|
HC BIVICDQUADASSMPCRT-DDF4CONNMRI
|
Facility
OP
|
$60,007.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607566
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$55,806.98 |
| Rate for Payer: Aetna Commercial |
$50,646.33
|
| Rate for Payer: Aetna Medicare |
$19,802.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19,802.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34,462.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37,510.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22,772.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21,782.72
|
| Rate for Payer: Cash Price |
$37,204.65
|
| Rate for Payer: Cash Price |
$37,204.65
|
| Rate for Payer: Centivo All Commercial |
$30,603.82
|
| Rate for Payer: Cigna All Commercial |
$51,786.47
|
| Rate for Payer: CORVEL All Commercial |
$55,806.98
|
| Rate for Payer: Coventry All Commercial |
$52,806.60
|
| Rate for Payer: Encore All Commercial |
$55,236.90
|
| Rate for Payer: Frontpath All Commercial |
$55,206.90
|
| Rate for Payer: Humana ChoiceCare |
$51,828.48
|
| Rate for Payer: Humana Medicare |
$30,603.82
|
| Rate for Payer: Lucent All Commercial |
$30,603.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54,006.75
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$45,005.62
|
| Rate for Payer: PHP All Commercial |
$45,509.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23,402.92
|
| Rate for Payer: Sagamore Health Network All Products |
$46,325.79
|
| Rate for Payer: Signature Care EPO |
$49,806.22
|
| Rate for Payer: Signature Care PPO |
$52,806.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,006.38
|
| Rate for Payer: United Healthcare Commercial |
$47,285.91
|
| Rate for Payer: United Healthcare Medicare |
$19,802.48
|
|
|
HC BIVICD UNI ASS CRTD 40 DF4CONN
|
Facility
OP
|
$56,133.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607570
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$52,203.69 |
| Rate for Payer: Aetna Commercial |
$47,376.25
|
| Rate for Payer: Aetna Medicare |
$18,523.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18,523.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32,237.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35,088.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21,302.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20,376.28
|
| Rate for Payer: Cash Price |
$34,802.46
|
| Rate for Payer: Cash Price |
$34,802.46
|
| Rate for Payer: Centivo All Commercial |
$28,627.83
|
| Rate for Payer: Cigna All Commercial |
$48,442.78
|
| Rate for Payer: CORVEL All Commercial |
$52,203.69
|
| Rate for Payer: Coventry All Commercial |
$49,397.04
|
| Rate for Payer: Encore All Commercial |
$51,670.43
|
| Rate for Payer: Frontpath All Commercial |
$51,642.36
|
| Rate for Payer: Humana ChoiceCare |
$48,482.07
|
| Rate for Payer: Humana Medicare |
$28,627.83
|
| Rate for Payer: Lucent All Commercial |
$28,627.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50,519.70
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$42,099.75
|
| Rate for Payer: PHP All Commercial |
$42,571.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21,891.87
|
| Rate for Payer: Sagamore Health Network All Products |
$43,334.68
|
| Rate for Payer: Signature Care EPO |
$46,590.39
|
| Rate for Payer: Signature Care PPO |
$49,397.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47,713.05
|
| Rate for Payer: United Healthcare Commercial |
$44,232.80
|
| Rate for Payer: United Healthcare Medicare |
$18,523.89
|
|
|
HC BIVICD UNI ASS CRTD 40 DF4CONN
|
Facility
IP
|
$56,133.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607570
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$42,099.75 |
| Max. Negotiated Rate |
$52,203.69 |
| Rate for Payer: Aetna Commercial |
$48,498.91
|
| Rate for Payer: Cash Price |
$34,802.46
|
| Rate for Payer: Cigna All Commercial |
$48,442.78
|
| Rate for Payer: CORVEL All Commercial |
$52,203.69
|
| Rate for Payer: Coventry All Commercial |
$49,397.04
|
| Rate for Payer: Encore All Commercial |
$51,670.43
|
| Rate for Payer: Frontpath All Commercial |
$51,642.36
|
| Rate for Payer: Humana ChoiceCare |
$48,482.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50,519.70
|
| Rate for Payer: PHCS All Commercial |
$42,099.75
|
| Rate for Payer: PHP All Commercial |
$42,571.27
|
| Rate for Payer: Sagamore Health Network All Products |
