|
HC PACEMAKER DC ZEPHYR DR
|
Facility
OP
|
$17,820.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607537
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$16,572.60 |
| Rate for Payer: Aetna Commercial |
$15,040.08
|
| Rate for Payer: Aetna Medicare |
$5,880.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,880.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,234.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,139.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,762.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,468.66
|
| Rate for Payer: Cash Price |
$11,048.40
|
| Rate for Payer: Cash Price |
$11,048.40
|
| Rate for Payer: Centivo All Commercial |
$9,088.20
|
| Rate for Payer: Cigna All Commercial |
$15,378.66
|
| Rate for Payer: CORVEL All Commercial |
$16,572.60
|
| Rate for Payer: Coventry All Commercial |
$15,681.60
|
| Rate for Payer: Encore All Commercial |
$16,403.31
|
| Rate for Payer: Frontpath All Commercial |
$16,394.40
|
| Rate for Payer: Humana ChoiceCare |
$15,391.13
|
| Rate for Payer: Humana Medicare |
$9,088.20
|
| Rate for Payer: Lucent All Commercial |
$9,088.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,038.00
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$13,365.00
|
| Rate for Payer: PHP All Commercial |
$13,514.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,949.80
|
| Rate for Payer: Sagamore Health Network All Products |
$13,757.04
|
| Rate for Payer: Signature Care EPO |
$14,790.60
|
| Rate for Payer: Signature Care PPO |
$15,681.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,147.00
|
| Rate for Payer: United Healthcare Commercial |
$14,042.16
|
| Rate for Payer: United Healthcare Medicare |
$5,880.60
|
|
|
HC PACEMAKER DC ZEPHYR XL DR
|
Facility
IP
|
$17,820.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607536
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,365.00 |
| Max. Negotiated Rate |
$16,572.60 |
| Rate for Payer: Aetna Commercial |
$15,396.48
|
| Rate for Payer: Cash Price |
$11,048.40
|
| Rate for Payer: Cigna All Commercial |
$15,378.66
|
| Rate for Payer: CORVEL All Commercial |
$16,572.60
|
| Rate for Payer: Coventry All Commercial |
$15,681.60
|
| Rate for Payer: Encore All Commercial |
$16,403.31
|
| Rate for Payer: Frontpath All Commercial |
$16,394.40
|
| Rate for Payer: Humana ChoiceCare |
$15,391.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,038.00
|
| Rate for Payer: PHCS All Commercial |
$13,365.00
|
| Rate for Payer: PHP All Commercial |
$13,514.69
|
| Rate for Payer: Sagamore Health Network All Products |
$13,757.04
|
| Rate for Payer: Signature Care EPO |
$14,790.60
|
| Rate for Payer: Signature Care PPO |
$15,681.60
|
| Rate for Payer: United Healthcare Commercial |
$14,042.16
|
|
|
HC PACEMAKER DC ZEPHYR XL DR
|
Facility
OP
|
$17,820.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
41607536
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$16,572.60 |
| Rate for Payer: Aetna Commercial |
$15,040.08
|
| Rate for Payer: Aetna Medicare |
$5,880.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,880.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,234.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,139.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,762.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,468.66
|
| Rate for Payer: Cash Price |
$11,048.40
|
| Rate for Payer: Cash Price |
$11,048.40
|
| Rate for Payer: Centivo All Commercial |
$9,088.20
|
| Rate for Payer: Cigna All Commercial |
$15,378.66
|
| Rate for Payer: CORVEL All Commercial |
$16,572.60
|
| Rate for Payer: Coventry All Commercial |
$15,681.60
|
| Rate for Payer: Encore All Commercial |
$16,403.31
|
| Rate for Payer: Frontpath All Commercial |
$16,394.40
|
| Rate for Payer: Humana ChoiceCare |
$15,391.13
|
| Rate for Payer: Humana Medicare |
$9,088.20
|
| Rate for Payer: Lucent All Commercial |
$9,088.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,038.00
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$13,365.00
|
| Rate for Payer: PHP All Commercial |
$13,514.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,949.80
|
| Rate for Payer: Sagamore Health Network All Products |
$13,757.04
|
| Rate for Payer: Signature Care EPO |
