|
HC S PATELLA S33X9 SYM TRI
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S33X9 TRI
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S33X9 TRI
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S36X10 SYM TRI
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S36X10 SYM TRI
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S36X10 SYM TRI E
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S36X10 SYM TRI E
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S36X10 SYM TRI L
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S36X10 SYM TRI L
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S39X11 SYM TRI E
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S39X11 SYM TRI E
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S39X11 SYM TRI G
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC S PATELLA S39X11 SYM TRI G
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S39X11 SYM TRI L
|
Facility
OP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,370.75
|
| Rate for Payer: Aetna Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,613.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,755.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,065.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,019.65
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Centivo All Commercial |
$1,432.56
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Humana Medicare |
$1,432.56
|
| Rate for Payer: Lucent All Commercial |
$1,432.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,095.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,387.60
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
| Rate for Payer: United Healthcare Medicare |
$926.95
|
|
|
HC S PATELLA S39X11 SYM TRI L
|
Facility
IP
|
$2,808.94
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.70 |
| Max. Negotiated Rate |
$2,612.31 |
| Rate for Payer: Aetna Commercial |
$2,426.92
|
| Rate for Payer: Cash Price |
$1,741.54
|
| Rate for Payer: Cigna All Commercial |
$2,424.12
|
| Rate for Payer: CORVEL All Commercial |
$2,612.31
|
| Rate for Payer: Coventry All Commercial |
$2,471.87
|
| Rate for Payer: Encore All Commercial |
$2,585.63
|
| Rate for Payer: Frontpath All Commercial |
$2,584.22
|
| Rate for Payer: Humana ChoiceCare |
$2,426.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,528.05
|
| Rate for Payer: PHCS All Commercial |
$2,106.70
|
| Rate for Payer: PHP All Commercial |
$2,130.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,168.50
|
| Rate for Payer: Signature Care EPO |
$2,331.42
|
| Rate for Payer: Signature Care PPO |
$2,471.87
|
| Rate for Payer: United Healthcare Commercial |
$2,213.44
|
|
|
HC SPECIAL PHYSICS CONSULT
|
Facility
OP
|
$1,591.20
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
01547370
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$487.07 |
| Max. Negotiated Rate |
$1,479.82 |
| Rate for Payer: Aetna Commercial |
$1,342.97
|
| Rate for Payer: Aetna Medicare |
$525.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$525.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$913.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$994.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$487.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$577.61
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Centivo All Commercial |
$811.51
|
| Rate for Payer: Cigna All Commercial |
$1,373.21
|
| Rate for Payer: CORVEL All Commercial |
$1,479.82
|
| Rate for Payer: Coventry All Commercial |
$1,400.26
|
| Rate for Payer: Encore All Commercial |
$1,464.70
|
| Rate for Payer: Frontpath All Commercial |
$1,463.90
|
| Rate for Payer: Humana ChoiceCare |
$1,374.32
|
| Rate for Payer: Humana Medicare |
$811.51
|
| Rate for Payer: Lucent All Commercial |
$811.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,432.08
|
| Rate for Payer: Managed Health Services Medicaid |
$487.07
|
| Rate for Payer: MDWise Medicaid |
$487.07
|
| Rate for Payer: PHCS All Commercial |