$43,334.68
|
| Rate for Payer: Signature Care EPO |
$46,590.39
|
| Rate for Payer: Signature Care PPO |
$49,397.04
|
| Rate for Payer: United Healthcare Commercial |
$44,232.80
|
|
|
HC BIV ICD UNIFY ASS CRT-D 40
|
Facility
IP
|
$56,133.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607569
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$42,099.75 |
| Max. Negotiated Rate |
$52,203.69 |
| Rate for Payer: Aetna Commercial |
$48,498.91
|
| Rate for Payer: Cash Price |
$34,802.46
|
| Rate for Payer: Cigna All Commercial |
$48,442.78
|
| Rate for Payer: CORVEL All Commercial |
$52,203.69
|
| Rate for Payer: Coventry All Commercial |
$49,397.04
|
| Rate for Payer: Encore All Commercial |
$51,670.43
|
| Rate for Payer: Frontpath All Commercial |
$51,642.36
|
| Rate for Payer: Humana ChoiceCare |
$48,482.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50,519.70
|
| Rate for Payer: PHCS All Commercial |
$42,099.75
|
| Rate for Payer: PHP All Commercial |
$42,571.27
|
| Rate for Payer: Sagamore Health Network All Products |
$43,334.68
|
| Rate for Payer: Signature Care EPO |
$46,590.39
|
| Rate for Payer: Signature Care PPO |
$49,397.04
|
| Rate for Payer: United Healthcare Commercial |
$44,232.80
|
|
|
HC BIV ICD UNIFY ASS CRT-D 40
|
Facility
OP
|
$56,133.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607569
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$52,203.69 |
| Rate for Payer: Aetna Commercial |
$47,376.25
|
| Rate for Payer: Aetna Medicare |
$18,523.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18,523.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32,237.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35,088.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21,302.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20,376.28
|
| Rate for Payer: Cash Price |
$34,802.46
|
| Rate for Payer: Cash Price |
$34,802.46
|
| Rate for Payer: Centivo All Commercial |
$28,627.83
|
| Rate for Payer: Cigna All Commercial |
$48,442.78
|
| Rate for Payer: CORVEL All Commercial |
$52,203.69
|
| Rate for Payer: Coventry All Commercial |
$49,397.04
|
| Rate for Payer: Encore All Commercial |
$51,670.43
|
| Rate for Payer: Frontpath All Commercial |
$51,642.36
|
| Rate for Payer: Humana ChoiceCare |
$48,482.07
|
| Rate for Payer: Humana Medicare |
$28,627.83
|
| Rate for Payer: Lucent All Commercial |
$28,627.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50,519.70
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$42,099.75
|
| Rate for Payer: PHP All Commercial |
$42,571.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21,891.87
|
| Rate for Payer: Sagamore Health Network All Products |
$43,334.68
|
| Rate for Payer: Signature Care EPO |
$46,590.39
|
| Rate for Payer: Signature Care PPO |
$49,397.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47,713.05
|
| Rate for Payer: United Healthcare Commercial |
$44,232.80
|
| Rate for Payer: United Healthcare Medicare |
$18,523.89
|
|
|
HC BIV ICD VIGILANT X4 IS4 DF4
|
Facility
IP
|
$65,782.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607247
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$49,336.88 |
| Max. Negotiated Rate |
$61,177.72 |
| Rate for Payer: Aetna Commercial |
$56,836.08
|
| Rate for Payer: Cash Price |
$40,785.15
|
| Rate for Payer: Cigna All Commercial |
$56,770.30
|
| Rate for Payer: CORVEL All Commercial |
$61,177.72
|
| Rate for Payer: Coventry All Commercial |
$57,888.60
|
| Rate for Payer: Encore All Commercial |
$60,552.79
|
| Rate for Payer: Frontpath All Commercial |
$60,519.90
|
| Rate for Payer: Humana ChoiceCare |
$56,816.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59,204.25
|
| Rate for Payer: PHCS All Commercial |
$49,336.88
|
| Rate for Payer: PHP All Commercial |
$49,889.45
|
| Rate for Payer: Sagamore Health Network All Products |
$50,784.09
|
| Rate for Payer: Signature Care EPO |
$54,599.48
|
| Rate for Payer: Signature Care PPO |
$57,888.60
|
| Rate for Payer: United Healthcare Commercial |
$51,836.61
|
|
|
HC BIV ICD VIGILANT X4 IS4 DF4
|
Facility
OP
|
$65,782.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
41607247
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$61,177.72 |
| Rate for Payer: Aetna Commercial |
$55,520.43
|
| Rate for Payer: Aetna Medicare |
