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Service Code CPT C1758
Hospital Charge Code 41602268
Hospital Revenue Code 272
Min. Negotiated Rate $29.13
Max. Negotiated Rate $121.68
Rate for Payer: Aetna Commercial $74.50
Rate for Payer: Aetna Medicare $29.13
Rate for Payer: Anthem Blue Cross of IN Medicare $29.13
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $50.69
Rate for Payer: Anthem Blue Cross of IN Traditional $55.18
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $33.50
Rate for Payer: CareSource Indiana of IN Medicare $32.04
Rate for Payer: Cash Price $54.73
Rate for Payer: Cash Price $54.73
Rate for Payer: Centivo All Commercial $45.02
Rate for Payer: Cigna All Commercial $76.18
Rate for Payer: CORVEL All Commercial $82.09
Rate for Payer: Coventry All Commercial $77.68
Rate for Payer: Encore All Commercial $81.25
Rate for Payer: Frontpath All Commercial $81.21
Rate for Payer: Humana ChoiceCare $76.24
Rate for Payer: Humana Medicare $45.02
Rate for Payer: Lucent All Commercial $45.02
Rate for Payer: Lutheran Preferred All Commercial $79.44
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $66.20
Rate for Payer: PHP All Commercial $66.94
Rate for Payer: Plain Church Group Ministry All Commercial $34.43
Rate for Payer: Sagamore Health Network All Products $68.14
Rate for Payer: Signature Care EPO $73.26
Rate for Payer: Signature Care PPO $77.68
Rate for Payer: Three Rivers Preferred All Commercial $75.03
Rate for Payer: United Healthcare Commercial $69.56
Rate for Payer: United Healthcare Medicare $29.13
Service Code CPT C1758
Hospital Charge Code 41602268
Hospital Revenue Code 272
Min. Negotiated Rate $66.20
Max. Negotiated Rate $82.09
Rate for Payer: Aetna Commercial $76.27
Rate for Payer: Cash Price $54.73
Rate for Payer: Cigna All Commercial $76.18
Rate for Payer: CORVEL All Commercial $82.09
Rate for Payer: Coventry All Commercial $77.68
Rate for Payer: Encore All Commercial $81.25
Rate for Payer: Frontpath All Commercial $81.21
Rate for Payer: Humana ChoiceCare $76.24
Rate for Payer: Lutheran Preferred All Commercial $79.44
Rate for Payer: PHCS All Commercial $66.20
Rate for Payer: PHP All Commercial $66.94
Rate for Payer: Sagamore Health Network All Products $68.14
Rate for Payer: Signature Care EPO $73.26
Rate for Payer: Signature Care PPO $77.68
Rate for Payer: United Healthcare Commercial $69.56
Service Code CPT C1758
Hospital Charge Code 41602484
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $374.59
Rate for Payer: Aetna Commercial $339.95
Rate for Payer: Aetna Medicare $132.92
Rate for Payer: Anthem Blue Cross of IN Medicare $132.92
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $231.32
Rate for Payer: Anthem Blue Cross of IN Traditional $251.78
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $152.86
Rate for Payer: CareSource Indiana of IN Medicare $146.21
Rate for Payer: Cash Price $249.72
Rate for Payer: Cash Price $249.72
Rate for Payer: Centivo All Commercial $205.42
Rate for Payer: Cigna All Commercial $347.60
Rate for Payer: CORVEL All Commercial $374.59
Rate for Payer: Coventry All Commercial $354.45
Rate for Payer: Encore All Commercial $370.76
Rate for Payer: Frontpath All Commercial $370.56
Rate for Payer: Humana ChoiceCare $347.88
Rate for Payer: Humana Medicare $205.42
Rate for Payer: Lucent All Commercial $205.42
Rate for Payer: Lutheran Preferred All Commercial $362.50
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $302.08
Rate for Payer: PHP All Commercial $305.47
