|
HC LEAD BIV ICD LV ATTAIN STAB QU
|
Facility
IP
|
$8,803.41
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,602.56 |
| Max. Negotiated Rate |
$8,187.17 |
| Rate for Payer: Aetna Commercial |
$7,606.15
|
| Rate for Payer: Cash Price |
$5,458.11
|
| Rate for Payer: Cigna All Commercial |
$7,597.34
|
| Rate for Payer: CORVEL All Commercial |
$8,187.17
|
| Rate for Payer: Coventry All Commercial |
$7,747.00
|
| Rate for Payer: Encore All Commercial |
$8,103.54
|
| Rate for Payer: Frontpath All Commercial |
$8,099.14
|
| Rate for Payer: Humana ChoiceCare |
$7,603.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,923.07
|
| Rate for Payer: PHCS All Commercial |
$6,602.56
|
| Rate for Payer: PHP All Commercial |
$6,676.51
|
| Rate for Payer: Sagamore Health Network All Products |
$6,796.23
|
| Rate for Payer: Signature Care EPO |
$7,306.83
|
| Rate for Payer: Signature Care PPO |
$7,747.00
|
| Rate for Payer: United Healthcare Commercial |
$6,937.09
|
|
|
HC LEAD BIV ICD LV ATT PERF QU CA
|
Facility
IP
|
$7,649.81
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.36 |
| Max. Negotiated Rate |
$7,114.32 |
| Rate for Payer: Aetna Commercial |
$6,609.44
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Cigna All Commercial |
$6,601.79
|
| Rate for Payer: CORVEL All Commercial |
$7,114.32
|
| Rate for Payer: Coventry All Commercial |
$6,731.83
|
| Rate for Payer: Encore All Commercial |
$7,041.65
|
| Rate for Payer: Frontpath All Commercial |
$7,037.83
|
| Rate for Payer: Humana ChoiceCare |
$6,607.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,884.83
|
| Rate for Payer: PHCS All Commercial |
$5,737.36
|
| Rate for Payer: PHP All Commercial |
$5,801.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.65
|
| Rate for Payer: Signature Care EPO |
$6,349.34
|
| Rate for Payer: Signature Care PPO |
$6,731.83
|
| Rate for Payer: United Healthcare Commercial |
$6,028.05
|
|
|
HC LEAD BIV ICD LV ATT PERF QU CA
|
Facility
OP
|
$7,649.81
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.32 |
| Rate for Payer: Aetna Commercial |
$6,456.44
|
| Rate for Payer: Aetna Medicare |
$2,524.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,781.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.88
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Centivo All Commercial |
$3,901.40
|
| Rate for Payer: Cigna All Commercial |
$6,601.79
|
| Rate for Payer: CORVEL All Commercial |
$7,114.32
|
| Rate for Payer: Coventry All Commercial |
$6,731.83
|
| Rate for Payer: Encore All Commercial |
$7,041.65
|
| Rate for Payer: Frontpath All Commercial |
$7,037.83
|
| Rate for Payer: Humana ChoiceCare |
$6,607.14
|
| Rate for Payer: Humana Medicare |
$3,901.40
|
| Rate for Payer: Lucent All Commercial |
$3,901.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,884.83
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.36
|
| Rate for Payer: PHP All Commercial |
$5,801.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.65
|
| Rate for Payer: Signature Care EPO |
$6,349.34
|
| Rate for Payer: Signature Care PPO |
$6,731.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.34
|
| Rate for Payer: United Healthcare Commercial |
$6,028.05
|
| Rate for Payer: United Healthcare Medicare |
$2,524.44
|
|
|
HC LEAD BIV ICD LV ATT PERF QU S
|
Facility
OP
|
$7,649.81
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.32 |
| Rate for Payer: Aetna Commercial |
$6,456.44
|
| Rate for Payer: Aetna Medicare |
$2,524.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,781.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.88
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Centivo All Commercial |
$3,901.40
|
| Rate for Payer: Cigna All Commercial |
$6,601.79
|
| Rate for Payer: CORVEL All Commercial |
$7,114.32
|
| Rate for Payer: Coventry All Commercial |
$6,731.83
|
| Rate for Payer: Encore All Commercial |
$7,041.65
|
| Rate for Payer: Frontpath All Commercial |
$7,037.83
|
| Rate for Payer: Humana ChoiceCare |
$6,607.14
|
| Rate for Payer: Humana Medicare |
$3,901.40
|
| Rate for Payer: Lucent All Commercial |
$3,901.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,884.83
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.36
|
| Rate for Payer: PHP All Commercial |
$5,801.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.65
|
| Rate for Payer: Signature Care EPO |
$6,349.34
|
| Rate for Payer: Signature Care PPO |
$6,731.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.34
|
| Rate for Payer: United Healthcare Commercial |
$6,028.05
|
| Rate for Payer: United Healthcare Medicare |
$2,524.44
|
|
|
HC LEAD BIV ICD LV ATT PERF QU S
|
Facility
IP
|
$7,649.81
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.36 |
| Max. Negotiated Rate |
$7,114.32 |
| Rate for Payer: Aetna Commercial |
$6,609.44
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Cigna All Commercial |
$6,601.79
|
| Rate for Payer: CORVEL All Commercial |
$7,114.32
|
| Rate for Payer: Coventry All Commercial |
$6,731.83
|
| Rate for Payer: Encore All Commercial |
$7,041.65
|
| Rate for Payer: Frontpath All Commercial |
$7,037.83
|
| Rate for Payer: Humana ChoiceCare |
$6,607.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,884.83
|
| Rate for Payer: PHCS All Commercial |
$5,737.36
|
| Rate for Payer: PHP All Commercial |
$5,801.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.65
|
| Rate for Payer: Signature Care EPO |
$6,349.34
|
| Rate for Payer: Signature Care PPO |
$6,731.83
|
| Rate for Payer: United Healthcare Commercial |
$6,028.05
|
|
|
HC LEAD BIV ICD LV ATT PERF QU ST
|
Facility
OP
|
$7,649.81
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.32 |