$21,708.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21,708.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37,778.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41,120.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24,964.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23,879.05
|
| Rate for Payer: Cash Price |
$40,785.15
|
| Rate for Payer: Cash Price |
$40,785.15
|
| Rate for Payer: Centivo All Commercial |
$33,549.08
|
| Rate for Payer: Cigna All Commercial |
$56,770.30
|
| Rate for Payer: CORVEL All Commercial |
$61,177.72
|
| Rate for Payer: Coventry All Commercial |
$57,888.60
|
| Rate for Payer: Encore All Commercial |
$60,552.79
|
| Rate for Payer: Frontpath All Commercial |
$60,519.90
|
| Rate for Payer: Humana ChoiceCare |
$56,816.35
|
| Rate for Payer: Humana Medicare |
$33,549.08
|
| Rate for Payer: Lucent All Commercial |
$33,549.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59,204.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$49,336.88
|
| Rate for Payer: PHP All Commercial |
$49,889.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25,655.18
|
| Rate for Payer: Sagamore Health Network All Products |
$50,784.09
|
| Rate for Payer: Signature Care EPO |
$54,599.48
|
| Rate for Payer: Signature Care PPO |
$57,888.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,915.12
|
| Rate for Payer: United Healthcare Commercial |
$51,836.61
|
| Rate for Payer: United Healthcare Medicare |
$21,708.22
|
|
|
HC BIV PM ALLURE CRT-P RF
|
Facility
IP
|
$22,275.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607546
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$16,706.25 |
| Max. Negotiated Rate |
$20,715.75 |
| Rate for Payer: Aetna Commercial |
$19,245.60
|
| Rate for Payer: Cash Price |
$13,810.50
|
| Rate for Payer: Cigna All Commercial |
$19,223.32
|
| Rate for Payer: CORVEL All Commercial |
$20,715.75
|
| Rate for Payer: Coventry All Commercial |
$19,602.00
|
| Rate for Payer: Encore All Commercial |
$20,504.14
|
| Rate for Payer: Frontpath All Commercial |
$20,493.00
|
| Rate for Payer: Humana ChoiceCare |
$19,238.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20,047.50
|
| Rate for Payer: PHCS All Commercial |
$16,706.25
|
| Rate for Payer: PHP All Commercial |
$16,893.36
|
| Rate for Payer: Sagamore Health Network All Products |
$17,196.30
|
| Rate for Payer: Signature Care EPO |
$18,488.25
|
| Rate for Payer: Signature Care PPO |
$19,602.00
|
| Rate for Payer: United Healthcare Commercial |
$17,552.70
|
|
|
HC BIV PM ALLURE CRT-P RF
|
Facility
OP
|
$22,275.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607546
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$20,715.75 |
| Rate for Payer: Aetna Commercial |
$18,800.10
|
| Rate for Payer: Aetna Medicare |
$7,350.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7,350.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12,792.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13,924.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8,453.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8,085.82
|
| Rate for Payer: Cash Price |
$13,810.50
|
| Rate for Payer: Cash Price |
$13,810.50
|
| Rate for Payer: Centivo All Commercial |
$11,360.25
|
| Rate for Payer: Cigna All Commercial |
$19,223.32
|
| Rate for Payer: CORVEL All Commercial |
$20,715.75
|
| Rate for Payer: Coventry All Commercial |
$19,602.00
|
| Rate for Payer: Encore All Commercial |
$20,504.14
|
| Rate for Payer: Frontpath All Commercial |
$20,493.00
|
| Rate for Payer: Humana ChoiceCare |
$19,238.92
|
| Rate for Payer: Humana Medicare |
$11,360.25
|
| Rate for Payer: Lucent All Commercial |
$11,360.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20,047.50
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$16,706.25
|
| Rate for Payer: PHP All Commercial |
$16,893.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,687.25
|
| Rate for Payer: Sagamore Health Network All Products |
$17,196.30
|
| Rate for Payer: Signature Care EPO |
$18,488.25
|
| Rate for Payer: Signature Care PPO |
$19,602.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,933.75
|
| Rate for Payer: United Healthcare Commercial |
$17,552.70
|
| Rate for Payer: United Healthcare Medicare |
$7,350.75
|
|
|
HC BIV PM ALLURE QUAD CRT-P RF
|
Facility
IP
|
$23,895.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607545