$14,790.60
|
| Rate for Payer: Signature Care PPO |
$15,681.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,147.00
|
| Rate for Payer: United Healthcare Commercial |
$14,042.16
|
| Rate for Payer: United Healthcare Medicare |
$5,880.60
|
|
|
HC PACEMAKER SC ACCOLADE DR
|
Facility
OP
|
$12,562.50
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607172
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$11,683.12 |
| Rate for Payer: Aetna Commercial |
$10,602.75
|
| Rate for Payer: Aetna Medicare |
$4,145.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,145.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,214.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,852.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,767.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,560.19
|
| Rate for Payer: Cash Price |
$7,788.75
|
| Rate for Payer: Cash Price |
$7,788.75
|
| Rate for Payer: Centivo All Commercial |
$6,406.88
|
| Rate for Payer: Cigna All Commercial |
$10,841.44
|
| Rate for Payer: CORVEL All Commercial |
$11,683.12
|
| Rate for Payer: Coventry All Commercial |
$11,055.00
|
| Rate for Payer: Encore All Commercial |
$11,563.78
|
| Rate for Payer: Frontpath All Commercial |
$11,557.50
|
| Rate for Payer: Humana ChoiceCare |
$10,850.23
|
| Rate for Payer: Humana Medicare |
$6,406.88
|
| Rate for Payer: Lucent All Commercial |
$6,406.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,306.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,421.88
|
| Rate for Payer: PHP All Commercial |
$9,527.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,899.38
|
| Rate for Payer: Sagamore Health Network All Products |
$9,698.25
|
| Rate for Payer: Signature Care EPO |
$10,426.88
|
| Rate for Payer: Signature Care PPO |
$11,055.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,678.12
|
| Rate for Payer: United Healthcare Commercial |
$9,899.25
|
| Rate for Payer: United Healthcare Medicare |
$4,145.62
|
|
|
HC PACEMAKER SC ACCOLADE DR
|
Facility
IP
|
$12,562.50
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607172
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,421.88 |
| Max. Negotiated Rate |
$11,683.12 |
| Rate for Payer: Aetna Commercial |
$10,854.00
|
| Rate for Payer: Cash Price |
$7,788.75
|
| Rate for Payer: Cigna All Commercial |
$10,841.44
|
| Rate for Payer: CORVEL All Commercial |
$11,683.12
|
| Rate for Payer: Coventry All Commercial |
$11,055.00
|
| Rate for Payer: Encore All Commercial |
$11,563.78
|
| Rate for Payer: Frontpath All Commercial |
$11,557.50
|
| Rate for Payer: Humana ChoiceCare |
$10,850.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,306.25
|
| Rate for Payer: PHCS All Commercial |
$9,421.88
|
| Rate for Payer: PHP All Commercial |
$9,527.40
|
| Rate for Payer: Sagamore Health Network All Products |
$9,698.25
|
| Rate for Payer: Signature Care EPO |
$10,426.88
|
| Rate for Payer: Signature Care PPO |
$11,055.00
|
| Rate for Payer: United Healthcare Commercial |
$9,899.25
|
|
|
HC PACEMAKER SC ASSURIT MRI SR RF
|
Facility
OP
|
$12,453.75
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607538
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$11,581.99 |
| Rate for Payer: Aetna Commercial |
$10,510.96
|
| Rate for Payer: Aetna Medicare |
$4,109.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,109.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,152.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,784.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,726.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,520.71
|
| Rate for Payer: Cash Price |
$7,721.33
|
| Rate for Payer: Cash Price |
$7,721.33
|
| Rate for Payer: Centivo All Commercial |
$6,351.41
|
| Rate for Payer: Cigna All Commercial |
$10,747.59
|
| Rate for Payer: CORVEL All Commercial |
$11,581.99
|
| Rate for Payer: Coventry All Commercial |
$10,959.30
|
| Rate for Payer: Encore All Commercial |
$11,463.68
|
| Rate for Payer: Frontpath All Commercial |
$11,457.45
|
| Rate for Payer: Humana ChoiceCare |
$10,756.30
|
| Rate for Payer: Humana Medicare |
$6,351.41
|
| Rate for Payer: Lucent All Commercial |
$6,351.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,208.38
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,340.31
