375.43 |
| Rate for Payer: Aetna Commercial |
$348.79
|
| Rate for Payer: Cash Price |
$242.21
|
| Rate for Payer: Cigna All Commercial |
$348.38
|
| Rate for Payer: CORVEL All Commercial |
$375.43
|
| Rate for Payer: Coventry All Commercial |
$355.25
|
| Rate for Payer: Encore All Commercial |
$371.60
|
| Rate for Payer: Frontpath All Commercial |
$371.39
|
| Rate for Payer: Humana ChoiceCare |
$348.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$363.32
|
| Rate for Payer: PHCS All Commercial |
$302.77
|
| Rate for Payer: PHP All Commercial |
$306.16
|
| Rate for Payer: Sagamore Health Network All Products |
$311.65
|
| Rate for Payer: Signature Care EPO |
$335.06
|
| Rate for Payer: Signature Care PPO |
$355.25
|
| Rate for Payer: United Healthcare Commercial |
$318.11
|
|
|
HC SHAVER TOMCAT 4.0 ANG
|
Facility
|
IP
|
$390.85
|
|
| Hospital Charge Code |
41603087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.14 |
| Max. Negotiated Rate |
$363.49 |
| Rate for Payer: Aetna Commercial |
$337.69
|
| Rate for Payer: Cash Price |
$234.51
|
| Rate for Payer: Cigna All Commercial |
$337.30
|
| Rate for Payer: CORVEL All Commercial |
$363.49
|
| Rate for Payer: Coventry All Commercial |
$343.95
|
| Rate for Payer: Encore All Commercial |
$359.78
|
| Rate for Payer: Frontpath All Commercial |
$359.58
|
| Rate for Payer: Humana ChoiceCare |
$337.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.76
|
| Rate for Payer: PHCS All Commercial |
$293.14
|
| Rate for Payer: PHP All Commercial |
$296.42
|
| Rate for Payer: Sagamore Health Network All Products |
$301.74
|
| Rate for Payer: Signature Care EPO |
$324.41
|
| Rate for Payer: Signature Care PPO |
$343.95
|
| Rate for Payer: United Healthcare Commercial |
$307.99
|
|
|
HC SHAVER TOMCAT 4.0 ANG
|
Facility
|
OP
|
$390.85
|
|
| Hospital Charge Code |
41603087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$363.49 |
| Rate for Payer: Aetna Commercial |
$329.88
|
| Rate for Payer: Aetna Medicare |
$125.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$224.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.58
|
| Rate for Payer: Cash Price |
$234.51
|
| Rate for Payer: Cash Price |
$234.51
|
| Rate for Payer: Centivo All Commercial |
$212.62
|
| Rate for Payer: Cigna All Commercial |
$337.30
|
| Rate for Payer: CORVEL All Commercial |
$363.49
|
| Rate for Payer: Coventry All Commercial |
$343.95
|
| Rate for Payer: Encore All Commercial |
$359.78
|
| Rate for Payer: Frontpath All Commercial |
$359.58
|
| Rate for Payer: Humana ChoiceCare |
$337.58
|
| Rate for Payer: Humana Medicare |
$125.07
|
| Rate for Payer: Lucent All Commercial |
$212.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$293.14
|
| Rate for Payer: PHP All Commercial |
$296.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.43
|
| Rate for Payer: Sagamore Health Network All Products |
$301.74
|
| Rate for Payer: Signature Care EPO |
$324.41
|
| Rate for Payer: Signature Care PPO |
$343.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.22
|
| Rate for Payer: United Healthcare Commercial |
$307.99
|
| Rate for Payer: United Healthcare Medicare |
$125.07
|
|
|
HC SHAVER TOMCAT HC 4.0
|
Facility
|
IP
|
$650.51
|
|
| Hospital Charge Code |
41608369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$487.88 |
| Max. Negotiated Rate |
$604.97 |
| Rate for Payer: Aetna Commercial |
$562.04
|
| Rate for Payer: Cash Price |
$390.31
|
| Rate for Payer: Cigna All Commercial |
$561.39
|
| Rate for Payer: CORVEL All Commercial |
$604.97
|
| Rate for Payer: Coventry All Commercial |
$572.45
|
| Rate for Payer: Encore All Commercial |
$598.79
|
| Rate for Payer: Frontpath All Commercial |
$598.47
|
| Rate for Payer: Humana ChoiceCare |
$561.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$585.46
|
| Rate for Payer: PHCS All Commercial |
$487.88
|
| Rate for Payer: PHP All Commercial |
$493.35
|
| Rate for Payer: Sagamore Health Network All Products |
$502.19
|
| Rate for Payer: Signature Care EPO |
$539.92
|
| Rate for Payer: Signature Care PPO |
$572.45
|
| Rate for Payer: United Healthcare Commercial |
$512.60
|
|
|
HC SHAVER TOMCAT HC 4.0