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$17,921.25 |
| Max. Negotiated Rate |
$22,222.35 |
| Rate for Payer: Aetna Commercial |
$20,645.28
|
| Rate for Payer: Cash Price |
$14,814.90
|
| Rate for Payer: Cigna All Commercial |
$20,621.38
|
| Rate for Payer: CORVEL All Commercial |
$22,222.35
|
| Rate for Payer: Coventry All Commercial |
$21,027.60
|
| Rate for Payer: Encore All Commercial |
$21,995.35
|
| Rate for Payer: Frontpath All Commercial |
$21,983.40
|
| Rate for Payer: Humana ChoiceCare |
$20,638.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21,505.50
|
| Rate for Payer: PHCS All Commercial |
$17,921.25
|
| Rate for Payer: PHP All Commercial |
$18,121.97
|
| Rate for Payer: Sagamore Health Network All Products |
$18,446.94
|
| Rate for Payer: Signature Care EPO |
$19,832.85
|
| Rate for Payer: Signature Care PPO |
$21,027.60
|
| Rate for Payer: United Healthcare Commercial |
$18,829.26
|
|
|
HC BIV PM ALLURE QUAD CRT-P RF
|
Facility
OP
|
$23,895.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607545
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$22,222.35 |
| Rate for Payer: Aetna Commercial |
$20,167.38
|
| Rate for Payer: Aetna Medicare |
$7,885.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7,885.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13,722.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14,936.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,068.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8,673.88
|
| Rate for Payer: Cash Price |
$14,814.90
|
| Rate for Payer: Cash Price |
$14,814.90
|
| Rate for Payer: Centivo All Commercial |
$12,186.45
|
| Rate for Payer: Cigna All Commercial |
$20,621.38
|
| Rate for Payer: CORVEL All Commercial |
$22,222.35
|
| Rate for Payer: Coventry All Commercial |
$21,027.60
|
| Rate for Payer: Encore All Commercial |
$21,995.35
|
| Rate for Payer: Frontpath All Commercial |
$21,983.40
|
| Rate for Payer: Humana ChoiceCare |
$20,638.11
|
| Rate for Payer: Humana Medicare |
$12,186.45
|
| Rate for Payer: Lucent All Commercial |
$12,186.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21,505.50
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$17,921.25
|
| Rate for Payer: PHP All Commercial |
$18,121.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,319.05
|
| Rate for Payer: Sagamore Health Network All Products |
$18,446.94
|
| Rate for Payer: Signature Care EPO |
$19,832.85
|
| Rate for Payer: Signature Care PPO |
$21,027.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,310.75
|
| Rate for Payer: United Healthcare Commercial |
$18,829.26
|
| Rate for Payer: United Healthcare Medicare |
$7,885.35
|
|
|
HC BIV PM CRT PERCEPTA MRI CRTP
|
Facility
IP
|
$27,025.91
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,269.43 |
| Max. Negotiated Rate |
$25,134.10 |
| Rate for Payer: Aetna Commercial |
$23,350.39
|
| Rate for Payer: Cash Price |
$16,756.06
|
| Rate for Payer: Cigna All Commercial |
$23,323.36
|
| Rate for Payer: CORVEL All Commercial |
$25,134.10
|
| Rate for Payer: Coventry All Commercial |
$23,782.80
|
| Rate for Payer: Encore All Commercial |
$24,877.35
|
| Rate for Payer: Frontpath All Commercial |
$24,863.84
|
| Rate for Payer: Humana ChoiceCare |
$23,342.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,323.32
|
| Rate for Payer: PHCS All Commercial |
$20,269.43
|
| Rate for Payer: PHP All Commercial |
$20,496.45
|
| Rate for Payer: Sagamore Health Network All Products |
$20,864.00
|
| Rate for Payer: Signature Care EPO |
$22,431.51
|
| Rate for Payer: Signature Care PPO |
$23,782.80
|
| Rate for Payer: United Healthcare Commercial |
$21,296.42
|
|
|
HC BIV PM CRT PERCEPTA MRI CRTP
|
Facility
OP
|
$27,025.91
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$25,134.10 |
| Rate for Payer: Aetna Commercial |
$22,809.87
|
| Rate for Payer: Aetna Medicare |
$8,918.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,918.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,520.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,893.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,256.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,810.41
|
| Rate for Payer: Cash Price |
$16,756.06
|
| Rate for Payer: Cash Price |
$16,756.06
|
| Rate for Payer: Centivo All Commercial |
$13,783.21
|
| Rate for Payer: Cigna All Commercial |
$23,323.36
|
