|
HC TORNIER GREAT TOE JOINT SZ 20
|
Facility
|
OP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$5,870.19
|
| Rate for Payer: Aetna Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,994.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,347.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,639.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,524.74
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Centivo All Commercial |
$3,547.15
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Humana Medicare |
$3,547.15
|
| Rate for Payer: Lucent All Commercial |
$3,547.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,712.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,911.92
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
| Rate for Payer: United Healthcare Medicare |
$2,295.22
|
|
|
HC TORNIER GREAT TOE JOINT SZ 30
|
Facility
|
IP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,216.40 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$6,009.29
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
|
|
HC TORNIER GREAT TOE JOINT SZ 30
|
Facility
|
OP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$5,870.19
|
| Rate for Payer: Aetna Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,994.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,347.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,639.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,524.74
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Centivo All Commercial |
$3,547.15
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Humana Medicare |
$3,547.15
|
| Rate for Payer: Lucent All Commercial |
$3,547.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,712.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,911.92
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
| Rate for Payer: United Healthcare Medicare |
$2,295.22
|
|
|
HC TORNIER GREAT TOE JOINT SZ 40
|
Facility
|
IP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,216.40 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$6,009.29
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
|
|
HC TORNIER GREAT TOE JOINT SZ 40
|
Facility
|
OP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$5,870.19
|
| Rate for Payer: Aetna Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,994.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,347.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,639.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,524.74
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Centivo All Commercial |
$3,547.15
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Humana Medicare |
$3,547.15
|
| Rate for Payer: Lucent All Commercial |
$3,547.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,712.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,911.92
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
| Rate for Payer: United Healthcare Medicare |
$2,295.22
|
|
|
HC TORNIER GREAT TOE JOINT SZ 50
|
Facility
|
IP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,216.40 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$6,009.29
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
|
|
HC TORNIER GREAT TOE JOINT SZ 50
|
Facility
|
OP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$5,870.19
|
| Rate for Payer: Aetna Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,994.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,347.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,639.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,524.74
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Centivo All Commercial |
$3,547.15
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Humana Medicare |
$3,547.15
|
| Rate for Payer: Lucent All Commercial |
$3,547.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,712.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,911.92
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
| Rate for Payer: United Healthcare Medicare |
$2,295.22
|
|
|
HC TORNIER LESS M-P JOINT SZ 20
|
Facility
|
IP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,876.20 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,617.38
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
|
|
HC TORNIER LESS M-P JOINT SZ 20
|
Facility
|
OP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,487.35
|
| Rate for Payer: Aetna Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,733.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,064.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,467.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,360.08
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Centivo All Commercial |
$3,315.82
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Humana Medicare |
$3,315.82
|
| Rate for Payer: Lucent All Commercial |
$3,315.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,535.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,526.36
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
| Rate for Payer: United Healthcare Medicare |
$2,145.53
|
|
|
HC TORNIER LESS M-P JOINT SZ 30
|
Facility
|
OP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41602566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,487.35
|
| Rate for Payer: Aetna Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,733.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,064.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,467.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,360.08