Rate for Payer: Plain Church Group Ministry All Commercial $157.08
Rate for Payer: Sagamore Health Network All Products $310.95
Rate for Payer: Signature Care EPO $334.31
Rate for Payer: Signature Care PPO $354.45
Rate for Payer: Three Rivers Preferred All Commercial $342.36
Rate for Payer: United Healthcare Commercial $317.39
Rate for Payer: United Healthcare Medicare $132.92
Service Code CPT C1758
Hospital Charge Code 41602484
Hospital Revenue Code 272
Min. Negotiated Rate $302.08
Max. Negotiated Rate $374.59
Rate for Payer: Aetna Commercial $348.00
Rate for Payer: Cash Price $249.72
Rate for Payer: Cigna All Commercial $347.60
Rate for Payer: CORVEL All Commercial $374.59
Rate for Payer: Coventry All Commercial $354.45
Rate for Payer: Encore All Commercial $370.76
Rate for Payer: Frontpath All Commercial $370.56
Rate for Payer: Humana ChoiceCare $347.88
Rate for Payer: Lutheran Preferred All Commercial $362.50
Rate for Payer: PHCS All Commercial $302.08
Rate for Payer: PHP All Commercial $305.47
Rate for Payer: Sagamore Health Network All Products $310.95
Rate for Payer: Signature Care EPO $334.31
Rate for Payer: Signature Care PPO $354.45
Rate for Payer: United Healthcare Commercial $317.39
Hospital Charge Code 41602336
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $4,335.66
Rate for Payer: Aetna Commercial $3,934.73
Rate for Payer: Aetna Medicare $1,538.46
Rate for Payer: Anthem Blue Cross of IN Medicare $1,538.46
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $2,677.39
Rate for Payer: Anthem Blue Cross of IN Traditional $2,914.22
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $1,769.23
Rate for Payer: CareSource Indiana of IN Medicare $1,692.31
Rate for Payer: Cash Price $2,890.44
Rate for Payer: Cash Price $2,890.44
Rate for Payer: Centivo All Commercial $2,377.62
Rate for Payer: Cigna All Commercial $4,023.31
Rate for Payer: CORVEL All Commercial $4,335.66
Rate for Payer: Coventry All Commercial $4,102.56
Rate for Payer: Encore All Commercial $4,291.37
Rate for Payer: Frontpath All Commercial $4,289.04
Rate for Payer: Humana ChoiceCare $4,026.57
Rate for Payer: Humana Medicare $2,377.62
Rate for Payer: Lucent All Commercial $2,377.62
Rate for Payer: Lutheran Preferred All Commercial $4,195.80
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $3,496.50
Rate for Payer: PHP All Commercial $3,535.66
Rate for Payer: Plain Church Group Ministry All Commercial $1,818.18
Rate for Payer: Sagamore Health Network All Products $3,599.06
Rate for Payer: Signature Care EPO $3,869.46
Rate for Payer: Signature Care PPO $4,102.56
Rate for Payer: Three Rivers Preferred All Commercial $3,962.70
Rate for Payer: United Healthcare Commercial $3,673.66
Rate for Payer: United Healthcare Medicare $1,538.46
Hospital Charge Code 41602336
Hospital Revenue Code 272
Min. Negotiated Rate $3,496.50
Max. Negotiated Rate $4,335.66
Rate for Payer: Aetna Commercial $4,027.97
Rate for Payer: Cash Price $2,890.44
Rate for Payer: Cigna All Commercial $4,023.31
Rate for Payer: CORVEL All Commercial $4,335.66
Rate for Payer: Coventry All Commercial $4,102.56
Rate for Payer: Encore All Commercial $4,291.37
Rate for Payer: Frontpath All Commercial $4,289.04
Rate for Payer: Humana ChoiceCare $4,026.57
Rate for Payer: Lutheran Preferred All Commercial $4,195.80
Rate for Payer: PHCS All Commercial $3,496.50
Rate for Payer: PHP All Commercial $3,535.66
Rate for Payer: Sagamore Health Network All Products $3,599.06
Rate for Payer: Signature Care EPO $3,869.46