| Rate for Payer: CORVEL All Commercial |
$25,134.10
|
| Rate for Payer: Coventry All Commercial |
$23,782.80
|
| Rate for Payer: Encore All Commercial |
$24,877.35
|
| Rate for Payer: Frontpath All Commercial |
$24,863.84
|
| Rate for Payer: Humana ChoiceCare |
$23,342.28
|
| Rate for Payer: Humana Medicare |
$13,783.21
|
| Rate for Payer: Lucent All Commercial |
$13,783.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,323.32
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$20,269.43
|
| Rate for Payer: PHP All Commercial |
$20,496.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,540.10
|
| Rate for Payer: Sagamore Health Network All Products |
$20,864.00
|
| Rate for Payer: Signature Care EPO |
$22,431.51
|
| Rate for Payer: Signature Care PPO |
$23,782.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,972.02
|
| Rate for Payer: United Healthcare Commercial |
$21,296.42
|
| Rate for Payer: United Healthcare Medicare |
$8,918.55
|
|
|
HC BIV PM CRT SOLARA MRI CRTP
|
Facility
IP
|
$25,403.66
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607355
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$19,052.74 |
| Max. Negotiated Rate |
$23,625.40 |
| Rate for Payer: Aetna Commercial |
$21,948.76
|
| Rate for Payer: Cash Price |
$15,750.27
|
| Rate for Payer: Cigna All Commercial |
$21,923.36
|
| Rate for Payer: CORVEL All Commercial |
$23,625.40
|
| Rate for Payer: Coventry All Commercial |
$22,355.22
|
| Rate for Payer: Encore All Commercial |
$23,384.07
|
| Rate for Payer: Frontpath All Commercial |
$23,371.37
|
| Rate for Payer: Humana ChoiceCare |
$21,941.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,863.29
|
| Rate for Payer: PHCS All Commercial |
$19,052.74
|
| Rate for Payer: PHP All Commercial |
$19,266.14
|
| Rate for Payer: Sagamore Health Network All Products |
$19,611.63
|
| Rate for Payer: Signature Care EPO |
$21,085.04
|
| Rate for Payer: Signature Care PPO |
$22,355.22
|
| Rate for Payer: United Healthcare Commercial |
$20,018.08
|
|
|
HC BIV PM CRT SOLARA MRI CRTP
|
Facility
OP
|
$25,403.66
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607355
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$23,625.40 |
| Rate for Payer: Aetna Commercial |
$21,440.69
|
| Rate for Payer: Aetna Medicare |
$8,383.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,383.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,589.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,879.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,640.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,221.53
|
| Rate for Payer: Cash Price |
$15,750.27
|
| Rate for Payer: Cash Price |
$15,750.27
|
| Rate for Payer: Centivo All Commercial |
$12,955.87
|
| Rate for Payer: Cigna All Commercial |
$21,923.36
|
| Rate for Payer: CORVEL All Commercial |
$23,625.40
|
| Rate for Payer: Coventry All Commercial |
$22,355.22
|
| Rate for Payer: Encore All Commercial |
$23,384.07
|
| Rate for Payer: Frontpath All Commercial |
$23,371.37
|
| Rate for Payer: Humana ChoiceCare |
$21,941.14
|
| Rate for Payer: Humana Medicare |
$12,955.87
|
| Rate for Payer: Lucent All Commercial |
$12,955.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,863.29
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$19,052.74
|
| Rate for Payer: PHP All Commercial |
$19,266.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,907.43
|
| Rate for Payer: Sagamore Health Network All Products |
$19,611.63
|
| Rate for Payer: Signature Care EPO |
$21,085.04
|
| Rate for Payer: Signature Care PPO |
$22,355.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,593.11
|
| Rate for Payer: United Healthcare Commercial |
$20,018.08
|
| Rate for Payer: United Healthcare Medicare |
$8,383.21
|
|
|
HC BIV PM CRT SOLARA MRI QUADCRTP
|
Facility
IP
|
$25,403.66
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$19,052.74 |
| Max. Negotiated Rate |
$23,625.40 |
| Rate for Payer: Aetna Commercial |
$21,948.76
|
| Rate for Payer: Cash Price |
$15,750.27
|
| Rate for Payer: Cigna All Commercial |
$21,923.36
|
| Rate for Payer: CORVEL All Commercial |
$23,625.40
|
| Rate for Payer: Coventry All Commercial |
$22,355.22
|
| Rate for Payer: Encore All Commercial |
$23,384.07
|
| Rate for Payer: Frontpath All Commercial |
$23,371.37
|
| Rate for Payer: Humana ChoiceCare |