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Centivo All Commercial |
$3,315.82
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Humana Medicare |
$3,315.82
|
| Rate for Payer: Lucent All Commercial |
$3,315.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,535.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,526.36
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
| Rate for Payer: United Healthcare Medicare |
$2,145.53
|
|
|
HC TORNIER LESS M-P JOINT SZ 30
|
Facility
|
IP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41602566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,876.20 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,617.38
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
|
|
HC TORNIER LESS M-P JOINT SZ 40
|
Facility
|
IP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,876.20 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,617.38
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
|
|
HC TORNIER LESS M-P JOINT SZ 40
|
Facility
|
OP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,487.35
|
| Rate for Payer: Aetna Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,733.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,064.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,467.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,360.08
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Centivo All Commercial |
$3,315.82
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Humana Medicare |
$3,315.82
|
| Rate for Payer: Lucent All Commercial |
$3,315.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,535.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,526.36
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
| Rate for Payer: United Healthcare Medicare |
$2,145.53
|
|
|
HC TORNIER LESS M-P JOINT SZ 50
|
Facility
|
OP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,487.35
|
| Rate for Payer: Aetna Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,145.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,733.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,064.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,467.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,360.08
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Centivo All Commercial |
$3,315.82
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Humana Medicare |
$3,315.82
|
| Rate for Payer: Lucent All Commercial |
$3,315.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,535.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,526.36
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
| Rate for Payer: United Healthcare Medicare |
$2,145.53
|
|
|
HC TORNIER LESS M-P JOINT SZ 50
|
Facility
|
IP
|
$6,501.60
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,876.20 |
| Max. Negotiated Rate |
$6,046.49 |
| Rate for Payer: Aetna Commercial |
$5,617.38
|
| Rate for Payer: Cash Price |
$4,030.99
|
| Rate for Payer: Cigna All Commercial |
$5,610.88
|
| Rate for Payer: CORVEL All Commercial |
$6,046.49
|
| Rate for Payer: Coventry All Commercial |
$5,721.41
|
| Rate for Payer: Encore All Commercial |
$5,984.72
|
| Rate for Payer: Frontpath All Commercial |
$5,981.47
|
| Rate for Payer: Humana ChoiceCare |
$5,615.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,851.44
|
| Rate for Payer: PHCS All Commercial |
$4,876.20
|
| Rate for Payer: PHP All Commercial |
$4,930.81
|
| Rate for Payer: Sagamore Health Network All Products |
$5,019.24
|
| Rate for Payer: Signature Care EPO |
$5,396.33
|
| Rate for Payer: Signature Care PPO |
$5,721.41
|
| Rate for Payer: United Healthcare Commercial |
$5,123.26
|
|
|
HC TOTAL CARE SPO2RT CONNECT BED/DAY
|
Facility
|
OP
|
$265.20
|
|
| Hospital Charge Code |
01895000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$246.64 |
| Rate for Payer: Aetna Commercial |
$223.83
|
| Rate for Payer: Aetna Medicare |
$87.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.27
|
| Rate for Payer: Cash Price |
$164.42
|
| Rate for Payer: Cash Price |
$164.42
|
| Rate for Payer: Centivo All Commercial |
$135.25
|
| Rate for Payer: Cigna All Commercial |
$228.87
|
| Rate for Payer: CORVEL All Commercial |
$246.64
|
| Rate for Payer: Coventry All Commercial |
$233.38
|
| Rate for Payer: Encore All Commercial |
$244.12
|
| Rate for Payer: Frontpath All Commercial |
$243.98
|
| Rate for Payer: Humana ChoiceCare |
$229.05
|
| Rate for Payer: Humana Medicare |
$135.25
|
| Rate for Payer: Lucent All Commercial |
$135.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.68
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$198.90
|
| Rate for Payer: PHP All Commercial |
$201.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.43
|
| Rate for Payer: Sagamore Health Network All Products |
$204.73
|
| Rate for Payer: Signature Care EPO |
$220.12
|
| Rate for Payer: Signature Care PPO |
$233.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.42
|
| Rate for Payer: United Healthcare Commercial |
$208.98
|
| Rate for Payer: United Healthcare Medicare |
$87.52
|
|
|
HC TOTAL CARE SPO2RT CONNECT BED/DAY
|
Facility
|
IP
|
$265.20
|
|
| Hospital Charge Code |
01895000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$246.64 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: Cash Price |
$164.42
|
| Rate for Payer: Cigna All Commercial |
$228.87
|