|
| Rate for Payer: PHP All Commercial |
$9,444.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,856.96
|
| Rate for Payer: Sagamore Health Network All Products |
$9,614.30
|
| Rate for Payer: Signature Care EPO |
$10,336.61
|
| Rate for Payer: Signature Care PPO |
$10,959.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,585.69
|
| Rate for Payer: United Healthcare Commercial |
$9,813.56
|
| Rate for Payer: United Healthcare Medicare |
$4,109.74
|
|
|
HC PACEMAKER SC ASSURIT MRI SR RF
|
Facility
IP
|
$12,453.75
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607538
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,340.31 |
| Max. Negotiated Rate |
$11,581.99 |
| Rate for Payer: Aetna Commercial |
$10,760.04
|
| Rate for Payer: Cash Price |
$7,721.33
|
| Rate for Payer: Cigna All Commercial |
$10,747.59
|
| Rate for Payer: CORVEL All Commercial |
$11,581.99
|
| Rate for Payer: Coventry All Commercial |
$10,959.30
|
| Rate for Payer: Encore All Commercial |
$11,463.68
|
| Rate for Payer: Frontpath All Commercial |
$11,457.45
|
| Rate for Payer: Humana ChoiceCare |
$10,756.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,208.38
|
| Rate for Payer: PHCS All Commercial |
$9,340.31
|
| Rate for Payer: PHP All Commercial |
$9,444.92
|
| Rate for Payer: Sagamore Health Network All Products |
$9,614.30
|
| Rate for Payer: Signature Care EPO |
$10,336.61
|
| Rate for Payer: Signature Care PPO |
$10,959.30
|
| Rate for Payer: United Healthcare Commercial |
$9,813.56
|
|
|
HC PACEMAKER SC ASSURITY SR RF
|
Facility
OP
|
$12,453.75
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607539
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$11,581.99 |
| Rate for Payer: Aetna Commercial |
$10,510.96
|
| Rate for Payer: Aetna Medicare |
$4,109.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,109.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,152.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,784.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,726.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,520.71
|
| Rate for Payer: Cash Price |
$7,721.33
|
| Rate for Payer: Cash Price |
$7,721.33
|
| Rate for Payer: Centivo All Commercial |
$6,351.41
|
| Rate for Payer: Cigna All Commercial |
$10,747.59
|
| Rate for Payer: CORVEL All Commercial |
$11,581.99
|
| Rate for Payer: Coventry All Commercial |
$10,959.30
|
| Rate for Payer: Encore All Commercial |
$11,463.68
|
| Rate for Payer: Frontpath All Commercial |
$11,457.45
|
| Rate for Payer: Humana ChoiceCare |
$10,756.30
|
| Rate for Payer: Humana Medicare |
$6,351.41
|
| Rate for Payer: Lucent All Commercial |
$6,351.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,208.38
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,340.31
|
| Rate for Payer: PHP All Commercial |
$9,444.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,856.96
|
| Rate for Payer: Sagamore Health Network All Products |
$9,614.30
|
| Rate for Payer: Signature Care EPO |
$10,336.61
|
| Rate for Payer: Signature Care PPO |
$10,959.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,585.69
|
| Rate for Payer: United Healthcare Commercial |
$9,813.56
|
| Rate for Payer: United Healthcare Medicare |
$4,109.74
|
|
|
HC PACEMAKER SC ASSURITY SR RF
|
Facility
IP
|
$12,453.75
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607539
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,340.31 |
| Max. Negotiated Rate |
$11,581.99 |
| Rate for Payer: Aetna Commercial |
$10,760.04
|
| Rate for Payer: Cash Price |
$7,721.33
|
| Rate for Payer: Cigna All Commercial |
$10,747.59
|
| Rate for Payer: CORVEL All Commercial |
$11,581.99
|
| Rate for Payer: Coventry All Commercial |
$10,959.30
|
| Rate for Payer: Encore All Commercial |
$11,463.68
|
| Rate for Payer: Frontpath All Commercial |
$11,457.45
|
| Rate for Payer: Humana ChoiceCare |
$10,756.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,208.38
|
| Rate for Payer: PHCS All Commercial |
$9,340.31
|
| Rate for Payer: PHP All Commercial |
$9,444.92
|
| Rate for Payer: Sagamore Health Network All Products |
$9,614.30
|
| Rate for Payer: Signature Care EPO |
$10,336.61
|
| Rate for Payer: Signature Care PPO |
$10,959.30
|
| Rate for Payer: United Healthcare Commercial |