$21,941.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,863.29
|
| Rate for Payer: PHCS All Commercial |
$19,052.74
|
| Rate for Payer: PHP All Commercial |
$19,266.14
|
| Rate for Payer: Sagamore Health Network All Products |
$19,611.63
|
| Rate for Payer: Signature Care EPO |
$21,085.04
|
| Rate for Payer: Signature Care PPO |
$22,355.22
|
| Rate for Payer: United Healthcare Commercial |
$20,018.08
|
|
|
HC BIV PM CRT SOLARA MRI QUADCRTP
|
Facility
OP
|
$25,403.66
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$23,625.40 |
| Rate for Payer: Aetna Commercial |
$21,440.69
|
| Rate for Payer: Aetna Medicare |
$8,383.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,383.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,589.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,879.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,640.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,221.53
|
| Rate for Payer: Cash Price |
$15,750.27
|
| Rate for Payer: Cash Price |
$15,750.27
|
| Rate for Payer: Centivo All Commercial |
$12,955.87
|
| Rate for Payer: Cigna All Commercial |
$21,923.36
|
| Rate for Payer: CORVEL All Commercial |
$23,625.40
|
| Rate for Payer: Coventry All Commercial |
$22,355.22
|
| Rate for Payer: Encore All Commercial |
$23,384.07
|
| Rate for Payer: Frontpath All Commercial |
$23,371.37
|
| Rate for Payer: Humana ChoiceCare |
$21,941.14
|
| Rate for Payer: Humana Medicare |
$12,955.87
|
| Rate for Payer: Lucent All Commercial |
$12,955.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,863.29
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$19,052.74
|
| Rate for Payer: PHP All Commercial |
$19,266.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,907.43
|
| Rate for Payer: Sagamore Health Network All Products |
$19,611.63
|
| Rate for Payer: Signature Care EPO |
$21,085.04
|
| Rate for Payer: Signature Care PPO |
$22,355.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,593.11
|
| Rate for Payer: United Healthcare Commercial |
$20,018.08
|
| Rate for Payer: United Healthcare Medicare |
$8,383.21
|
|
|
HC BIV PM PERCEPTA MRI QUAD CRTP
|
Facility
IP
|
$27,025.91
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,269.43 |
| Max. Negotiated Rate |
$25,134.10 |
| Rate for Payer: Aetna Commercial |
$23,350.39
|
| Rate for Payer: Cash Price |
$16,756.06
|
| Rate for Payer: Cigna All Commercial |
$23,323.36
|
| Rate for Payer: CORVEL All Commercial |
$25,134.10
|
| Rate for Payer: Coventry All Commercial |
$23,782.80
|
| Rate for Payer: Encore All Commercial |
$24,877.35
|
| Rate for Payer: Frontpath All Commercial |
$24,863.84
|
| Rate for Payer: Humana ChoiceCare |
$23,342.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,323.32
|
| Rate for Payer: PHCS All Commercial |
$20,269.43
|
| Rate for Payer: PHP All Commercial |
$20,496.45
|
| Rate for Payer: Sagamore Health Network All Products |
$20,864.00
|
| Rate for Payer: Signature Care EPO |
$22,431.51
|
| Rate for Payer: Signature Care PPO |
$23,782.80
|
| Rate for Payer: United Healthcare Commercial |
$21,296.42
|
|
|
HC BIV PM PERCEPTA MRI QUAD CRTP
|
Facility
OP
|
$27,025.91
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$25,134.10 |
| Rate for Payer: Aetna Commercial |
$22,809.87
|
| Rate for Payer: Aetna Medicare |
$8,918.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,918.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,520.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,893.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,256.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,810.41
|
| Rate for Payer: Cash Price |
$16,756.06
|
| Rate for Payer: Cash Price |
$16,756.06
|
| Rate for Payer: Centivo All Commercial |
$13,783.21
|
| Rate for Payer: Cigna All Commercial |
$23,323.36
|
| Rate for Payer: CORVEL All Commercial |
$25,134.10
|
| Rate for Payer: Coventry All Commercial |
$23,782.80
|
| Rate for Payer: Encore All Commercial |
$24,877.35
|
| Rate for Payer: Frontpath All Commercial |
$24,863.84
|
| Rate for Payer: Humana ChoiceCare |
$23,342.28
|
| Rate for Payer: Humana Medicare |
$13,783.21
|
| Rate for Payer: Lucent All Commercial |
$13,783.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,323.32
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$20,269.43
|
| Rate for Payer: PHP All Commercial |
$20,496.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,540.10
