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Service Code CPT C9399
Hospital Charge Code 41602558
Hospital Revenue Code 278
Min. Negotiated Rate $1,668.75
Max. Negotiated Rate $2,069.25
Rate for Payer: Aetna Commercial $1,922.40
Rate for Payer: Cash Price $1,379.50
Rate for Payer: Cigna All Commercial $1,920.18
Rate for Payer: CORVEL All Commercial $2,069.25
Rate for Payer: Coventry All Commercial $1,958.00
Rate for Payer: Encore All Commercial $2,048.11
Rate for Payer: Frontpath All Commercial $2,047.00
Rate for Payer: Humana ChoiceCare $1,921.73
Rate for Payer: Lutheran Preferred All Commercial $2,002.50
Rate for Payer: PHCS All Commercial $1,668.75
Rate for Payer: PHP All Commercial $1,687.44
Rate for Payer: Sagamore Health Network All Products $1,717.70
Rate for Payer: Signature Care EPO $1,846.75
Rate for Payer: Signature Care PPO $1,958.00
Rate for Payer: United Healthcare Commercial $1,753.30
Service Code CPT C9399
Hospital Charge Code 41602558
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $2,069.25
Rate for Payer: Aetna Commercial $1,877.90
Rate for Payer: Aetna Medicare $734.25
Rate for Payer: Anthem Blue Cross of IN Medicare $734.25
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $1,277.82
Rate for Payer: Anthem Blue Cross of IN Traditional $1,390.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $844.39
Rate for Payer: CareSource Indiana of IN Medicare $807.68
Rate for Payer: Cash Price $1,379.50
Rate for Payer: Cash Price $1,379.50
Rate for Payer: Centivo All Commercial $1,134.75
Rate for Payer: Cigna All Commercial $1,920.18
Rate for Payer: CORVEL All Commercial $2,069.25
Rate for Payer: Coventry All Commercial $1,958.00
Rate for Payer: Encore All Commercial $2,048.11
Rate for Payer: Frontpath All Commercial $2,047.00
Rate for Payer: Humana ChoiceCare $1,921.73
Rate for Payer: Humana Medicare $1,134.75
Rate for Payer: Lucent All Commercial $1,134.75
Rate for Payer: Lutheran Preferred All Commercial $2,002.50
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $1,668.75
Rate for Payer: PHP All Commercial $1,687.44
Rate for Payer: Plain Church Group Ministry All Commercial $867.75
Rate for Payer: Sagamore Health Network All Products $1,717.70
Rate for Payer: Signature Care EPO $1,846.75
Rate for Payer: Signature Care PPO $1,958.00
Rate for Payer: Three Rivers Preferred All Commercial $1,891.25
Rate for Payer: United Healthcare Commercial $1,753.30
Rate for Payer: United Healthcare Medicare $734.25
Service Code CPT C9399
Hospital Charge Code 41602559
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $2,996.46
Rate for Payer: Aetna Commercial $2,719.37
Rate for Payer: Aetna Medicare $1,063.26
Rate for Payer: Anthem Blue Cross of IN Medicare $1,063.26
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $1,850.39
Rate for Payer: Anthem Blue Cross of IN Traditional $2,014.07
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $1,222.75
Rate for Payer: CareSource Indiana of IN Medicare $1,169.59
Rate for Payer: Cash Price $1,997.64
Rate for Payer: Cash Price $1,997.64
Rate for Payer: Centivo All Commercial $1,643.22
Rate for Payer: Cigna All Commercial $2,780.59
Rate for Payer: CORVEL All Commercial $2,996.46
Rate for Payer: Coventry All Commercial $2,835.36
Rate for Payer: Encore All Commercial $2,965.85
Rate for Payer: Frontpath All Commercial $2,964.24
Rate for Payer: Humana ChoiceCare $2,782.84
Rate for Payer: Humana Medicare $1,643.22
Rate for Payer: Lucent All Commercial $1,643.22
Rate for Payer: Lutheran Preferred All Commercial $2,899.80
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $2,416.50
Rate for Payer: PHP All Commercial $2,443.56
Rate for Payer: Plain Church Group Ministry All Commercial $1,256.58
Rate for Payer: Sagamore Health Network All Products $2,487.38