Rate for Payer: Signature Care PPO $4,102.56
Rate for Payer: United Healthcare Commercial $3,673.66
Hospital Charge Code 41602067
Hospital Revenue Code 272
Min. Negotiated Rate $525.00
Max. Negotiated Rate $651.00
Rate for Payer: Aetna Commercial $604.80
Rate for Payer: Cash Price $434.00
Rate for Payer: Cigna All Commercial $604.10
Rate for Payer: CORVEL All Commercial $651.00
Rate for Payer: Coventry All Commercial $616.00
Rate for Payer: Encore All Commercial $644.35
Rate for Payer: Frontpath All Commercial $644.00
Rate for Payer: Humana ChoiceCare $604.59
Rate for Payer: Lutheran Preferred All Commercial $630.00
Rate for Payer: PHCS All Commercial $525.00
Rate for Payer: PHP All Commercial $530.88
Rate for Payer: Sagamore Health Network All Products $540.40
Rate for Payer: Signature Care EPO $581.00
Rate for Payer: Signature Care PPO $616.00
Rate for Payer: United Healthcare Commercial $551.60
Hospital Charge Code 41602067
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $651.00
Rate for Payer: Aetna Commercial $590.80
Rate for Payer: Aetna Medicare $231.00
Rate for Payer: Anthem Blue Cross of IN Medicare $231.00
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $402.01
Rate for Payer: Anthem Blue Cross of IN Traditional $437.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $265.65
Rate for Payer: CareSource Indiana of IN Medicare $254.10
Rate for Payer: Cash Price $434.00
Rate for Payer: Cash Price $434.00
Rate for Payer: Centivo All Commercial $357.00
Rate for Payer: Cigna All Commercial $604.10
Rate for Payer: CORVEL All Commercial $651.00
Rate for Payer: Coventry All Commercial $616.00
Rate for Payer: Encore All Commercial $644.35
Rate for Payer: Frontpath All Commercial $644.00
Rate for Payer: Humana ChoiceCare $604.59
Rate for Payer: Humana Medicare $357.00
Rate for Payer: Lucent All Commercial $357.00
Rate for Payer: Lutheran Preferred All Commercial $630.00
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $525.00
Rate for Payer: PHP All Commercial $530.88
Rate for Payer: Plain Church Group Ministry All Commercial $273.00
Rate for Payer: Sagamore Health Network All Products $540.40
Rate for Payer: Signature Care EPO $581.00
Rate for Payer: Signature Care PPO $616.00
Rate for Payer: Three Rivers Preferred All Commercial $595.00
Rate for Payer: United Healthcare Commercial $551.60
Rate for Payer: United Healthcare Medicare $231.00
Hospital Charge Code 41602072
Hospital Revenue Code 272
Min. Negotiated Rate $721.88
Max. Negotiated Rate $895.12
Rate for Payer: Aetna Commercial $831.60
Rate for Payer: Cash Price $596.75
Rate for Payer: Cigna All Commercial $830.64
Rate for Payer: CORVEL All Commercial $895.12
Rate for Payer: Coventry All Commercial $847.00
Rate for Payer: Encore All Commercial $885.98
Rate for Payer: Frontpath All Commercial $885.50
Rate for Payer: Humana ChoiceCare $831.31
Rate for Payer: Lutheran Preferred All Commercial $866.25
Rate for Payer: PHCS All Commercial $721.88
Rate for Payer: PHP All Commercial $729.96
Rate for Payer: Sagamore Health Network All Products $743.05
Rate for Payer: Signature Care EPO $798.88
Rate for Payer: Signature Care PPO $847.00
Rate for Payer: United Healthcare Commercial $758.45
Hospital Charge Code 41602072
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $895.12
Rate for Payer: Aetna Commercial $812.35
Rate for Payer: Aetna Medicare $317.62
Rate for Payer: Anthem Blue Cross of IN Medicare $317.62
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $552.76