| Rate for Payer: Aetna Commercial |
$6,456.44
|
| Rate for Payer: Aetna Medicare |
$2,524.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,781.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.88
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Centivo All Commercial |
$3,901.40
|
| Rate for Payer: Cigna All Commercial |
$6,601.79
|
| Rate for Payer: CORVEL All Commercial |
$7,114.32
|
| Rate for Payer: Coventry All Commercial |
$6,731.83
|
| Rate for Payer: Encore All Commercial |
$7,041.65
|
| Rate for Payer: Frontpath All Commercial |
$7,037.83
|
| Rate for Payer: Humana ChoiceCare |
$6,607.14
|
| Rate for Payer: Humana Medicare |
$3,901.40
|
| Rate for Payer: Lucent All Commercial |
$3,901.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,884.83
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.36
|
| Rate for Payer: PHP All Commercial |
$5,801.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.65
|
| Rate for Payer: Signature Care EPO |
$6,349.34
|
| Rate for Payer: Signature Care PPO |
$6,731.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.34
|
| Rate for Payer: United Healthcare Commercial |
$6,028.05
|
| Rate for Payer: United Healthcare Medicare |
$2,524.44
|
|
|
HC LEAD BIV ICD LV ATT PERF QU ST
|
Facility
IP
|
$7,649.81
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.36 |
| Max. Negotiated Rate |
$7,114.32 |
| Rate for Payer: Aetna Commercial |
$6,609.44
|
| Rate for Payer: Cash Price |
$4,742.88
|
| Rate for Payer: Cigna All Commercial |
$6,601.79
|
| Rate for Payer: CORVEL All Commercial |
$7,114.32
|
| Rate for Payer: Coventry All Commercial |
$6,731.83
|
| Rate for Payer: Encore All Commercial |
$7,041.65
|
| Rate for Payer: Frontpath All Commercial |
$7,037.83
|
| Rate for Payer: Humana ChoiceCare |
$6,607.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,884.83
|
| Rate for Payer: PHCS All Commercial |
$5,737.36
|
| Rate for Payer: PHP All Commercial |
$5,801.62
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.65
|
| Rate for Payer: Signature Care EPO |
$6,349.34
|
| Rate for Payer: Signature Care PPO |
$6,731.83
|
| Rate for Payer: United Healthcare Commercial |
$6,028.05
|
|
|
HC LEAD BIV ICD LV BIP ATTAIN4196
|
Facility
OP
|
$5,600.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: Aetna Commercial |
$4,726.40
|
| Rate for Payer: Aetna Medicare |
$1,848.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,848.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,216.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,500.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,125.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,032.80
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Centivo All Commercial |
$2,856.00
|
| Rate for Payer: Cigna All Commercial |
$4,832.80
|
| Rate for Payer: CORVEL All Commercial |
$5,208.00
|
| Rate for Payer: Coventry All Commercial |
$4,928.00
|
| Rate for Payer: Encore All Commercial |
$5,154.80
|
| Rate for Payer: Frontpath All Commercial |
$5,152.00
|
| Rate for Payer: Humana ChoiceCare |
$4,836.72
|
| Rate for Payer: Humana Medicare |
$2,856.00
|
| Rate for Payer: Lucent All Commercial |
$2,856.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,040.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,200.00
|
| Rate for Payer: PHP All Commercial |
$4,247.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,184.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,323.20
|
| Rate for Payer: Signature Care EPO |
$4,648.00
|
| Rate for Payer: Signature Care PPO |
$4,928.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,760.00
|
| Rate for Payer: United Healthcare Commercial |
$4,412.80
|
| Rate for Payer: United Healthcare Medicare |
$1,848.00
|
|
|
HC LEAD BIV ICD LV BIP ATTAIN4196
|
Facility
IP
|
$5,600.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
41607360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: Aetna Commercial |
$4,838.40
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna All Commercial |
$4,832.80
|
| Rate for Payer: CORVEL All Commercial |
$5,208.00
|
| Rate for Payer: Coventry All Commercial |
$4,928.00
|
| Rate for Payer: Encore All Commercial |
$5,154.80
|
| Rate for Payer: Frontpath All Commercial |
$5,152.00
|
| Rate for Payer: Humana ChoiceCare |
$4,836.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,040.00
|
| Rate for Payer: PHCS All Commercial |
$4,200.00
|
| Rate for Payer: PHP All Commercial |
$4,247.04
|
| Rate for Payer: Sagamore Health Network All Products |
$4,323.20
|
| Rate for Payer: Signature Care EPO |
$4,648.00
|
| Rate for Payer: Signature Care PPO |
$4,928.00
|
| Rate for Payer: United Healthcare Commercial |
$4,412.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0636
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0636
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0662
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0662
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0663
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0663
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0665
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0665
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0672
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0672
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0673
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0673
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0675
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0675
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0676
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE 4 FRONT 0676
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