| Rate for Payer: CORVEL All Commercial |
$246.64
|
| Rate for Payer: Coventry All Commercial |
$233.38
|
| Rate for Payer: Encore All Commercial |
$244.12
|
| Rate for Payer: Frontpath All Commercial |
$243.98
|
| Rate for Payer: Humana ChoiceCare |
$229.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.68
|
| Rate for Payer: PHCS All Commercial |
$198.90
|
| Rate for Payer: PHP All Commercial |
$201.13
|
| Rate for Payer: Sagamore Health Network All Products |
$204.73
|
| Rate for Payer: Signature Care EPO |
$220.12
|
| Rate for Payer: Signature Care PPO |
$233.38
|
| Rate for Payer: United Healthcare Commercial |
$208.98
|
|
|
HC TOTAL COMP
|
Facility
|
OP
|
$245.16
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
63001871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$206.91
|
| Rate for Payer: Aetna Medicare |
$80.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.99
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Centivo All Commercial |
$125.03
|
| Rate for Payer: Cigna All Commercial |
$211.57
|
| Rate for Payer: CORVEL All Commercial |
$228.00
|
| Rate for Payer: Coventry All Commercial |
$215.74
|
| Rate for Payer: Encore All Commercial |
$225.67
|
| Rate for Payer: Frontpath All Commercial |
$225.54
|
| Rate for Payer: Humana ChoiceCare |
$211.74
|
| Rate for Payer: Humana Medicare |
$125.03
|
| Rate for Payer: Lucent All Commercial |
$125.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.32
|
| Rate for Payer: MDWise Medicaid |
$20.32
|
| Rate for Payer: PHCS All Commercial |
$183.87
|
| Rate for Payer: PHP All Commercial |
$185.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.61
|
| Rate for Payer: Sagamore Health Network All Products |
$189.26
|
| Rate for Payer: Signature Care EPO |
$203.48
|
| Rate for Payer: Signature Care PPO |
$215.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.38
|
| Rate for Payer: United Healthcare Commercial |
$193.18
|
| Rate for Payer: United Healthcare Medicare |
$80.90
|
|
|
HC TOTAL COMP
|
Facility
|
IP
|
$245.16
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
63001871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.87 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna All Commercial |
$211.57
|
| Rate for Payer: CORVEL All Commercial |
$228.00
|
| Rate for Payer: Coventry All Commercial |
$215.74
|
| Rate for Payer: Encore All Commercial |
$225.67
|
| Rate for Payer: Frontpath All Commercial |
$225.54
|
| Rate for Payer: Humana ChoiceCare |
$211.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.64
|
| Rate for Payer: PHCS All Commercial |
$183.87
|
| Rate for Payer: PHP All Commercial |
$185.93
|
| Rate for Payer: Sagamore Health Network All Products |
$189.26
|
| Rate for Payer: Signature Care EPO |
$203.48
|
| Rate for Payer: Signature Care PPO |
$215.74
|
| Rate for Payer: United Healthcare Commercial |
$193.18
|
|
|
HC TOTAL HIP COBALT CHROME XLPE R
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,900.00 |
| Max. Negotiated Rate |
$23,436.00 |
| Rate for Payer: Aetna Commercial |
$21,772.80
|
| Rate for Payer: Cash Price |
$15,624.00
|
| Rate for Payer: Cigna All Commercial |
$21,747.60
|
| Rate for Payer: CORVEL All Commercial |
$23,436.00
|
| Rate for Payer: Coventry All Commercial |
$22,176.00
|
| Rate for Payer: Encore All Commercial |
$23,196.60
|
| Rate for Payer: Frontpath All Commercial |
$23,184.00
|
| Rate for Payer: Humana ChoiceCare |
$21,765.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,680.00
|
| Rate for Payer: PHCS All Commercial |
$18,900.00
|
| Rate for Payer: PHP All Commercial |
$19,111.68
|
| Rate for Payer: Sagamore Health Network All Products |
$19,454.40
|
| Rate for Payer: Signature Care EPO |
$20,916.00
|
| Rate for Payer: Signature Care PPO |
$22,176.00
|
| Rate for Payer: United Healthcare Commercial |
$19,857.60
|
|
|
HC TOTAL HIP COBALT CHROME XLPE R
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$23,436.00 |
| Rate for Payer: Aetna Commercial |
$21,268.80
|
| Rate for Payer: Aetna Medicare |
$8,316.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,316.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,472.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,752.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,563.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,147.60
|
| Rate for Payer: Cash Price |
$15,624.00
|
| Rate for Payer: Cash Price |
$15,624.00
|
| Rate for Payer: Centivo All Commercial |
$12,852.00
|
| Rate for Payer: Cigna All Commercial |
$21,747.60
|
| Rate for Payer: CORVEL All Commercial |
$23,436.00
|
| Rate for Payer: Coventry All Commercial |
$22,176.00
|
| Rate for Payer: Encore All Commercial |
$23,196.60
|
| Rate for Payer: Frontpath All Commercial |
$23,184.00
|
| Rate for Payer: Humana ChoiceCare |
$21,765.24
|
| Rate for Payer: Humana Medicare |
$12,852.00
|
| Rate for Payer: Lucent All Commercial |
$12,852.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,680.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$18,900.00
|
| Rate for Payer: PHP All Commercial |
$19,111.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,828.00
|
| Rate for Payer: Sagamore Health Network All Products |
$19,454.40
|
| Rate for Payer: Signature Care EPO |
$20,916.00
|
| Rate for Payer: Signature Care PPO |
$22,176.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,420.00
|
| Rate for Payer: United Healthcare Commercial |