Rate for Payer: Signature Care EPO $2,674.26
Rate for Payer: Signature Care PPO $2,835.36
Rate for Payer: Three Rivers Preferred All Commercial $2,738.70
Rate for Payer: United Healthcare Commercial $2,538.94
Rate for Payer: United Healthcare Medicare $1,063.26
Service Code CPT C9399
Hospital Charge Code 41602559
Hospital Revenue Code 278
Min. Negotiated Rate $2,416.50
Max. Negotiated Rate $2,996.46
Rate for Payer: Aetna Commercial $2,783.81
Rate for Payer: Cash Price $1,997.64
Rate for Payer: Cigna All Commercial $2,780.59
Rate for Payer: CORVEL All Commercial $2,996.46
Rate for Payer: Coventry All Commercial $2,835.36
Rate for Payer: Encore All Commercial $2,965.85
Rate for Payer: Frontpath All Commercial $2,964.24
Rate for Payer: Humana ChoiceCare $2,782.84
Rate for Payer: Lutheran Preferred All Commercial $2,899.80
Rate for Payer: PHCS All Commercial $2,416.50
Rate for Payer: PHP All Commercial $2,443.56
Rate for Payer: Sagamore Health Network All Products $2,487.38
Rate for Payer: Signature Care EPO $2,674.26
Rate for Payer: Signature Care PPO $2,835.36
Rate for Payer: United Healthcare Commercial $2,538.94
Service Code CPT C9399
Hospital Charge Code 41602560
Hospital Revenue Code 278
Min. Negotiated Rate $3,510.00
Max. Negotiated Rate $4,352.40
Rate for Payer: Aetna Commercial $4,043.52
Rate for Payer: Cash Price $2,901.60
Rate for Payer: Cigna All Commercial $4,038.84
Rate for Payer: CORVEL All Commercial $4,352.40
Rate for Payer: Coventry All Commercial $4,118.40
Rate for Payer: Encore All Commercial $4,307.94
Rate for Payer: Frontpath All Commercial $4,305.60
Rate for Payer: Humana ChoiceCare $4,042.12
Rate for Payer: Lutheran Preferred All Commercial $4,212.00
Rate for Payer: PHCS All Commercial $3,510.00
Rate for Payer: PHP All Commercial $3,549.31
Rate for Payer: Sagamore Health Network All Products $3,612.96
Rate for Payer: Signature Care EPO $3,884.40
Rate for Payer: Signature Care PPO $4,118.40
Rate for Payer: United Healthcare Commercial $3,687.84
Service Code CPT C9399
Hospital Charge Code 41602560
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $4,352.40
Rate for Payer: Aetna Commercial $3,949.92
Rate for Payer: Aetna Medicare $1,544.40
Rate for Payer: Anthem Blue Cross of IN Medicare $1,544.40
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $2,687.72
Rate for Payer: Anthem Blue Cross of IN Traditional $2,925.47
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $1,776.06
Rate for Payer: CareSource Indiana of IN Medicare $1,698.84
Rate for Payer: Cash Price $2,901.60
Rate for Payer: Cash Price $2,901.60
Rate for Payer: Centivo All Commercial $2,386.80
Rate for Payer: Cigna All Commercial $4,038.84
Rate for Payer: CORVEL All Commercial $4,352.40
Rate for Payer: Coventry All Commercial $4,118.40
Rate for Payer: Encore All Commercial $4,307.94
Rate for Payer: Frontpath All Commercial $4,305.60
Rate for Payer: Humana ChoiceCare $4,042.12
Rate for Payer: Humana Medicare $2,386.80
Rate for Payer: Lucent All Commercial $2,386.80
Rate for Payer: Lutheran Preferred All Commercial $4,212.00
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $3,510.00
Rate for Payer: PHP All Commercial $3,549.31
Rate for Payer: Plain Church Group Ministry All Commercial $1,825.20
Rate for Payer: Sagamore Health Network All Products $3,612.96
Rate for Payer: Signature Care EPO $3,884.40
Rate for Payer: Signature Care PPO $4,118.40
Rate for Payer: Three Rivers Preferred All Commercial $3,978.00
Rate for Payer: United Healthcare Commercial $3,687.84
Rate for Payer: United Healthcare Medicare $1,544.40
Service Code CPT C9399
Hospital Charge Code 41602561
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $6,019.70
Rate for Payer: Aetna Commercial $5,463.04
Rate for Payer: Aetna Medicare $2,136.02