$9,813.56
|
|
|
HC PACEMAKER SC AZURE S SR MRI
|
Facility
IP
|
$12,746.25
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607337
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,559.69 |
| Max. Negotiated Rate |
$11,854.01 |
| Rate for Payer: Aetna Commercial |
$11,012.76
|
| Rate for Payer: Cash Price |
$7,902.68
|
| Rate for Payer: Cigna All Commercial |
$11,000.01
|
| Rate for Payer: CORVEL All Commercial |
$11,854.01
|
| Rate for Payer: Coventry All Commercial |
$11,216.70
|
| Rate for Payer: Encore All Commercial |
$11,732.92
|
| Rate for Payer: Frontpath All Commercial |
$11,726.55
|
| Rate for Payer: Humana ChoiceCare |
$11,008.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,471.62
|
| Rate for Payer: PHCS All Commercial |
$9,559.69
|
| Rate for Payer: PHP All Commercial |
$9,666.76
|
| Rate for Payer: Sagamore Health Network All Products |
$9,840.10
|
| Rate for Payer: Signature Care EPO |
$10,579.39
|
| Rate for Payer: Signature Care PPO |
$11,216.70
|
| Rate for Payer: United Healthcare Commercial |
$10,044.04
|
|
|
HC PACEMAKER SC AZURE S SR MRI
|
Facility
OP
|
$12,746.25
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607337
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$11,854.01 |
| Rate for Payer: Aetna Commercial |
$10,757.84
|
| Rate for Payer: Aetna Medicare |
$4,206.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,206.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,320.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,967.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,837.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,626.89
|
| Rate for Payer: Cash Price |
$7,902.68
|
| Rate for Payer: Cash Price |
$7,902.68
|
| Rate for Payer: Centivo All Commercial |
$6,500.59
|
| Rate for Payer: Cigna All Commercial |
$11,000.01
|
| Rate for Payer: CORVEL All Commercial |
$11,854.01
|
| Rate for Payer: Coventry All Commercial |
$11,216.70
|
| Rate for Payer: Encore All Commercial |
$11,732.92
|
| Rate for Payer: Frontpath All Commercial |
$11,726.55
|
| Rate for Payer: Humana ChoiceCare |
$11,008.94
|
| Rate for Payer: Humana Medicare |
$6,500.59
|
| Rate for Payer: Lucent All Commercial |
$6,500.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,471.62
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,559.69
|
| Rate for Payer: PHP All Commercial |
$9,666.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,971.04
|
| Rate for Payer: Sagamore Health Network All Products |
$9,840.10
|
| Rate for Payer: Signature Care EPO |
$10,579.39
|
| Rate for Payer: Signature Care PPO |
$11,216.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,834.31
|
| Rate for Payer: United Healthcare Commercial |
$10,044.04
|
| Rate for Payer: United Healthcare Medicare |
$4,206.26
|
|
|
HC PACEMAKER SC ENDURITY SR
|
Facility
OP
|
$9,416.25
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607540
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$8,757.11 |
| Rate for Payer: Aetna Commercial |
$7,947.32
|
| Rate for Payer: Aetna Medicare |
$3,107.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,107.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,407.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,886.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,573.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,418.10
|
| Rate for Payer: Cash Price |
$5,838.08
|
| Rate for Payer: Cash Price |
$5,838.08
|
| Rate for Payer: Centivo All Commercial |
$4,802.29
|
| Rate for Payer: Cigna All Commercial |
$8,126.22
|
| Rate for Payer: CORVEL All Commercial |
$8,757.11
|
| Rate for Payer: Coventry All Commercial |
$8,286.30
|
| Rate for Payer: Encore All Commercial |
$8,667.66
|
| Rate for Payer: Frontpath All Commercial |
$8,662.95
|
| Rate for Payer: Humana ChoiceCare |
$8,132.82
|
| Rate for Payer: Humana Medicare |
$4,802.29
|
| Rate for Payer: Lucent All Commercial |
$4,802.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,474.62
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$7,062.19
|
| Rate for Payer: PHP All Commercial |
$7,141.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,672.34
|
| Rate for Payer: Sagamore Health Network All Products |
$7,269.34
|