|
| Rate for Payer: Sagamore Health Network All Products |
$20,864.00
|
| Rate for Payer: Signature Care EPO |
$22,431.51
|
| Rate for Payer: Signature Care PPO |
$23,782.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,972.02
|
| Rate for Payer: United Healthcare Commercial |
$21,296.42
|
| Rate for Payer: United Healthcare Medicare |
$8,918.55
|
|
|
HC BIV PM QUAD ALL. MP RF CRT-P
|
Facility
OP
|
$25,312.50
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607544
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$23,540.62 |
| Rate for Payer: Aetna Commercial |
$21,363.75
|
| Rate for Payer: Aetna Medicare |
$8,353.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,353.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,536.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,822.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,606.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,188.44
|
| Rate for Payer: Cash Price |
$15,693.75
|
| Rate for Payer: Cash Price |
$15,693.75
|
| Rate for Payer: Centivo All Commercial |
$12,909.38
|
| Rate for Payer: Cigna All Commercial |
$21,844.69
|
| Rate for Payer: CORVEL All Commercial |
$23,540.62
|
| Rate for Payer: Coventry All Commercial |
$22,275.00
|
| Rate for Payer: Encore All Commercial |
$23,300.16
|
| Rate for Payer: Frontpath All Commercial |
$23,287.50
|
| Rate for Payer: Humana ChoiceCare |
$21,862.41
|
| Rate for Payer: Humana Medicare |
$12,909.38
|
| Rate for Payer: Lucent All Commercial |
$12,909.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,781.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$18,984.38
|
| Rate for Payer: PHP All Commercial |
$19,197.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,871.88
|
| Rate for Payer: Sagamore Health Network All Products |
$19,541.25
|
| Rate for Payer: Signature Care EPO |
$21,009.38
|
| Rate for Payer: Signature Care PPO |
$22,275.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,515.62
|
| Rate for Payer: United Healthcare Commercial |
$19,946.25
|
| Rate for Payer: United Healthcare Medicare |
$8,353.12
|
|
|
HC BIV PM QUAD ALL. MP RF CRT-P
|
Facility
IP
|
$25,312.50
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607544
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$18,984.38 |
| Max. Negotiated Rate |
$23,540.62 |
| Rate for Payer: Aetna Commercial |
$21,870.00
|
| Rate for Payer: Cash Price |
$15,693.75
|
| Rate for Payer: Cigna All Commercial |
$21,844.69
|
| Rate for Payer: CORVEL All Commercial |
$23,540.62
|
| Rate for Payer: Coventry All Commercial |
$22,275.00
|
| Rate for Payer: Encore All Commercial |
$23,300.16
|
| Rate for Payer: Frontpath All Commercial |
$23,287.50
|
| Rate for Payer: Humana ChoiceCare |
$21,862.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,781.25
|
| Rate for Payer: PHCS All Commercial |
$18,984.38
|
| Rate for Payer: PHP All Commercial |
$19,197.00
|
| Rate for Payer: Sagamore Health Network All Products |
$19,541.25
|
| Rate for Payer: Signature Care EPO |
$21,009.38
|
| Rate for Payer: Signature Care PPO |
$22,275.00
|
| Rate for Payer: United Healthcare Commercial |
$19,946.25
|
|
|
HC BIV PM QUAD ALL. MPRF CRTP MRI
|
Facility
OP
|
$25,312.50
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607543
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$23,540.62 |
| Rate for Payer: Aetna Commercial |
$21,363.75
|
| Rate for Payer: Aetna Medicare |
$8,353.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,353.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,536.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,822.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,606.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,188.44
|
| Rate for Payer: Cash Price |
$15,693.75
|
| Rate for Payer: Cash Price |
$15,693.75
|
| Rate for Payer: Centivo All Commercial |
$12,909.38
|
| Rate for Payer: Cigna All Commercial |
$21,844.69
|
| Rate for Payer: CORVEL All Commercial |
$23,540.62
|
| Rate for Payer: Coventry All Commercial |
$22,275.00
|
| Rate for Payer: Encore All Commercial |
$23,300.16
|
| Rate for Payer: Frontpath All Commercial |
$23,287.50
|
| Rate for Payer: Humana ChoiceCare |
$21,862.41
|
| Rate for Payer: Humana Medicare |
$12,909.38
|
| Rate for Payer: Lucent All Commercial |