Rate for Payer: Anthem Blue Cross of IN Medicare $2,136.02
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $3,717.33
Rate for Payer: Anthem Blue Cross of IN Traditional $4,046.15
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $2,456.43
Rate for Payer: CareSource Indiana of IN Medicare $2,349.63
Rate for Payer: Cash Price $4,013.14
Rate for Payer: Cash Price $4,013.14
Rate for Payer: Centivo All Commercial $3,301.13
Rate for Payer: Cigna All Commercial $5,586.03
Rate for Payer: CORVEL All Commercial $6,019.70
Rate for Payer: Coventry All Commercial $5,696.06
Rate for Payer: Encore All Commercial $5,958.21
Rate for Payer: Frontpath All Commercial $5,954.98
Rate for Payer: Humana ChoiceCare $5,590.56
Rate for Payer: Humana Medicare $3,301.13
Rate for Payer: Lucent All Commercial $3,301.13
Rate for Payer: Lutheran Preferred All Commercial $5,825.52
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $4,854.60
Rate for Payer: PHP All Commercial $4,908.97
Rate for Payer: Plain Church Group Ministry All Commercial $2,524.39
Rate for Payer: Sagamore Health Network All Products $4,997.00
Rate for Payer: Signature Care EPO $5,372.42
Rate for Payer: Signature Care PPO $5,696.06
Rate for Payer: Three Rivers Preferred All Commercial $5,501.88
Rate for Payer: United Healthcare Commercial $5,100.57
Rate for Payer: United Healthcare Medicare $2,136.02
Service Code CPT C9399
Hospital Charge Code 41602561
Hospital Revenue Code 278
Min. Negotiated Rate $4,854.60
Max. Negotiated Rate $6,019.70
Rate for Payer: Aetna Commercial $5,592.50
Rate for Payer: Cash Price $4,013.14
Rate for Payer: Cigna All Commercial $5,586.03
Rate for Payer: CORVEL All Commercial $6,019.70
Rate for Payer: Coventry All Commercial $5,696.06
Rate for Payer: Encore All Commercial $5,958.21
Rate for Payer: Frontpath All Commercial $5,954.98
Rate for Payer: Humana ChoiceCare $5,590.56
Rate for Payer: Lutheran Preferred All Commercial $5,825.52
Rate for Payer: PHCS All Commercial $4,854.60
Rate for Payer: PHP All Commercial $4,908.97
Rate for Payer: Sagamore Health Network All Products $4,997.00
Rate for Payer: Signature Care EPO $5,372.42
Rate for Payer: Signature Care PPO $5,696.06
Rate for Payer: United Healthcare Commercial $5,100.57
Service Code CPT C9399
Hospital Charge Code 41602562
Hospital Revenue Code 278
Min. Negotiated Rate $5,259.60
Max. Negotiated Rate $6,521.90
Rate for Payer: Aetna Commercial $6,059.06
Rate for Payer: Cash Price $4,347.94
Rate for Payer: Cigna All Commercial $6,052.05
Rate for Payer: CORVEL All Commercial $6,521.90
Rate for Payer: Coventry All Commercial $6,171.26
Rate for Payer: Encore All Commercial $6,455.28
Rate for Payer: Frontpath All Commercial $6,451.78
Rate for Payer: Humana ChoiceCare $6,056.96
Rate for Payer: Lutheran Preferred All Commercial $6,311.52
Rate for Payer: PHCS All Commercial $5,259.60
Rate for Payer: PHP All Commercial $5,318.51
Rate for Payer: Sagamore Health Network All Products $5,413.88
Rate for Payer: Signature Care EPO $5,820.62
Rate for Payer: Signature Care PPO $6,171.26
Rate for Payer: United Healthcare Commercial $5,526.09
Service Code CPT C9399
Hospital Charge Code 41602562
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $6,521.90
Rate for Payer: Aetna Commercial $5,918.80
Rate for Payer: Aetna Medicare $2,314.22
Rate for Payer: Anthem Blue Cross of IN Medicare $2,314.22
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $4,027.45
Rate for Payer: Anthem Blue Cross of IN Traditional $4,383.70
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $2,661.36
Rate for Payer: CareSource Indiana of IN Medicare $2,545.65
Rate for Payer: Cash Price $4,347.94
Rate for Payer: Cash Price $4,347.94
Rate for Payer: Centivo All Commercial $3,576.53
Rate for Payer: Cigna All Commercial $6,052.05