| Rate for Payer: Signature Care EPO |
$7,815.49
|
| Rate for Payer: Signature Care PPO |
$8,286.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,003.81
|
| Rate for Payer: United Healthcare Commercial |
$7,420.00
|
| Rate for Payer: United Healthcare Medicare |
$3,107.36
|
|
|
HC PACEMAKER SC ENDURITY SR
|
Facility
IP
|
$9,416.25
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607540
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,062.19 |
| Max. Negotiated Rate |
$8,757.11 |
| Rate for Payer: Aetna Commercial |
$8,135.64
|
| Rate for Payer: Cash Price |
$5,838.08
|
| Rate for Payer: Cigna All Commercial |
$8,126.22
|
| Rate for Payer: CORVEL All Commercial |
$8,757.11
|
| Rate for Payer: Coventry All Commercial |
$8,286.30
|
| Rate for Payer: Encore All Commercial |
$8,667.66
|
| Rate for Payer: Frontpath All Commercial |
$8,662.95
|
| Rate for Payer: Humana ChoiceCare |
$8,132.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,474.62
|
| Rate for Payer: PHCS All Commercial |
$7,062.19
|
| Rate for Payer: PHP All Commercial |
$7,141.28
|
| Rate for Payer: Sagamore Health Network All Products |
$7,269.34
|
| Rate for Payer: Signature Care EPO |
$7,815.49
|
| Rate for Payer: Signature Care PPO |
$8,286.30
|
| Rate for Payer: United Healthcare Commercial |
$7,420.00
|
|
|
HC PACEMAKER SC ZEPHYR SR
|
Facility
OP
|
$12,960.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607541
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$12,052.80 |
| Rate for Payer: Aetna Commercial |
$10,938.24
|
| Rate for Payer: Aetna Medicare |
$4,276.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,276.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,442.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,101.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,918.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,704.48
|
| Rate for Payer: Cash Price |
$8,035.20
|
| Rate for Payer: Cash Price |
$8,035.20
|
| Rate for Payer: Centivo All Commercial |
$6,609.60
|
| Rate for Payer: Cigna All Commercial |
$11,184.48
|
| Rate for Payer: CORVEL All Commercial |
$12,052.80
|
| Rate for Payer: Coventry All Commercial |
$11,404.80
|
| Rate for Payer: Encore All Commercial |
$11,929.68
|
| Rate for Payer: Frontpath All Commercial |
$11,923.20
|
| Rate for Payer: Humana ChoiceCare |
$11,193.55
|
| Rate for Payer: Humana Medicare |
$6,609.60
|
| Rate for Payer: Lucent All Commercial |
$6,609.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,664.00
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,720.00
|
| Rate for Payer: PHP All Commercial |
$9,828.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,054.40
|
| Rate for Payer: Sagamore Health Network All Products |
$10,005.12
|
| Rate for Payer: Signature Care EPO |
$10,756.80
|
| Rate for Payer: Signature Care PPO |
$11,404.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,016.00
|
| Rate for Payer: United Healthcare Commercial |
$10,212.48
|
| Rate for Payer: United Healthcare Medicare |
$4,276.80
|
|
|
HC PACEMAKER SC ZEPHYR SR
|
Facility
IP
|
$12,960.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607541
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,720.00 |
| Max. Negotiated Rate |
$12,052.80 |
| Rate for Payer: Aetna Commercial |
$11,197.44
|
| Rate for Payer: Cash Price |
$8,035.20
|
| Rate for Payer: Cigna All Commercial |
$11,184.48
|
| Rate for Payer: CORVEL All Commercial |
$12,052.80
|
| Rate for Payer: Coventry All Commercial |
$11,404.80
|
| Rate for Payer: Encore All Commercial |
$11,929.68
|
| Rate for Payer: Frontpath All Commercial |
$11,923.20
|
| Rate for Payer: Humana ChoiceCare |
$11,193.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,664.00
|
| Rate for Payer: PHCS All Commercial |
$9,720.00
|
| Rate for Payer: PHP All Commercial |
$9,828.86
|
| Rate for Payer: Sagamore Health Network All Products |
$10,005.12
|
| Rate for Payer: Signature Care EPO |
$10,756.80
|
| Rate for Payer: Signature Care PPO |
$11,404.80
|
| Rate for Payer: United Healthcare Commercial |
$10,212.48
|
|
|
HC PACEMAKER SC ZEPHYR SR XL
|
Facility
IP
|
$12,960.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607542
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,720.00 |
| Max. Negotiated Rate |