Rate for Payer: Anthem Blue Cross of IN Traditional $601.66
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $365.27
Rate for Payer: CareSource Indiana of IN Medicare $349.39
Rate for Payer: Cash Price $596.75
Rate for Payer: Cash Price $596.75
Rate for Payer: Centivo All Commercial $490.88
Rate for Payer: Cigna All Commercial $830.64
Rate for Payer: CORVEL All Commercial $895.12
Rate for Payer: Coventry All Commercial $847.00
Rate for Payer: Encore All Commercial $885.98
Rate for Payer: Frontpath All Commercial $885.50
Rate for Payer: Humana ChoiceCare $831.31
Rate for Payer: Humana Medicare $490.88
Rate for Payer: Lucent All Commercial $490.88
Rate for Payer: Lutheran Preferred All Commercial $866.25
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $721.88
Rate for Payer: PHP All Commercial $729.96
Rate for Payer: Plain Church Group Ministry All Commercial $375.38
Rate for Payer: Sagamore Health Network All Products $743.05
Rate for Payer: Signature Care EPO $798.88
Rate for Payer: Signature Care PPO $847.00
Rate for Payer: Three Rivers Preferred All Commercial $818.12
Rate for Payer: United Healthcare Commercial $758.45
Rate for Payer: United Healthcare Medicare $317.62
Hospital Charge Code 41603094
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $1,162.50
Rate for Payer: Aetna Commercial $1,055.00
Rate for Payer: Aetna Medicare $412.50
Rate for Payer: Anthem Blue Cross of IN Medicare $412.50
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $717.88
Rate for Payer: Anthem Blue Cross of IN Traditional $781.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $474.38
Rate for Payer: CareSource Indiana of IN Medicare $453.75
Rate for Payer: Cash Price $775.00
Rate for Payer: Cash Price $775.00
Rate for Payer: Centivo All Commercial $637.50
Rate for Payer: Cigna All Commercial $1,078.75
Rate for Payer: CORVEL All Commercial $1,162.50
Rate for Payer: Coventry All Commercial $1,100.00
Rate for Payer: Encore All Commercial $1,150.62
Rate for Payer: Frontpath All Commercial $1,150.00
Rate for Payer: Humana ChoiceCare $1,079.62
Rate for Payer: Humana Medicare $637.50
Rate for Payer: Lucent All Commercial $637.50
Rate for Payer: Lutheran Preferred All Commercial $1,125.00
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $937.50
Rate for Payer: PHP All Commercial $948.00
Rate for Payer: Plain Church Group Ministry All Commercial $487.50
Rate for Payer: Sagamore Health Network All Products $965.00
Rate for Payer: Signature Care EPO $1,037.50
Rate for Payer: Signature Care PPO $1,100.00
Rate for Payer: Three Rivers Preferred All Commercial $1,062.50
Rate for Payer: United Healthcare Commercial $985.00
Rate for Payer: United Healthcare Medicare $412.50
Hospital Charge Code 41603094
Hospital Revenue Code 272
Min. Negotiated Rate $937.50
Max. Negotiated Rate $1,162.50
Rate for Payer: Aetna Commercial $1,080.00
Rate for Payer: Cash Price $775.00
Rate for Payer: Cigna All Commercial $1,078.75
Rate for Payer: CORVEL All Commercial $1,162.50
Rate for Payer: Coventry All Commercial $1,100.00
Rate for Payer: Encore All Commercial $1,150.62
Rate for Payer: Frontpath All Commercial $1,150.00
Rate for Payer: Humana ChoiceCare $1,079.62
Rate for Payer: Lutheran Preferred All Commercial $1,125.00
Rate for Payer: PHCS All Commercial $937.50
Rate for Payer: PHP All Commercial $948.00
Rate for Payer: Sagamore Health Network All Products $965.00
Rate for Payer: Signature Care EPO $1,037.50
Rate for Payer: Signature Care PPO $1,100.00