Rate for Payer: CORVEL All Commercial $6,521.90
Rate for Payer: Coventry All Commercial $6,171.26
Rate for Payer: Encore All Commercial $6,455.28
Rate for Payer: Frontpath All Commercial $6,451.78
Rate for Payer: Humana ChoiceCare $6,056.96
Rate for Payer: Humana Medicare $3,576.53
Rate for Payer: Lucent All Commercial $3,576.53
Rate for Payer: Lutheran Preferred All Commercial $6,311.52
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $5,259.60
Rate for Payer: PHP All Commercial $5,318.51
Rate for Payer: Plain Church Group Ministry All Commercial $2,734.99
Rate for Payer: Sagamore Health Network All Products $5,413.88
Rate for Payer: Signature Care EPO $5,820.62
Rate for Payer: Signature Care PPO $6,171.26
Rate for Payer: Three Rivers Preferred All Commercial $5,960.88
Rate for Payer: United Healthcare Commercial $5,526.09
Rate for Payer: United Healthcare Medicare $2,314.22
Service Code CPT C9399
Hospital Charge Code 41602563
Hospital Revenue Code 278
Min. Negotiated Rate $10,233.00
Max. Negotiated Rate $12,688.92
Rate for Payer: Aetna Commercial $11,788.42
Rate for Payer: Cash Price $8,459.28
Rate for Payer: Cigna All Commercial $11,774.77
Rate for Payer: CORVEL All Commercial $12,688.92
Rate for Payer: Coventry All Commercial $12,006.72
Rate for Payer: Encore All Commercial $12,559.30
Rate for Payer: Frontpath All Commercial $12,552.48
Rate for Payer: Humana ChoiceCare $11,784.32
Rate for Payer: Lutheran Preferred All Commercial $12,279.60
Rate for Payer: PHCS All Commercial $10,233.00
Rate for Payer: PHP All Commercial $10,347.61
Rate for Payer: Sagamore Health Network All Products $10,533.17
Rate for Payer: Signature Care EPO $11,324.52
Rate for Payer: Signature Care PPO $12,006.72
Rate for Payer: United Healthcare Commercial $10,751.47
Service Code CPT C9399
Hospital Charge Code 41602563
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $12,688.92
Rate for Payer: Aetna Commercial $11,515.54
Rate for Payer: Aetna Medicare $4,502.52
Rate for Payer: Anthem Blue Cross of IN Medicare $4,502.52
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $7,835.75
Rate for Payer: Anthem Blue Cross of IN Traditional $8,528.86
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $5,177.90
Rate for Payer: CareSource Indiana of IN Medicare $4,952.77
Rate for Payer: Cash Price $8,459.28
Rate for Payer: Cash Price $8,459.28
Rate for Payer: Centivo All Commercial $6,958.44
Rate for Payer: Cigna All Commercial $11,774.77
Rate for Payer: CORVEL All Commercial $12,688.92
Rate for Payer: Coventry All Commercial $12,006.72
Rate for Payer: Encore All Commercial $12,559.30
Rate for Payer: Frontpath All Commercial $12,552.48
Rate for Payer: Humana ChoiceCare $11,784.32
Rate for Payer: Humana Medicare $6,958.44
Rate for Payer: Lucent All Commercial $6,958.44
Rate for Payer: Lutheran Preferred All Commercial $12,279.60
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $10,233.00
Rate for Payer: PHP All Commercial $10,347.61
Rate for Payer: Plain Church Group Ministry All Commercial $5,321.16
Rate for Payer: Sagamore Health Network All Products $10,533.17
Rate for Payer: Signature Care EPO $11,324.52
Rate for Payer: Signature Care PPO $12,006.72
Rate for Payer: Three Rivers Preferred All Commercial $11,597.40
Rate for Payer: United Healthcare Commercial $10,751.47
Rate for Payer: United Healthcare Medicare $4,502.52
Service Code CPT C9399
Hospital Charge Code 41602556
Hospital Revenue Code 278
Min. Negotiated Rate $4,725.00
Max. Negotiated Rate $5,859.00
Rate for Payer: Aetna Commercial $5,443.20
Rate for Payer: Cash Price $3,906.00
Rate for Payer: Cigna All Commercial $5,436.90
Rate for Payer: CORVEL All Commercial $5,859.00
Rate for Payer: Coventry All Commercial $5,544.00
Rate for Payer: Encore All Commercial $5,799.15