$1,193.40
|
| Rate for Payer: PHP All Commercial |
$1,206.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$620.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,228.41
|
| Rate for Payer: Signature Care EPO |
$1,320.70
|
| Rate for Payer: Signature Care PPO |
$1,400.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,352.52
|
| Rate for Payer: United Healthcare Commercial |
$1,253.87
|
| Rate for Payer: United Healthcare Medicare |
$525.10
|
|
|
HC SPECIAL PHYSICS CONSULT
|
Facility
IP
|
$1,591.20
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
01547370
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,193.40 |
| Max. Negotiated Rate |
$1,479.82 |
| Rate for Payer: Aetna Commercial |
$1,374.80
|
| Rate for Payer: Cash Price |
$986.54
|
| Rate for Payer: Cigna All Commercial |
$1,373.21
|
| Rate for Payer: CORVEL All Commercial |
$1,479.82
|
| Rate for Payer: Coventry All Commercial |
$1,400.26
|
| Rate for Payer: Encore All Commercial |
$1,464.70
|
| Rate for Payer: Frontpath All Commercial |
$1,463.90
|
| Rate for Payer: Humana ChoiceCare |
$1,374.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,432.08
|
| Rate for Payer: PHCS All Commercial |
$1,193.40
|
| Rate for Payer: PHP All Commercial |
$1,206.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,228.41
|
| Rate for Payer: Signature Care EPO |
$1,320.70
|
| Rate for Payer: Signature Care PPO |
$1,400.26
|
| Rate for Payer: United Healthcare Commercial |
$1,253.87
|
|
|
HC SPECIAL PORT PLAN
|
Facility
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
01547321
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$1,233.18 |
| Rate for Payer: Aetna Commercial |
$1,119.14
|
| Rate for Payer: Aetna Medicare |
$437.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$437.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$761.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$828.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$114.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$503.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$481.34
|
| Rate for Payer: Cash Price |
$822.12
|
| Rate for Payer: Cash Price |
$822.12
|
| Rate for Payer: Centivo All Commercial |
$676.26
|
| Rate for Payer: Cigna All Commercial |
$1,144.34
|
| Rate for Payer: CORVEL All Commercial |
$1,233.18
|
| Rate for Payer: Coventry All Commercial |
$1,166.88
|
| Rate for Payer: Encore All Commercial |
$1,220.58
|
| Rate for Payer: Frontpath All Commercial |
$1,219.92
|
| Rate for Payer: Humana ChoiceCare |
$1,145.27
|
| Rate for Payer: Humana Medicare |
$676.26
|
| Rate for Payer: Lucent All Commercial |
$676.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,193.40
|
| Rate for Payer: Managed Health Services Medicaid |
$114.66
|
| Rate for Payer: MDWise Medicaid |
$114.66
|
| Rate for Payer: PHCS All Commercial |
$994.50
|
| Rate for Payer: PHP All Commercial |
$1,005.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$517.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,023.67
|
| Rate for Payer: Signature Care EPO |
$1,100.58
|
| Rate for Payer: Signature Care PPO |
$1,166.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,127.10
|
| Rate for Payer: United Healthcare Commercial |
$1,044.89
|
| Rate for Payer: United Healthcare Medicare |
$437.58
|
|
|
HC SPECIAL PORT PLAN
|
Facility
IP
|
$1,326.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
01547321
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$994.50 |
| Max. Negotiated Rate |
$1,233.18 |
| Rate for Payer: Aetna Commercial |
$1,145.66
|
| Rate for Payer: Cash Price |
$822.12
|
| Rate for Payer: Cigna All Commercial |
$1,144.34
|
| Rate for Payer: CORVEL All Commercial |
$1,233.18
|
| Rate for Payer: Coventry All Commercial |
$1,166.88
|
| Rate for Payer: Encore All Commercial |
$1,220.58
|
| Rate for Payer: Frontpath All Commercial |
$1,219.92
|
| Rate for Payer: Humana ChoiceCare |
$1,145.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,193.40