Rate for Payer: United Healthcare Commercial $985.00
Hospital Charge Code 41602068
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $651.00
Rate for Payer: Aetna Commercial $590.80
Rate for Payer: Aetna Medicare $231.00
Rate for Payer: Anthem Blue Cross of IN Medicare $231.00
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $402.01
Rate for Payer: Anthem Blue Cross of IN Traditional $437.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $265.65
Rate for Payer: CareSource Indiana of IN Medicare $254.10
Rate for Payer: Cash Price $434.00
Rate for Payer: Cash Price $434.00
Rate for Payer: Centivo All Commercial $357.00
Rate for Payer: Cigna All Commercial $604.10
Rate for Payer: CORVEL All Commercial $651.00
Rate for Payer: Coventry All Commercial $616.00
Rate for Payer: Encore All Commercial $644.35
Rate for Payer: Frontpath All Commercial $644.00
Rate for Payer: Humana ChoiceCare $604.59
Rate for Payer: Humana Medicare $357.00
Rate for Payer: Lucent All Commercial $357.00
Rate for Payer: Lutheran Preferred All Commercial $630.00
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $525.00
Rate for Payer: PHP All Commercial $530.88
Rate for Payer: Plain Church Group Ministry All Commercial $273.00
Rate for Payer: Sagamore Health Network All Products $540.40
Rate for Payer: Signature Care EPO $581.00
Rate for Payer: Signature Care PPO $616.00
Rate for Payer: Three Rivers Preferred All Commercial $595.00
Rate for Payer: United Healthcare Commercial $551.60
Rate for Payer: United Healthcare Medicare $231.00
Hospital Charge Code 41602068
Hospital Revenue Code 272
Min. Negotiated Rate $525.00
Max. Negotiated Rate $651.00
Rate for Payer: Aetna Commercial $604.80
Rate for Payer: Cash Price $434.00
Rate for Payer: Cigna All Commercial $604.10
Rate for Payer: CORVEL All Commercial $651.00
Rate for Payer: Coventry All Commercial $616.00
Rate for Payer: Encore All Commercial $644.35
Rate for Payer: Frontpath All Commercial $644.00
Rate for Payer: Humana ChoiceCare $604.59
Rate for Payer: Lutheran Preferred All Commercial $630.00
Rate for Payer: PHCS All Commercial $525.00
Rate for Payer: PHP All Commercial $530.88
Rate for Payer: Sagamore Health Network All Products $540.40
Rate for Payer: Signature Care EPO $581.00
Rate for Payer: Signature Care PPO $616.00
Rate for Payer: United Healthcare Commercial $551.60
Hospital Charge Code 41608106
Hospital Revenue Code 272
Min. Negotiated Rate $7.87
Max. Negotiated Rate $121.68
Rate for Payer: Aetna Commercial $20.12
Rate for Payer: Aetna Medicare $7.87
Rate for Payer: Anthem Blue Cross of IN Medicare $7.87
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $13.69
Rate for Payer: Anthem Blue Cross of IN Traditional $14.90
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $9.05
Rate for Payer: CareSource Indiana of IN Medicare $8.65
Rate for Payer: Cash Price $14.78
Rate for Payer: Cash Price $14.78
Rate for Payer: Centivo All Commercial $12.16
Rate for Payer: Cigna All Commercial $20.57
Rate for Payer: CORVEL All Commercial $22.17
Rate for Payer: Coventry All Commercial $20.98
Rate for Payer: Encore All Commercial $21.94
Rate for Payer: Frontpath All Commercial $21.93
Rate for Payer: Humana ChoiceCare $20.59
Rate for Payer: Humana Medicare $12.16
Rate for Payer: Lucent All Commercial $12.16
Rate for Payer: Lutheran Preferred All Commercial $21.46
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $17.88
Rate for Payer: PHP All Commercial $18.08
Rate for Payer: Plain Church Group Ministry All Commercial $9.30