Rate for Payer: Frontpath All Commercial $5,796.00
Rate for Payer: Humana ChoiceCare $5,441.31
Rate for Payer: Lutheran Preferred All Commercial $5,670.00
Rate for Payer: PHCS All Commercial $4,725.00
Rate for Payer: PHP All Commercial $4,777.92
Rate for Payer: Sagamore Health Network All Products $4,863.60
Rate for Payer: Signature Care EPO $5,229.00
Rate for Payer: Signature Care PPO $5,544.00
Rate for Payer: United Healthcare Commercial $4,964.40
Service Code CPT C9399
Hospital Charge Code 41602556
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $5,859.00
Rate for Payer: Aetna Commercial $5,317.20
Rate for Payer: Aetna Medicare $2,079.00
Rate for Payer: Anthem Blue Cross of IN Medicare $2,079.00
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $3,618.09
Rate for Payer: Anthem Blue Cross of IN Traditional $3,938.13
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $2,390.85
Rate for Payer: CareSource Indiana of IN Medicare $2,286.90
Rate for Payer: Cash Price $3,906.00
Rate for Payer: Cash Price $3,906.00
Rate for Payer: Centivo All Commercial $3,213.00
Rate for Payer: Cigna All Commercial $5,436.90
Rate for Payer: CORVEL All Commercial $5,859.00
Rate for Payer: Coventry All Commercial $5,544.00
Rate for Payer: Encore All Commercial $5,799.15
Rate for Payer: Frontpath All Commercial $5,796.00
Rate for Payer: Humana ChoiceCare $5,441.31
Rate for Payer: Humana Medicare $3,213.00
Rate for Payer: Lucent All Commercial $3,213.00
Rate for Payer: Lutheran Preferred All Commercial $5,670.00
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $4,725.00
Rate for Payer: PHP All Commercial $4,777.92
Rate for Payer: Plain Church Group Ministry All Commercial $2,457.00
Rate for Payer: Sagamore Health Network All Products $4,863.60
Rate for Payer: Signature Care EPO $5,229.00
Rate for Payer: Signature Care PPO $5,544.00
Rate for Payer: Three Rivers Preferred All Commercial $5,355.00
Rate for Payer: United Healthcare Commercial $4,964.40
Rate for Payer: United Healthcare Medicare $2,079.00
Service Code CPT C9399
Hospital Charge Code 41602557
Hospital Revenue Code 278
Min. Negotiated Rate $6,615.00
Max. Negotiated Rate $8,202.60
Rate for Payer: Aetna Commercial $7,620.48
Rate for Payer: Cash Price $5,468.40
Rate for Payer: Cigna All Commercial $7,611.66
Rate for Payer: CORVEL All Commercial $8,202.60
Rate for Payer: Coventry All Commercial $7,761.60
Rate for Payer: Encore All Commercial $8,118.81
Rate for Payer: Frontpath All Commercial $8,114.40
Rate for Payer: Humana ChoiceCare $7,617.83
Rate for Payer: Lutheran Preferred All Commercial $7,938.00
Rate for Payer: PHCS All Commercial $6,615.00
Rate for Payer: PHP All Commercial $6,689.09
Rate for Payer: Sagamore Health Network All Products $6,809.04
Rate for Payer: Signature Care EPO $7,320.60
Rate for Payer: Signature Care PPO $7,761.60
Rate for Payer: United Healthcare Commercial $6,950.16
Service Code CPT C9399
Hospital Charge Code 41602557
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $8,202.60
Rate for Payer: Aetna Commercial $7,444.08
Rate for Payer: Aetna Medicare $2,910.60
Rate for Payer: Anthem Blue Cross of IN Medicare $2,910.60
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $5,065.33
Rate for Payer: Anthem Blue Cross of IN Traditional $5,513.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $3,347.19
Rate for Payer: CareSource Indiana of IN Medicare $3,201.66
Rate for Payer: Cash Price $5,468.40
Rate for Payer: Cash Price $5,468.40
Rate for Payer: Centivo All Commercial $4,498.20
Rate for Payer: Cigna All Commercial $7,611.66
Rate for Payer: CORVEL All Commercial $8,202.60
Rate for Payer: Coventry All Commercial $7,761.60
Rate for Payer: Encore All Commercial $8,118.81
Rate for Payer: Frontpath All Commercial $8,114.40
Rate for Payer: Humana ChoiceCare $7,617.83
