|
HC SHOULDER ARTHROGRAM RT
|
Facility
OP
|
$924.49
|
|
|
Service Code
|
CPT 73040 RT
|
| Hospital Charge Code |
11616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.08 |
| Max. Negotiated Rate |
$859.77 |
| Rate for Payer: Aetna Commercial |
$780.27
|
| Rate for Payer: Aetna Medicare |
$305.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.59
|
| Rate for Payer: Cash Price |
$573.18
|
| Rate for Payer: Centivo All Commercial |
$471.49
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.77
|
| 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 |
$471.49
|
| Rate for Payer: Lucent All Commercial |
$471.49
|
| 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: Plain Church Group Ministry All Commercial |
$360.55
|
| Rate for Payer: Sagamore Health Network All Products |
$713.70
|
| Rate for Payer: Signature Care EPO |
$767.32
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.81
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
| Rate for Payer: United Healthcare Medicare |
$305.08
|
|
|
HC SICKLE CELL SCR
|
Facility
OP
|
$62.64
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
63001323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$58.25 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.74
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Centivo All Commercial |
$31.95
|
| Rate for Payer: Cigna All Commercial |
$54.06
|
| Rate for Payer: CORVEL All Commercial |
$58.25
|
| Rate for Payer: Coventry All Commercial |
$55.12
|
| Rate for Payer: Encore All Commercial |
$57.66
|
| Rate for Payer: Frontpath All Commercial |
$57.63
|
| Rate for Payer: Humana ChoiceCare |
$54.10
|
| Rate for Payer: Humana Medicare |
$31.95
|
| Rate for Payer: Lucent All Commercial |
$31.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.37
|
| Rate for Payer: Managed Health Services Medicaid |
$5.51
|
| Rate for Payer: MDWise Medicaid |
$5.51
|
| Rate for Payer: PHCS All Commercial |
$46.98
|
| Rate for Payer: PHP All Commercial |
$47.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.43
|
| Rate for Payer: Sagamore Health Network All Products |
$48.36
|
| Rate for Payer: Signature Care EPO |
$51.99
|
| Rate for Payer: Signature Care PPO |
$55.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.24
|
| Rate for Payer: United Healthcare Commercial |
$49.36
|
| Rate for Payer: United Healthcare Medicare |
$20.67
|
|
|
HC SICKLE CELL SCR
|
Facility
IP
|
$62.64
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
63001323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$58.25 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna All Commercial |
$54.06
|
| Rate for Payer: CORVEL All Commercial |
$58.25
|
| Rate for Payer: Coventry All Commercial |
$55.12
|
| Rate for Payer: Encore All Commercial |
$57.66
|
| Rate for Payer: Frontpath All Commercial |
$57.63
|
| Rate for Payer: Humana ChoiceCare |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.37
|
| Rate for Payer: PHCS All Commercial |
$46.98
|
| Rate for Payer: PHP All Commercial |
$47.50
|
| Rate for Payer: Sagamore Health Network All Products |
$48.36
|
| Rate for Payer: Signature Care EPO |
$51.99
|
| Rate for Payer: Signature Care PPO |
$55.12
|
| Rate for Payer: United Healthcare Commercial |
$49.36
|
|
|
HC SIG 3BX MOTION PX BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603642
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3BX MOTION PX BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603642
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX ACE BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603632
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX ACE BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603632
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX CARAT BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603634
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX CARAT BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603634
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX CELLION BTE HA MON
|
Facility
OP
|
$2,470.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603639
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Aetna Commercial |
$2,084.68
|
| Rate for Payer: Aetna Medicare |
$815.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$815.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,418.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,544.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$937.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$896.61
|
| Rate for Payer: Cash Price |
$1,531.40
|
| Rate for Payer: Cash Price |
$1,531.40
|
| Rate for Payer: Centivo All Commercial |
$1,259.70
|
| Rate for Payer: Cigna All Commercial |
$2,131.61
|
| Rate for Payer: CORVEL All Commercial |
$2,297.10
|
| Rate for Payer: Coventry All Commercial |
$2,173.60
|
| Rate for Payer: Encore All Commercial |
$2,273.64
|
| Rate for Payer: Frontpath All Commercial |
$2,272.40
|
| Rate for Payer: Humana ChoiceCare |
$2,133.34
|
| Rate for Payer: Humana Medicare |
$1,259.70
|
| Rate for Payer: Lucent All Commercial |
$1,259.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,223.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,852.50
|
| Rate for Payer: PHP All Commercial |
$1,873.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$963.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,906.84
|
| Rate for Payer: Signature Care EPO |
$2,050.10
|
| Rate for Payer: Signature Care PPO |
$2,173.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,099.50
|
| Rate for Payer: United Healthcare Commercial |
$1,946.36
|
| Rate for Payer: United Healthcare Medicare |
$815.10
|
|
|
HC SIG 3PX CELLION BTE HA MON
|
Facility
IP
|
$2,470.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603639
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Aetna Commercial |
$2,134.08
|
| Rate for Payer: Cash Price |
$1,531.40
|
| Rate for Payer: Cigna All Commercial |
$2,131.61
|
| Rate for Payer: CORVEL All Commercial |
$2,297.10
|
| Rate for Payer: Coventry All Commercial |
$2,173.60
|
| Rate for Payer: Encore All Commercial |
$2,273.64
|
| Rate for Payer: Frontpath All Commercial |
$2,272.40
|
| Rate for Payer: Humana ChoiceCare |
$2,133.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,223.00
|
| Rate for Payer: PHCS All Commercial |
$1,852.50
|
| Rate for Payer: PHP All Commercial |
$1,873.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,906.84
|
| Rate for Payer: Signature Care EPO |
$2,050.10
|
| Rate for Payer: Signature Care PPO |
$2,173.60
|
| Rate for Payer: United Healthcare Commercial |
$1,946.36
|
|
|
HC SIG 3PX INSIO CUST CIC HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603641
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX INSIO CUST CIC HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603641
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX INSIO CUST ITE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603640
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX INSIO CUST ITE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603640
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX MOTION P BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603637
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX MOTION P BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603637
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX MOTION SA BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603636
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX MOTION SA BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603636
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX MOTION SP BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603638
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX MOTION SP BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603638
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX MOTION SX BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603635
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX MOTION SX BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603635
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 3PX PURE BTE HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603633
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX PURE BTE HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603633
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