Rate for Payer: Sagamore Health Network All Products $18.40
Rate for Payer: Signature Care EPO $19.79
Rate for Payer: Signature Care PPO $20.98
Rate for Payer: Three Rivers Preferred All Commercial $20.26
Rate for Payer: United Healthcare Commercial $18.79
Rate for Payer: United Healthcare Medicare $7.87
Hospital Charge Code 41608106
Hospital Revenue Code 272
Min. Negotiated Rate $17.88
Max. Negotiated Rate $22.17
Rate for Payer: Aetna Commercial $20.60
Rate for Payer: Cash Price $14.78
Rate for Payer: Cigna All Commercial $20.57
Rate for Payer: CORVEL All Commercial $22.17
Rate for Payer: Coventry All Commercial $20.98
Rate for Payer: Encore All Commercial $21.94
Rate for Payer: Frontpath All Commercial $21.93
Rate for Payer: Humana ChoiceCare $20.59
Rate for Payer: Lutheran Preferred All Commercial $21.46
Rate for Payer: PHCS All Commercial $17.88
Rate for Payer: PHP All Commercial $18.08
Rate for Payer: Sagamore Health Network All Products $18.40
Rate for Payer: Signature Care EPO $19.79
Rate for Payer: Signature Care PPO $20.98
Rate for Payer: United Healthcare Commercial $18.79
Hospital Charge Code 41608107
Hospital Revenue Code 272
Min. Negotiated Rate $7.87
Max. Negotiated Rate $121.68
Rate for Payer: Aetna Commercial $20.12
Rate for Payer: Aetna Medicare $7.87
Rate for Payer: Anthem Blue Cross of IN Medicare $7.87
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $13.69
Rate for Payer: Anthem Blue Cross of IN Traditional $14.90
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $9.05
Rate for Payer: CareSource Indiana of IN Medicare $8.65
Rate for Payer: Cash Price $14.78
Rate for Payer: Cash Price $14.78
Rate for Payer: Centivo All Commercial $12.16
Rate for Payer: Cigna All Commercial $20.57
Rate for Payer: CORVEL All Commercial $22.17
Rate for Payer: Coventry All Commercial $20.98
Rate for Payer: Encore All Commercial $21.94
Rate for Payer: Frontpath All Commercial $21.93
Rate for Payer: Humana ChoiceCare $20.59
Rate for Payer: Humana Medicare $12.16
Rate for Payer: Lucent All Commercial $12.16
Rate for Payer: Lutheran Preferred All Commercial $21.46
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $17.88
Rate for Payer: PHP All Commercial $18.08
Rate for Payer: Plain Church Group Ministry All Commercial $9.30
Rate for Payer: Sagamore Health Network All Products $18.40
Rate for Payer: Signature Care EPO $19.79
Rate for Payer: Signature Care PPO $20.98
Rate for Payer: Three Rivers Preferred All Commercial $20.26
Rate for Payer: United Healthcare Commercial $18.79
Rate for Payer: United Healthcare Medicare $7.87
Hospital Charge Code 41608107
Hospital Revenue Code 272
Min. Negotiated Rate $17.88
Max. Negotiated Rate $22.17
Rate for Payer: Aetna Commercial $20.60
Rate for Payer: Cash Price $14.78
Rate for Payer: Cigna All Commercial $20.57
Rate for Payer: CORVEL All Commercial $22.17
Rate for Payer: Coventry All Commercial $20.98
Rate for Payer: Encore All Commercial $21.94
Rate for Payer: Frontpath All Commercial $21.93
Rate for Payer: Humana ChoiceCare $20.59
Rate for Payer: Lutheran Preferred All Commercial $21.46
Rate for Payer: PHCS All Commercial $17.88
Rate for Payer: PHP All Commercial $18.08
Rate for Payer: Sagamore Health Network All Products $18.40
Rate for Payer: Signature Care EPO $19.79
Rate for Payer: Signature Care PPO $20.98
Rate for Payer: United Healthcare Commercial $18.79
Hospital Charge Code 41601821
Hospital Revenue Code 270
Min. Negotiated Rate $20.22
Max. Negotiated Rate $96.84