Rate for Payer: Humana Medicare $4,498.20
Rate for Payer: Lucent All Commercial $4,498.20
Rate for Payer: Lutheran Preferred All Commercial $7,938.00
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $6,615.00
Rate for Payer: PHP All Commercial $6,689.09
Rate for Payer: Plain Church Group Ministry All Commercial $3,439.80
Rate for Payer: Sagamore Health Network All Products $6,809.04
Rate for Payer: Signature Care EPO $7,320.60
Rate for Payer: Signature Care PPO $7,761.60
Rate for Payer: Three Rivers Preferred All Commercial $7,497.00
Rate for Payer: United Healthcare Commercial $6,950.16
Rate for Payer: United Healthcare Medicare $2,910.60
Service Code CPT C9399
Hospital Charge Code 41602555
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $4,185.00
Rate for Payer: Aetna Commercial $3,798.00
Rate for Payer: Aetna Medicare $1,485.00
Rate for Payer: Anthem Blue Cross of IN Medicare $1,485.00
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $2,584.35
Rate for Payer: Anthem Blue Cross of IN Traditional $2,812.95
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $1,707.75
Rate for Payer: CareSource Indiana of IN Medicare $1,633.50
Rate for Payer: Cash Price $2,790.00
Rate for Payer: Cash Price $2,790.00
Rate for Payer: Centivo All Commercial $2,295.00
Rate for Payer: Cigna All Commercial $3,883.50
Rate for Payer: CORVEL All Commercial $4,185.00
Rate for Payer: Coventry All Commercial $3,960.00
Rate for Payer: Encore All Commercial $4,142.25
Rate for Payer: Frontpath All Commercial $4,140.00
Rate for Payer: Humana ChoiceCare $3,886.65
Rate for Payer: Humana Medicare $2,295.00
Rate for Payer: Lucent All Commercial $2,295.00
Rate for Payer: Lutheran Preferred All Commercial $4,050.00
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $3,375.00
Rate for Payer: PHP All Commercial $3,412.80
Rate for Payer: Plain Church Group Ministry All Commercial $1,755.00
Rate for Payer: Sagamore Health Network All Products $3,474.00
Rate for Payer: Signature Care EPO $3,735.00
Rate for Payer: Signature Care PPO $3,960.00
Rate for Payer: Three Rivers Preferred All Commercial $3,825.00
Rate for Payer: United Healthcare Commercial $3,546.00
Rate for Payer: United Healthcare Medicare $1,485.00
Service Code CPT C9399
Hospital Charge Code 41602555
Hospital Revenue Code 278
Min. Negotiated Rate $3,375.00
Max. Negotiated Rate $4,185.00
Rate for Payer: Aetna Commercial $3,888.00
Rate for Payer: Cash Price $2,790.00
Rate for Payer: Cigna All Commercial $3,883.50
Rate for Payer: CORVEL All Commercial $4,185.00
Rate for Payer: Coventry All Commercial $3,960.00
Rate for Payer: Encore All Commercial $4,142.25
Rate for Payer: Frontpath All Commercial $4,140.00
Rate for Payer: Humana ChoiceCare $3,886.65
Rate for Payer: Lutheran Preferred All Commercial $4,050.00
Rate for Payer: PHCS All Commercial $3,375.00
Rate for Payer: PHP All Commercial $3,412.80
Rate for Payer: Sagamore Health Network All Products $3,474.00
Rate for Payer: Signature Care EPO $3,735.00
Rate for Payer: Signature Care PPO $3,960.00
Rate for Payer: United Healthcare Commercial $3,546.00
Service Code CPT C9399
Hospital Charge Code 41602620
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $8,194.23
Rate for Payer: Aetna Commercial $7,436.48
Rate for Payer: Aetna Medicare $2,907.63
Rate for Payer: Anthem Blue Cross of IN Medicare $2,907.63
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $5,060.16
Rate for Payer: Anthem Blue Cross of IN Traditional $5,507.76
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $3,343.77
Rate for Payer: CareSource Indiana of IN Medicare $3,198.39
Rate for Payer: Cash Price $5,462.82
Rate for Payer: Cash Price $5,462.82
Rate for Payer: Centivo All Commercial $4,493.61
Rate for Payer: Cigna All Commercial $7,603.89