$19,857.60
|
| Rate for Payer: United Healthcare Medicare |
$8,316.00
|
|
|
HC TOTAL HIP OXINIUM XLPE R3 3318
|
Facility
|
OP
|
$28,800.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$26,784.00 |
| Rate for Payer: Aetna Commercial |
$24,307.20
|
| Rate for Payer: Aetna Medicare |
$9,504.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,504.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16,539.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18,002.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,929.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,454.40
|
| Rate for Payer: Cash Price |
$17,856.00
|
| Rate for Payer: Cash Price |
$17,856.00
|
| Rate for Payer: Centivo All Commercial |
$14,688.00
|
| Rate for Payer: Cigna All Commercial |
$24,854.40
|
| Rate for Payer: CORVEL All Commercial |
$26,784.00
|
| Rate for Payer: Coventry All Commercial |
$25,344.00
|
| Rate for Payer: Encore All Commercial |
$26,510.40
|
| Rate for Payer: Frontpath All Commercial |
$26,496.00
|
| Rate for Payer: Humana ChoiceCare |
$24,874.56
|
| Rate for Payer: Humana Medicare |
$14,688.00
|
| Rate for Payer: Lucent All Commercial |
$14,688.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25,920.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$21,600.00
|
| Rate for Payer: PHP All Commercial |
$21,841.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11,232.00
|
| Rate for Payer: Sagamore Health Network All Products |
$22,233.60
|
| Rate for Payer: Signature Care EPO |
$23,904.00
|
| Rate for Payer: Signature Care PPO |
$25,344.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,480.00
|
| Rate for Payer: United Healthcare Commercial |
$22,694.40
|
| Rate for Payer: United Healthcare Medicare |
$9,504.00
|
|
|
HC TOTAL HIP OXINIUM XLPE R3 3318
|
Facility
|
IP
|
$28,800.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,600.00 |
| Max. Negotiated Rate |
$26,784.00 |
| Rate for Payer: Aetna Commercial |
$24,883.20
|
| Rate for Payer: Cash Price |
$17,856.00
|
| Rate for Payer: Cigna All Commercial |
$24,854.40
|
| Rate for Payer: CORVEL All Commercial |
$26,784.00
|
| Rate for Payer: Coventry All Commercial |
$25,344.00
|
| Rate for Payer: Encore All Commercial |
$26,510.40
|
| Rate for Payer: Frontpath All Commercial |
$26,496.00
|
| Rate for Payer: Humana ChoiceCare |
$24,874.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25,920.00
|
| Rate for Payer: PHCS All Commercial |
$21,600.00
|
| Rate for Payer: PHP All Commercial |
$21,841.92
|
| Rate for Payer: Sagamore Health Network All Products |
$22,233.60
|
| Rate for Payer: Signature Care EPO |
$23,904.00
|
| Rate for Payer: Signature Care PPO |
$25,344.00
|
| Rate for Payer: United Healthcare Commercial |
$22,694.40
|
|
|
HC TOTAL KNEE COBALT CHROME CONST
|
Facility
|
OP
|
$19,800.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$18,414.00 |
| Rate for Payer: Aetna Commercial |
$16,711.20
|
| Rate for Payer: Aetna Medicare |
$6,534.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,534.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11,371.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,376.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,514.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,187.40
|
| Rate for Payer: Cash Price |
$12,276.00
|
| Rate for Payer: Cash Price |
$12,276.00
|
| Rate for Payer: Centivo All Commercial |
$10,098.00
|
| Rate for Payer: Cigna All Commercial |
$17,087.40
|
| Rate for Payer: CORVEL All Commercial |
$18,414.00
|
| Rate for Payer: Coventry All Commercial |
$17,424.00
|
| Rate for Payer: Encore All Commercial |
$18,225.90
|
| Rate for Payer: Frontpath All Commercial |
$18,216.00
|
| Rate for Payer: Humana ChoiceCare |
$17,101.26
|
| Rate for Payer: Humana Medicare |
$10,098.00
|
| Rate for Payer: Lucent All Commercial |
$10,098.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,820.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$14,850.00
|
| Rate for Payer: PHP All Commercial |
$15,016.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,722.00
|
| Rate for Payer: Sagamore Health Network All Products |
$15,285.60
|
| Rate for Payer: Signature Care EPO |
$16,434.00
|
| Rate for Payer: Signature Care PPO |
$17,424.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,830.00
|
| Rate for Payer: United Healthcare Commercial |
$15,602.40
|
| Rate for Payer: United Healthcare Medicare |
$6,534.00
|
|
|
HC TOTAL KNEE COBALT CHROME CONST
|
Facility
|
IP
|
$19,800.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,850.00 |
| Max. Negotiated Rate |
$18,414.00 |
| Rate for Payer: Aetna Commercial |
$17,107.20
|
| Rate for Payer: Cash Price |
$12,276.00
|
| Rate for Payer: Cigna All Commercial |
$17,087.40
|
| Rate for Payer: CORVEL All Commercial |
$18,414.00
|
| Rate for Payer: Coventry All Commercial |
$17,424.00
|
| Rate for Payer: Encore All Commercial |
$18,225.90
|
| Rate for Payer: Frontpath All Commercial |
$18,216.00
|
| Rate for Payer: Humana ChoiceCare |
$17,101.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,820.00
|
| Rate for Payer: PHCS All Commercial |
$14,850.00
|
| Rate for Payer: PHP All Commercial |
$15,016.32
|
| Rate for Payer: Sagamore Health Network All Products |
$15,285.60
|
| Rate for Payer: Signature Care EPO |
$16,434.00
|
| Rate for Payer: Signature Care PPO |
$17,424.00
|
| Rate for Payer: United Healthcare Commercial |
$15,602.40
|
|