Rate for Payer: Aetna Commercial $51.71
Rate for Payer: Aetna Medicare $20.22
Rate for Payer: Anthem Blue Cross of IN Medicare $20.22
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $35.19
Rate for Payer: Anthem Blue Cross of IN Traditional $38.30
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $96.84
Rate for Payer: CareSource Indiana of IN Just 4 Me $23.25
Rate for Payer: CareSource Indiana of IN Medicare $22.24
Rate for Payer: Cash Price $37.99
Rate for Payer: Cash Price $37.99
Rate for Payer: Centivo All Commercial $31.25
Rate for Payer: Cigna All Commercial $52.88
Rate for Payer: CORVEL All Commercial $56.98
Rate for Payer: Coventry All Commercial $53.92
Rate for Payer: Encore All Commercial $56.40
Rate for Payer: Frontpath All Commercial $56.37
Rate for Payer: Humana ChoiceCare $52.92
Rate for Payer: Humana Medicare $31.25
Rate for Payer: Lucent All Commercial $31.25
Rate for Payer: Lutheran Preferred All Commercial $55.14
Rate for Payer: Managed Health Services Medicaid $96.84
Rate for Payer: MDWise Medicaid $96.84
Rate for Payer: PHCS All Commercial $45.95
Rate for Payer: PHP All Commercial $46.47
Rate for Payer: Plain Church Group Ministry All Commercial $23.90
Rate for Payer: Sagamore Health Network All Products $47.30
Rate for Payer: Signature Care EPO $50.85
Rate for Payer: Signature Care PPO $53.92
Rate for Payer: Three Rivers Preferred All Commercial $52.08
Rate for Payer: United Healthcare Commercial $48.28
Rate for Payer: United Healthcare Medicare $20.22
Hospital Charge Code 41601821
Hospital Revenue Code 270
Min. Negotiated Rate $45.95
Max. Negotiated Rate $56.98
Rate for Payer: Aetna Commercial $52.94
Rate for Payer: Cash Price $37.99
Rate for Payer: Cigna All Commercial $52.88
Rate for Payer: CORVEL All Commercial $56.98
Rate for Payer: Coventry All Commercial $53.92
Rate for Payer: Encore All Commercial $56.40
Rate for Payer: Frontpath All Commercial $56.37
Rate for Payer: Humana ChoiceCare $52.92
Rate for Payer: Lutheran Preferred All Commercial $55.14
Rate for Payer: PHCS All Commercial $45.95
Rate for Payer: PHP All Commercial $46.47
Rate for Payer: Sagamore Health Network All Products $47.30
Rate for Payer: Signature Care EPO $50.85
Rate for Payer: Signature Care PPO $53.92
Rate for Payer: United Healthcare Commercial $48.28
Hospital Charge Code 41601814
Hospital Revenue Code 270
Min. Negotiated Rate $15.19
Max. Negotiated Rate $96.84
Rate for Payer: Aetna Commercial $38.86
Rate for Payer: Aetna Medicare $15.19
Rate for Payer: Anthem Blue Cross of IN Medicare $15.19
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $26.44
Rate for Payer: Anthem Blue Cross of IN Traditional $28.78
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $96.84
Rate for Payer: CareSource Indiana of IN Just 4 Me $17.47
Rate for Payer: CareSource Indiana of IN Medicare $16.71
Rate for Payer: Cash Price $28.55
Rate for Payer: Cash Price $28.55
Rate for Payer: Centivo All Commercial $23.48
Rate for Payer: Cigna All Commercial $39.73
Rate for Payer: CORVEL All Commercial $42.82
Rate for Payer: Coventry All Commercial $40.52
Rate for Payer: Encore All Commercial $42.38
Rate for Payer: Frontpath All Commercial $42.36
Rate for Payer: Humana ChoiceCare $39.76
Rate for Payer: Humana Medicare $23.48
Rate for Payer: Lucent All Commercial $23.48
Rate for Payer: Lutheran Preferred All Commercial $41.44
Rate for Payer: Managed Health Services Medicaid $96.84
Rate for Payer: MDWise Medicaid $96.84
Rate for Payer: PHCS All Commercial $34.53