Rate for Payer: CORVEL All Commercial $8,194.23
Rate for Payer: Coventry All Commercial $7,753.68
Rate for Payer: Encore All Commercial $8,110.53
Rate for Payer: Frontpath All Commercial $8,106.12
Rate for Payer: Humana ChoiceCare $7,610.06
Rate for Payer: Humana Medicare $4,493.61
Rate for Payer: Lucent All Commercial $4,493.61
Rate for Payer: Lutheran Preferred All Commercial $7,929.90
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $6,608.25
Rate for Payer: PHP All Commercial $6,682.26
Rate for Payer: Plain Church Group Ministry All Commercial $3,436.29
Rate for Payer: Sagamore Health Network All Products $6,802.09
Rate for Payer: Signature Care EPO $7,313.13
Rate for Payer: Signature Care PPO $7,753.68
Rate for Payer: Three Rivers Preferred All Commercial $7,489.35
Rate for Payer: United Healthcare Commercial $6,943.07
Rate for Payer: United Healthcare Medicare $2,907.63
Service Code CPT C9399
Hospital Charge Code 41602620
Hospital Revenue Code 278
Min. Negotiated Rate $6,608.25
Max. Negotiated Rate $8,194.23
Rate for Payer: Aetna Commercial $7,612.70
Rate for Payer: Cash Price $5,462.82
Rate for Payer: Cigna All Commercial $7,603.89
Rate for Payer: CORVEL All Commercial $8,194.23
Rate for Payer: Coventry All Commercial $7,753.68
Rate for Payer: Encore All Commercial $8,110.53
Rate for Payer: Frontpath All Commercial $8,106.12
Rate for Payer: Humana ChoiceCare $7,610.06
Rate for Payer: Lutheran Preferred All Commercial $7,929.90
Rate for Payer: PHCS All Commercial $6,608.25
Rate for Payer: PHP All Commercial $6,682.26
Rate for Payer: Sagamore Health Network All Products $6,802.09
Rate for Payer: Signature Care EPO $7,313.13
Rate for Payer: Signature Care PPO $7,753.68
Rate for Payer: United Healthcare Commercial $6,943.07
Service Code CPT G0480
Hospital Charge Code 63001405
Hospital Revenue Code 300
Min. Negotiated Rate $117.27
Max. Negotiated Rate $145.42
Rate for Payer: Aetna Commercial $135.10
Rate for Payer: Cash Price $96.95
Rate for Payer: Cigna All Commercial $134.94
Rate for Payer: CORVEL All Commercial $145.42
Rate for Payer: Coventry All Commercial $137.60
Rate for Payer: Encore All Commercial $143.93
Rate for Payer: Frontpath All Commercial $143.86
Rate for Payer: Humana ChoiceCare $135.05
Rate for Payer: Lutheran Preferred All Commercial $140.73
Rate for Payer: PHCS All Commercial $117.27
Rate for Payer: PHP All Commercial $118.59
Rate for Payer: Sagamore Health Network All Products $120.71
Rate for Payer: Signature Care EPO $129.78
Rate for Payer: Signature Care PPO $137.60
Rate for Payer: United Healthcare Commercial $123.22
Service Code CPT G0480
Hospital Charge Code 63001405
Hospital Revenue Code 300
Min. Negotiated Rate $51.60
Max. Negotiated Rate $145.42
Rate for Payer: Aetna Commercial $131.97
Rate for Payer: Aetna Medicare $51.60
Rate for Payer: Anthem Blue Cross of IN Medicare $51.60
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $71.87
Rate for Payer: Anthem Blue Cross of IN Traditional $71.87
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $77.12
Rate for Payer: CareSource Indiana of IN Just 4 Me $59.34
Rate for Payer: CareSource Indiana of IN Medicare $56.76
Rate for Payer: Cash Price $96.95
Rate for Payer: Cash Price $96.95
Rate for Payer: Centivo All Commercial $79.75
Rate for Payer: Cigna All Commercial $134.94
Rate for Payer: CORVEL All Commercial $145.42
Rate for Payer: Coventry All Commercial $137.60
Rate for Payer: Encore All Commercial $143.93
Rate for Payer: Frontpath All Commercial $143.86
Rate for Payer: Humana ChoiceCare $135.05
Rate for Payer: Humana Medicare $79.75
Rate for Payer: Lucent All Commercial $79.75
Rate for Payer: Lutheran Preferred All Commercial $140.73
Rate for Payer: Managed Health Services Medicaid $77.12
Rate for Payer: MDWise Medicaid $77.12