$12,052.80 |
| Rate for Payer: Aetna Commercial |
$11,197.44
|
| Rate for Payer: Cash Price |
$8,035.20
|
| Rate for Payer: Cigna All Commercial |
$11,184.48
|
| Rate for Payer: CORVEL All Commercial |
$12,052.80
|
| Rate for Payer: Coventry All Commercial |
$11,404.80
|
| Rate for Payer: Encore All Commercial |
$11,929.68
|
| Rate for Payer: Frontpath All Commercial |
$11,923.20
|
| Rate for Payer: Humana ChoiceCare |
$11,193.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,664.00
|
| Rate for Payer: PHCS All Commercial |
$9,720.00
|
| Rate for Payer: PHP All Commercial |
$9,828.86
|
| Rate for Payer: Sagamore Health Network All Products |
$10,005.12
|
| Rate for Payer: Signature Care EPO |
$10,756.80
|
| Rate for Payer: Signature Care PPO |
$11,404.80
|
| Rate for Payer: United Healthcare Commercial |
$10,212.48
|
|
|
HC PACEMAKER SC ZEPHYR SR XL
|
Facility
OP
|
$12,960.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607542
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$12,052.80 |
| Rate for Payer: Aetna Commercial |
$10,938.24
|
| Rate for Payer: Aetna Medicare |
$4,276.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,276.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,442.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,101.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,918.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,704.48
|
| Rate for Payer: Cash Price |
$8,035.20
|
| Rate for Payer: Cash Price |
$8,035.20
|
| Rate for Payer: Centivo All Commercial |
$6,609.60
|
| Rate for Payer: Cigna All Commercial |
$11,184.48
|
| Rate for Payer: CORVEL All Commercial |
$12,052.80
|
| Rate for Payer: Coventry All Commercial |
$11,404.80
|
| Rate for Payer: Encore All Commercial |
$11,929.68
|
| Rate for Payer: Frontpath All Commercial |
$11,923.20
|
| Rate for Payer: Humana ChoiceCare |
$11,193.55
|
| Rate for Payer: Humana Medicare |
$6,609.60
|
| Rate for Payer: Lucent All Commercial |
$6,609.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,664.00
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,720.00
|
| Rate for Payer: PHP All Commercial |
$9,828.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,054.40
|
| Rate for Payer: Sagamore Health Network All Products |
$10,005.12
|
| Rate for Payer: Signature Care EPO |
$10,756.80
|
| Rate for Payer: Signature Care PPO |
$11,404.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,016.00
|
| Rate for Payer: United Healthcare Commercial |
$10,212.48
|
| Rate for Payer: United Healthcare Medicare |
$4,276.80
|
|
|
HC PACEMAKER SR ACCOLADE MRI SR
|
Facility
OP
|
$13,312.50
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607171
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$12,380.62 |
| Rate for Payer: Aetna Commercial |
$11,235.75
|
| Rate for Payer: Aetna Medicare |
$4,393.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,393.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,645.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,321.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,052.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,832.44
|
| Rate for Payer: Cash Price |
$8,253.75
|
| Rate for Payer: Cash Price |
$8,253.75
|
| Rate for Payer: Centivo All Commercial |
$6,789.38
|
| Rate for Payer: Cigna All Commercial |
$11,488.69
|
| Rate for Payer: CORVEL All Commercial |
$12,380.62
|
| Rate for Payer: Coventry All Commercial |
$11,715.00
|
| Rate for Payer: Encore All Commercial |
$12,254.16
|
| Rate for Payer: Frontpath All Commercial |
$12,247.50
|
| Rate for Payer: Humana ChoiceCare |
$11,498.01
|
| Rate for Payer: Humana Medicare |
$6,789.38
|
| Rate for Payer: Lucent All Commercial |
$6,789.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,981.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$9,984.38
|
| Rate for Payer: PHP All Commercial |
$10,096.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,191.88
|
| Rate for Payer: Sagamore Health Network All Products |
$10,277.25
|
| Rate for Payer: Signature Care EPO |
$11,049.38
|
| Rate for Payer: Signature Care PPO |
$11,715.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,315.62
|
| Rate for Payer: United Healthcare Commercial |
$10,490.25
|
| Rate for Payer: United Healthcare Medicare |