$12,909.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,781.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$18,984.38
|
| Rate for Payer: PHP All Commercial |
$19,197.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,871.88
|
| Rate for Payer: Sagamore Health Network All Products |
$19,541.25
|
| Rate for Payer: Signature Care EPO |
$21,009.38
|
| Rate for Payer: Signature Care PPO |
$22,275.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,515.62
|
| Rate for Payer: United Healthcare Commercial |
$19,946.25
|
| Rate for Payer: United Healthcare Medicare |
$8,353.12
|
|
|
HC BIV PM QUAD ALL. MPRF CRTP MRI
|
Facility
IP
|
$25,312.50
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
41607543
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$18,984.38 |
| Max. Negotiated Rate |
$23,540.62 |
| Rate for Payer: Aetna Commercial |
$21,870.00
|
| Rate for Payer: Cash Price |
$15,693.75
|
| Rate for Payer: Cigna All Commercial |
$21,844.69
|
| Rate for Payer: CORVEL All Commercial |
$23,540.62
|
| Rate for Payer: Coventry All Commercial |
$22,275.00
|
| Rate for Payer: Encore All Commercial |
$23,300.16
|
| Rate for Payer: Frontpath All Commercial |
$23,287.50
|
| Rate for Payer: Humana ChoiceCare |
$21,862.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,781.25
|
| Rate for Payer: PHCS All Commercial |
$18,984.38
|
| Rate for Payer: PHP All Commercial |
$19,197.00
|
| Rate for Payer: Sagamore Health Network All Products |
$19,541.25
|
| Rate for Payer: Signature Care EPO |
$21,009.38
|
| Rate for Payer: Signature Care PPO |
$22,275.00
|
| Rate for Payer: United Healthcare Commercial |
$19,946.25
|
|
|
HC BIV PM VISIONIST IS1
|
Facility
OP
|
$27,562.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607258
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$25,633.12 |
| Rate for Payer: Aetna Commercial |
$23,262.75
|
| Rate for Payer: Aetna Medicare |
$9,095.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,095.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15,829.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17,229.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,459.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,005.19
|
| Rate for Payer: Cash Price |
$17,088.75
|
| Rate for Payer: Cash Price |
$17,088.75
|
| Rate for Payer: Centivo All Commercial |
$14,056.88
|
| Rate for Payer: Cigna All Commercial |
$23,786.44
|
| Rate for Payer: CORVEL All Commercial |
$25,633.12
|
| Rate for Payer: Coventry All Commercial |
$24,255.00
|
| Rate for Payer: Encore All Commercial |
$25,371.28
|
| Rate for Payer: Frontpath All Commercial |
$25,357.50
|
| Rate for Payer: Humana ChoiceCare |
$23,805.73
|
| Rate for Payer: Humana Medicare |
$14,056.88
|
| Rate for Payer: Lucent All Commercial |
$14,056.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,806.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$20,671.88
|
| Rate for Payer: PHP All Commercial |
$20,903.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,749.38
|
| Rate for Payer: Sagamore Health Network All Products |
$21,278.25
|
| Rate for Payer: Signature Care EPO |
$22,876.88
|
| Rate for Payer: Signature Care PPO |
$24,255.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,428.12
|
| Rate for Payer: United Healthcare Commercial |
$21,719.25
|
| Rate for Payer: United Healthcare Medicare |
$9,095.62
|
|
|
HC BIV PM VISIONIST IS1
|
Facility
IP
|
$27,562.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607258
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,671.88 |
| Max. Negotiated Rate |
$25,633.12 |
| Rate for Payer: Aetna Commercial |
$23,814.00
|
| Rate for Payer: Cash Price |
$17,088.75
|
| Rate for Payer: Cigna All Commercial |
$23,786.44
|
| Rate for Payer: CORVEL All Commercial |
$25,633.12
|
| Rate for Payer: Coventry All Commercial |
$24,255.00
|
| Rate for Payer: Encore All Commercial |
$25,371.28
|
| Rate for Payer: Frontpath All Commercial |
$25,357.50
|
| Rate for Payer: Humana ChoiceCare |
$23,805.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24,806.25
|
| Rate for Payer: PHCS All Commercial |
$20,671.88
|
| Rate for Payer: PHP All Commercial |
$20,903.40
|
| Rate for Payer: Sagamore Health Network All Products |
$21,278.25
|
| Rate for Payer: Signature Care EPO |
$22,876.88
|
| Rate for Payer: Signature Care PPO |
$24,255.00
|
| Rate for Payer: United Healthcare Commercial |
$21,719.25
|
|