|
Facility
|
OP
|
$650.51
|
|
| Hospital Charge Code |
41608369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$604.97 |
| Rate for Payer: Aetna Commercial |
$549.03
|
| Rate for Payer: Aetna Medicare |
$208.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.98
|
| Rate for Payer: Cash Price |
$390.31
|
| Rate for Payer: Cash Price |
$390.31
|
| Rate for Payer: Centivo All Commercial |
$353.88
|
| Rate for Payer: Cigna All Commercial |
$561.39
|
| Rate for Payer: CORVEL All Commercial |
$604.97
|
| Rate for Payer: Coventry All Commercial |
$572.45
|
| Rate for Payer: Encore All Commercial |
$598.79
|
| Rate for Payer: Frontpath All Commercial |
$598.47
|
| Rate for Payer: Humana ChoiceCare |
$561.85
|
| Rate for Payer: Humana Medicare |
$208.16
|
| Rate for Payer: Lucent All Commercial |
$353.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$585.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$487.88
|
| Rate for Payer: PHP All Commercial |
$493.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$253.70
|
| Rate for Payer: Sagamore Health Network All Products |
$502.19
|
| Rate for Payer: Signature Care EPO |
$539.92
|
| Rate for Payer: Signature Care PPO |
$572.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.93
|
| Rate for Payer: United Healthcare Commercial |
$512.60
|
| Rate for Payer: United Healthcare Medicare |
$208.16
|
|
|
HC S HEX SCREW 6.5X25 LP
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$590.80
|
| Rate for Payer: Aetna Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$402.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.40
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Centivo All Commercial |
$380.80
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Humana Medicare |
$224.00
|
| Rate for Payer: Lucent All Commercial |
$380.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.00
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$595.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
| Rate for Payer: United Healthcare Medicare |
$224.00
|
|
|
HC S HEX SCREW 6.5X25 LP
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
|
|
HC S HIP STEM SO 4
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC S HIP STEM SO 4
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC SHOULDER ARTHROGRAM LT
|
Facility
|
OP
|
$924.49
|
|
|
Service Code
|
CPT 73040 LT
|
| Hospital Charge Code |
1616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$859.78 |
| Rate for Payer: Aetna Commercial |
$780.27
|
| Rate for Payer: Aetna Medicare |
$295.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$54.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$286.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$530.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.42
|
| Rate for Payer: Cash Price |
$554.69
|
| Rate for Payer: Cash Price |
$554.69
|
| Rate for Payer: Centivo All Commercial |
$502.92
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.78
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Humana Medicare |
$295.84
|
| Rate for Payer: Lucent All Commercial |
$502.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: Managed Health Services Medicaid |
$54.66
|
| Rate for Payer: MDWise Medicaid |
$54.66
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.55
|
| Rate for Payer: Sagamore Health Network All Products |
$713.71
|
| Rate for Payer: Signature Care EPO |
$767.33
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.82
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
| Rate for Payer: United Healthcare Medicare |
$295.84
|
|
|
HC SHOULDER ARTHROGRAM LT
|
Facility
|
IP
|
$924.49
|
|
|
Service Code
|
CPT 73040 LT
|
| Hospital Charge Code |
1616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$693.37 |
| Max. Negotiated Rate |
$859.78 |
| Rate for Payer: Aetna Commercial |
$798.76
|
| Rate for Payer: Cash Price |
$554.69
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.78
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Sagamore Health Network All Products |
$713.71
|
| Rate for Payer: Signature Care EPO |
$767.33
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
|