$4,393.12
|
|
|
HC PACEMAKER SR ACCOLADE MRI SR
|
Facility
IP
|
$13,312.50
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
41607171
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,984.38 |
| Max. Negotiated Rate |
$12,380.62 |
| Rate for Payer: Aetna Commercial |
$11,502.00
|
| Rate for Payer: Cash Price |
$8,253.75
|
| Rate for Payer: Cigna All Commercial |
$11,488.69
|
| Rate for Payer: CORVEL All Commercial |
$12,380.62
|
| Rate for Payer: Coventry All Commercial |
$11,715.00
|
| Rate for Payer: Encore All Commercial |
$12,254.16
|
| Rate for Payer: Frontpath All Commercial |
$12,247.50
|
| Rate for Payer: Humana ChoiceCare |
$11,498.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,981.25
|
| Rate for Payer: PHCS All Commercial |
$9,984.38
|
| Rate for Payer: PHP All Commercial |
$10,096.20
|
| Rate for Payer: Sagamore Health Network All Products |
$10,277.25
|
| Rate for Payer: Signature Care EPO |
$11,049.38
|
| Rate for Payer: Signature Care PPO |
$11,715.00
|
| Rate for Payer: United Healthcare Commercial |
$10,490.25
|
|
|
HC PACK CT BIOPSY
|
Facility
OP
|
$53.25
|
|
| Hospital Charge Code |
41607751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$44.94
|
| Rate for Payer: Aetna Medicare |
$17.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$33.02
|
| Rate for Payer: Cash Price |
$33.02
|
| Rate for Payer: Centivo All Commercial |
$27.16
|
| Rate for Payer: Cigna All Commercial |
$45.95
|
| Rate for Payer: CORVEL All Commercial |
$49.52
|
| Rate for Payer: Coventry All Commercial |
$46.86
|
| Rate for Payer: Encore All Commercial |
$49.02
|
| Rate for Payer: Frontpath All Commercial |
$48.99
|
| Rate for Payer: Humana ChoiceCare |
$45.99
|
| Rate for Payer: Humana Medicare |
$27.16
|
| Rate for Payer: Lucent All Commercial |
$27.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$39.94
|
| Rate for Payer: PHP All Commercial |
$40.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.77
|
| Rate for Payer: Sagamore Health Network All Products |
$41.11
|
| Rate for Payer: Signature Care EPO |
$44.20
|
| Rate for Payer: Signature Care PPO |
$46.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.26
|
| Rate for Payer: United Healthcare Commercial |
$41.96
|
| Rate for Payer: United Healthcare Medicare |
$17.57
|
|
|
HC PACK CT BIOPSY
|
Facility
IP
|
$53.25
|
|
| Hospital Charge Code |
41607751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$49.52 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Cash Price |
$33.02
|
| Rate for Payer: Cigna All Commercial |
$45.95
|
| Rate for Payer: CORVEL All Commercial |
$49.52
|
| Rate for Payer: Coventry All Commercial |
$46.86
|
| Rate for Payer: Encore All Commercial |
$49.02
|
| Rate for Payer: Frontpath All Commercial |
$48.99
|
| Rate for Payer: Humana ChoiceCare |
$45.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.92
|
| Rate for Payer: PHCS All Commercial |
$39.94
|
| Rate for Payer: PHP All Commercial |
$40.38
|
| Rate for Payer: Sagamore Health Network All Products |
$41.11
|
| Rate for Payer: Signature Care EPO |
$44.20
|
| Rate for Payer: Signature Care PPO |
$46.86
|
| Rate for Payer: United Healthcare Commercial |
$41.96
|
|
|
HC PACKED RBC
|
Facility
OP
|
$257.25
|
|
|
Service Code
|
CPT P9021
|
| Hospital Charge Code |
01370131
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$217.12
|
| Rate for Payer: Aetna Medicare |
$84.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$147.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$160.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.38
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Centivo All Commercial |
$131.20
|
| Rate for Payer: Cigna All Commercial |
$222.01
|
| Rate for Payer: CORVEL All Commercial |
$239.25
|
| Rate for Payer: Coventry All Commercial |
$226.38
|
| Rate for Payer: Encore All Commercial |
$236.80
|
| Rate for Payer: Frontpath All Commercial |
$236.67
|
| Rate for Payer: Humana ChoiceCare |
$222.19
|
| Rate for Payer: Humana Medicare |
$131.20
|
| Rate for Payer: Lucent All Commercial |
$131.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.53
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$192.94
|
| Rate for Payer: PHP All Commercial |