|
| Rate for Payer: PHCS All Commercial |
$994.50
|
| Rate for Payer: PHP All Commercial |
$1,005.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,023.67
|
| Rate for Payer: Signature Care EPO |
$1,100.58
|
| Rate for Payer: Signature Care PPO |
$1,166.88
|
| Rate for Payer: United Healthcare Commercial |
$1,044.89
|
|
|
HC SPECIAL STAIN GROUP 2 EA
|
Facility
IP
|
$270.71
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
63001263
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$203.03 |
| Max. Negotiated Rate |
$251.76 |
| Rate for Payer: Aetna Commercial |
$233.89
|
| Rate for Payer: Cash Price |
$167.84
|
| Rate for Payer: Cigna All Commercial |
$233.62
|
| Rate for Payer: CORVEL All Commercial |
$251.76
|
| Rate for Payer: Coventry All Commercial |
$238.22
|
| Rate for Payer: Encore All Commercial |
$249.19
|
| Rate for Payer: Frontpath All Commercial |
$249.05
|
| Rate for Payer: Humana ChoiceCare |
$233.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.64
|
| Rate for Payer: PHCS All Commercial |
$203.03
|
| Rate for Payer: PHP All Commercial |
$205.30
|
| Rate for Payer: Sagamore Health Network All Products |
$208.99
|
| Rate for Payer: Signature Care EPO |
$224.69
|
| Rate for Payer: Signature Care PPO |
$238.22
|
| Rate for Payer: United Healthcare Commercial |
$213.32
|
|
|
HC SPECIAL STAIN GROUP 2 EA
|
Facility
OP
|
$270.71
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
63001263
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$251.76 |
| Rate for Payer: Aetna Commercial |
$228.48
|
| Rate for Payer: Aetna Medicare |
$89.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$155.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$32.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.27
|
| Rate for Payer: Cash Price |
$167.84
|
| Rate for Payer: Cash Price |
$167.84
|
| Rate for Payer: Centivo All Commercial |
$138.06
|
| Rate for Payer: Cigna All Commercial |
$233.62
|
| Rate for Payer: CORVEL All Commercial |
$251.76
|
| Rate for Payer: Coventry All Commercial |
$238.22
|
| Rate for Payer: Encore All Commercial |
$249.19
|
| Rate for Payer: Frontpath All Commercial |
$249.05
|
| Rate for Payer: Humana ChoiceCare |
$233.81
|
| Rate for Payer: Humana Medicare |
$138.06
|
| Rate for Payer: Lucent All Commercial |
$138.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.64
|
| Rate for Payer: Managed Health Services Medicaid |
$32.57
|
| Rate for Payer: MDWise Medicaid |
$32.57
|
| Rate for Payer: PHCS All Commercial |
$203.03
|
| Rate for Payer: PHP All Commercial |
$205.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.58
|
| Rate for Payer: Sagamore Health Network All Products |
$208.99
|
| Rate for Payer: Signature Care EPO |
$224.69
|
| Rate for Payer: Signature Care PPO |
$238.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$230.10
|
| Rate for Payer: United Healthcare Commercial |
$213.32
|
| Rate for Payer: United Healthcare Medicare |
$89.33
|
|
|
HC SPECIAL STAIN GROUP PATH 1 EA
|
Facility
OP
|
$291.72
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
63001265
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Aetna Medicare |
$96.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$167.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.89
|
| Rate for Payer: Cash Price |
$180.87
|
| Rate for Payer: Cash Price |
$180.87
|
| Rate for Payer: Centivo All Commercial |
$148.78
|
| Rate for Payer: Cigna All Commercial |
$251.75
|
| Rate for Payer: CORVEL All Commercial |
$271.30
|
| Rate for Payer: Coventry All Commercial |
$256.71
|
| Rate for Payer: Encore All Commercial |
$268.53
|
| Rate for Payer: Frontpath All Commercial |
$268.38
|
| Rate for Payer: Humana ChoiceCare |
$251.96
|
| Rate for Payer: Humana Medicare |
$148.78
|
| Rate for Payer: Lucent All Commercial |
$148.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$262.55
|
| Rate for Payer: Managed Health Services Medicaid |
$34.52
|