Rate for Payer: PHCS All Commercial $117.27
Rate for Payer: PHP All Commercial $118.59
Rate for Payer: Plain Church Group Ministry All Commercial $60.98
Rate for Payer: Sagamore Health Network All Products $120.71
Rate for Payer: Signature Care EPO $129.78
Rate for Payer: Signature Care PPO $137.60
Rate for Payer: Three Rivers Preferred All Commercial $132.91
Rate for Payer: United Healthcare Commercial $123.22
Rate for Payer: United Healthcare Medicare $51.60
Service Code CPT G0480
Hospital Charge Code 63001406
Hospital Revenue Code 300
Min. Negotiated Rate $51.60
Max. Negotiated Rate $145.42
Rate for Payer: Aetna Commercial $131.97
Rate for Payer: Aetna Medicare $51.60
Rate for Payer: Anthem Blue Cross of IN Medicare $51.60
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $71.87
Rate for Payer: Anthem Blue Cross of IN Traditional $71.87
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $77.12
Rate for Payer: CareSource Indiana of IN Just 4 Me $59.34
Rate for Payer: CareSource Indiana of IN Medicare $56.76
Rate for Payer: Cash Price $96.95
Rate for Payer: Cash Price $96.95
Rate for Payer: Centivo All Commercial $79.75
Rate for Payer: Cigna All Commercial $134.94
Rate for Payer: CORVEL All Commercial $145.42
Rate for Payer: Coventry All Commercial $137.60
Rate for Payer: Encore All Commercial $143.93
Rate for Payer: Frontpath All Commercial $143.86
Rate for Payer: Humana ChoiceCare $135.05
Rate for Payer: Humana Medicare $79.75
Rate for Payer: Lucent All Commercial $79.75
Rate for Payer: Lutheran Preferred All Commercial $140.73
Rate for Payer: Managed Health Services Medicaid $77.12
Rate for Payer: MDWise Medicaid $77.12
Rate for Payer: PHCS All Commercial $117.27
Rate for Payer: PHP All Commercial $118.59
Rate for Payer: Plain Church Group Ministry All Commercial $60.98
Rate for Payer: Sagamore Health Network All Products $120.71
Rate for Payer: Signature Care EPO $129.78
Rate for Payer: Signature Care PPO $137.60
Rate for Payer: Three Rivers Preferred All Commercial $132.91
Rate for Payer: United Healthcare Commercial $123.22
Rate for Payer: United Healthcare Medicare $51.60
Service Code CPT G0480
Hospital Charge Code 63001406
Hospital Revenue Code 300
Min. Negotiated Rate $117.27
Max. Negotiated Rate $145.42
Rate for Payer: Aetna Commercial $135.10
Rate for Payer: Cash Price $96.95
Rate for Payer: Cigna All Commercial $134.94
Rate for Payer: CORVEL All Commercial $145.42
Rate for Payer: Coventry All Commercial $137.60
Rate for Payer: Encore All Commercial $143.93
Rate for Payer: Frontpath All Commercial $143.86
Rate for Payer: Humana ChoiceCare $135.05
Rate for Payer: Lutheran Preferred All Commercial $140.73
Rate for Payer: PHCS All Commercial $117.27
Rate for Payer: PHP All Commercial $118.59
Rate for Payer: Sagamore Health Network All Products $120.71
Rate for Payer: Signature Care EPO $129.78
Rate for Payer: Signature Care PPO $137.60
Rate for Payer: United Healthcare Commercial $123.22
Service Code CPT G0480
Hospital Charge Code 63001407
Hospital Revenue Code 300
Min. Negotiated Rate $117.27
Max. Negotiated Rate $145.42
Rate for Payer: Aetna Commercial $135.10
Rate for Payer: Cash Price $96.95
Rate for Payer: Cigna All Commercial $134.94
Rate for Payer: CORVEL All Commercial $145.42
Rate for Payer: Coventry All Commercial $137.60
Rate for Payer: Encore All Commercial $143.93
Rate for Payer: Frontpath All Commercial $143.86
Rate for Payer: Humana ChoiceCare $135.05
Rate for Payer: Lutheran Preferred All Commercial $140.73
Rate for Payer: PHCS All Commercial $117.27
Rate for Payer: PHP All Commercial $118.59
Rate for Payer: Sagamore Health Network All Products $120.71
Rate for Payer: Signature Care EPO $129.78
Rate for Payer: Signature Care PPO $137.60
Rate for Payer: United Healthcare Commercial $123.22