$195.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.33
|
| Rate for Payer: Sagamore Health Network All Products |
$198.60
|
| Rate for Payer: Signature Care EPO |
$213.52
|
| Rate for Payer: Signature Care PPO |
$226.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$218.67
|
| Rate for Payer: United Healthcare Commercial |
$202.72
|
| Rate for Payer: United Healthcare Medicare |
$84.89
|
|
|
HC PACKED RBC
|
Facility
IP
|
$257.25
|
|
|
Service Code
|
CPT P9021
|
| Hospital Charge Code |
01370131
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$192.94 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Aetna Commercial |
$222.27
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna All Commercial |
$222.01
|
| Rate for Payer: CORVEL All Commercial |
$239.25
|
| Rate for Payer: Coventry All Commercial |
$226.38
|
| Rate for Payer: Encore All Commercial |
$236.80
|
| Rate for Payer: Frontpath All Commercial |
$236.67
|
| Rate for Payer: Humana ChoiceCare |
$222.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.53
|
| Rate for Payer: PHCS All Commercial |
$192.94
|
| Rate for Payer: PHP All Commercial |
$195.10
|
| Rate for Payer: Sagamore Health Network All Products |
$198.60
|
| Rate for Payer: Signature Care EPO |
$213.52
|
| Rate for Payer: Signature Care PPO |
$226.38
|
| Rate for Payer: United Healthcare Commercial |
$202.72
|
|
|
HC PACKED RBC LR CMV NEGATIVE
|
Facility
OP
|
$2,615.07
|
|
|
Service Code
|
CPT P9051
|
| Hospital Charge Code |
01371000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$2,432.01 |
| Rate for Payer: Aetna Commercial |
$2,207.12
|
| Rate for Payer: Aetna Medicare |
$862.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$862.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,501.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,634.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$278.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$992.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$949.27
|
| Rate for Payer: Cash Price |
$1,621.34
|
| Rate for Payer: Cash Price |
$1,621.34
|
| Rate for Payer: Centivo All Commercial |
$1,333.68
|
| Rate for Payer: Cigna All Commercial |
$2,256.80
|
| Rate for Payer: CORVEL All Commercial |
$2,432.01
|
| Rate for Payer: Coventry All Commercial |
$2,301.26
|
| Rate for Payer: Encore All Commercial |
$2,407.17
|
| Rate for Payer: Frontpath All Commercial |
$2,405.86
|
| Rate for Payer: Humana ChoiceCare |
$2,258.63
|
| Rate for Payer: Humana Medicare |
$1,333.68
|
| Rate for Payer: Lucent All Commercial |
$1,333.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,353.56
|
| Rate for Payer: Managed Health Services Medicaid |
$278.73
|
| Rate for Payer: MDWise Medicaid |
$278.73
|
| Rate for Payer: PHCS All Commercial |
$1,961.30
|
| Rate for Payer: PHP All Commercial |
$1,983.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,019.88
|
| Rate for Payer: Sagamore Health Network All Products |
$2,018.83
|
| Rate for Payer: Signature Care EPO |
$2,170.50
|
| Rate for Payer: Signature Care PPO |
$2,301.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,222.81
|
| Rate for Payer: United Healthcare Commercial |
$2,060.67
|
| Rate for Payer: United Healthcare Medicare |
$862.97
|
|
|
HC PACKED RBC LR CMV NEGATIVE
|
Facility
IP
|
$2,615.07
|
|
|
Service Code
|
CPT P9051
|
| Hospital Charge Code |
01371000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,961.30 |
| Max. Negotiated Rate |
$2,432.01 |
| Rate for Payer: Aetna Commercial |
$2,259.42
|
| Rate for Payer: Cash Price |
$1,621.34
|
| Rate for Payer: Cigna All Commercial |
$2,256.80
|
| Rate for Payer: CORVEL All Commercial |
$2,432.01
|
| Rate for Payer: Coventry All Commercial |
$2,301.26
|
| Rate for Payer: Encore All Commercial |
$2,407.17
|
| Rate for Payer: Frontpath All Commercial |
$2,405.86
|
| Rate for Payer: Humana ChoiceCare |
$2,258.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,353.56
|
| Rate for Payer: PHCS All Commercial |
$1,961.30
|
| Rate for Payer: PHP All Commercial |
$1,983.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,018.83
|
| Rate for Payer: Signature Care EPO |
$2,170.50
|
| Rate for Payer: Signature Care PPO |
$2,301.26
|
| Rate for Payer: United Healthcare Commercial |
$2,060.67
|
|