| Rate for Payer: MDWise Medicaid |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$218.79
|
| Rate for Payer: PHP All Commercial |
$221.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.77
|
| Rate for Payer: Sagamore Health Network All Products |
$225.21
|
| Rate for Payer: Signature Care EPO |
$242.13
|
| Rate for Payer: Signature Care PPO |
$256.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$247.96
|
| Rate for Payer: United Healthcare Commercial |
$229.88
|
| Rate for Payer: United Healthcare Medicare |
$96.27
|
|
|
HC SPECIAL STAIN GROUP PATH 1 EA
|
Facility
IP
|
$291.72
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
63001265
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$180.87
|
| Rate for Payer: Cigna All Commercial |
$251.75
|
| Rate for Payer: CORVEL All Commercial |
$271.30
|
| Rate for Payer: Coventry All Commercial |
$256.71
|
| Rate for Payer: Encore All Commercial |
$268.53
|
| Rate for Payer: Frontpath All Commercial |
$268.38
|
| Rate for Payer: Humana ChoiceCare |
$251.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$262.55
|
| Rate for Payer: PHCS All Commercial |
$218.79
|
| Rate for Payer: PHP All Commercial |
$221.24
|
| Rate for Payer: Sagamore Health Network All Products |
$225.21
|
| Rate for Payer: Signature Care EPO |
$242.13
|
| Rate for Payer: Signature Care PPO |
$256.71
|
| Rate for Payer: United Healthcare Commercial |
$229.88
|
|
|
HC SPECIAL STAIN GROUP PATH 1 EA X2
|
Facility
OP
|
$203.50
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
63002101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$189.26 |
| Rate for Payer: Aetna Commercial |
$171.75
|
| Rate for Payer: Aetna Medicare |
$67.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$34.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.87
|
| Rate for Payer: Cash Price |
$126.17
|
| Rate for Payer: Cash Price |
$126.17
|
| Rate for Payer: Centivo All Commercial |
$103.79
|
| Rate for Payer: Cigna All Commercial |
$175.62
|
| Rate for Payer: CORVEL All Commercial |
$189.26
|
| Rate for Payer: Coventry All Commercial |
$179.08
|
| Rate for Payer: Encore All Commercial |
$187.32
|
| Rate for Payer: Frontpath All Commercial |
$187.22
|
| Rate for Payer: Humana ChoiceCare |
$175.76
|
| Rate for Payer: Humana Medicare |
$103.79
|
| Rate for Payer: Lucent All Commercial |
$103.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.15
|
| Rate for Payer: Managed Health Services Medicaid |
$34.52
|
| Rate for Payer: MDWise Medicaid |
$34.52
|
| Rate for Payer: PHCS All Commercial |
$152.63
|
| Rate for Payer: PHP All Commercial |
$154.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.37
|
| Rate for Payer: Sagamore Health Network All Products |
$157.10
|
| Rate for Payer: Signature Care EPO |
$168.91
|
| Rate for Payer: Signature Care PPO |
$179.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$172.98
|
| Rate for Payer: United Healthcare Commercial |
$160.36
|
| Rate for Payer: United Healthcare Medicare |
$67.16
|
|
|
HC SPECIAL STAIN GROUP PATH 1 EA X2
|
Facility
IP
|
$203.50
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
63002101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$152.63 |
| Max. Negotiated Rate |
$189.26 |
| Rate for Payer: Aetna Commercial |
$175.82
|
| Rate for Payer: Cash Price |
$126.17
|
| Rate for Payer: Cigna All Commercial |
$175.62
|
| Rate for Payer: CORVEL All Commercial |
$189.26
|
| Rate for Payer: Coventry All Commercial |
$179.08
|
| Rate for Payer: Encore All Commercial |
$187.32
|
| Rate for Payer: Frontpath All Commercial |
$187.22
|
| Rate for Payer: Humana ChoiceCare |
$175.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.15
|
| Rate for Payer: PHCS All Commercial |
$152.63
|
| Rate for Payer: PHP All Commercial |
$154.33
|
| Rate for Payer: Sagamore Health Network All Products |
$157.10
|
| Rate for Payer: Signature Care EPO |
$168.91
|
| Rate for Payer: Signature Care PPO |
$179.08
|
| Rate for Payer: United Healthcare Commercial |
$160.36
|
|