Rate for Payer: PHP All Commercial $34.92
Rate for Payer: Plain Church Group Ministry All Commercial $17.96
Rate for Payer: Sagamore Health Network All Products $35.54
Rate for Payer: Signature Care EPO $38.21
Rate for Payer: Signature Care PPO $40.52
Rate for Payer: Three Rivers Preferred All Commercial $39.13
Rate for Payer: United Healthcare Commercial $36.28
Rate for Payer: United Healthcare Medicare $15.19
Hospital Charge Code 41601814
Hospital Revenue Code 270
Min. Negotiated Rate $34.53
Max. Negotiated Rate $42.82
Rate for Payer: Aetna Commercial $39.78
Rate for Payer: Cash Price $28.55
Rate for Payer: Cigna All Commercial $39.73
Rate for Payer: CORVEL All Commercial $42.82
Rate for Payer: Coventry All Commercial $40.52
Rate for Payer: Encore All Commercial $42.38
Rate for Payer: Frontpath All Commercial $42.36
Rate for Payer: Humana ChoiceCare $39.76
Rate for Payer: Lutheran Preferred All Commercial $41.44
Rate for Payer: PHCS All Commercial $34.53
Rate for Payer: PHP All Commercial $34.92
Rate for Payer: Sagamore Health Network All Products $35.54
Rate for Payer: Signature Care EPO $38.21
Rate for Payer: Signature Care PPO $40.52
Rate for Payer: United Healthcare Commercial $36.28
Hospital Charge Code 41608108
Hospital Revenue Code 272
Min. Negotiated Rate $9.97
Max. Negotiated Rate $121.68
Rate for Payer: Aetna Commercial $25.51
Rate for Payer: Aetna Medicare $9.97
Rate for Payer: Anthem Blue Cross of IN Medicare $9.97
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $17.36
Rate for Payer: Anthem Blue Cross of IN Traditional $18.89
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $11.47
Rate for Payer: CareSource Indiana of IN Medicare $10.97
Rate for Payer: Cash Price $18.74
Rate for Payer: Cash Price $18.74
Rate for Payer: Centivo All Commercial $15.41
Rate for Payer: Cigna All Commercial $26.08
Rate for Payer: CORVEL All Commercial $28.10
Rate for Payer: Coventry All Commercial $26.59
Rate for Payer: Encore All Commercial $27.82
Rate for Payer: Frontpath All Commercial $27.80
Rate for Payer: Humana ChoiceCare $26.10
Rate for Payer: Humana Medicare $15.41
Rate for Payer: Lucent All Commercial $15.41
Rate for Payer: Lutheran Preferred All Commercial $27.20
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $22.66
Rate for Payer: PHP All Commercial $22.92
Rate for Payer: Plain Church Group Ministry All Commercial $11.79
Rate for Payer: Sagamore Health Network All Products $23.33
Rate for Payer: Signature Care EPO $25.08
Rate for Payer: Signature Care PPO $26.59
Rate for Payer: Three Rivers Preferred All Commercial $25.69
Rate for Payer: United Healthcare Commercial $23.81
Rate for Payer: United Healthcare Medicare $9.97
Hospital Charge Code 41608108
Hospital Revenue Code 272
Min. Negotiated Rate $22.66
Max. Negotiated Rate $28.10
Rate for Payer: Aetna Commercial $26.11
Rate for Payer: Cash Price $18.74
Rate for Payer: Cigna All Commercial $26.08
Rate for Payer: CORVEL All Commercial $28.10
Rate for Payer: Coventry All Commercial $26.59
Rate for Payer: Encore All Commercial $27.82
Rate for Payer: Frontpath All Commercial $27.80
Rate for Payer: Humana ChoiceCare $26.10
Rate for Payer: Lutheran Preferred All Commercial $27.20
Rate for Payer: PHCS All Commercial $22.66
Rate for Payer: PHP All Commercial $22.92
Rate for Payer: Sagamore Health Network All Products $23.33
Rate for Payer: Signature Care EPO $25.08
Rate for Payer: Signature Care PPO $26.59
Rate for Payer: United Healthcare Commercial $23.81
Hospital Charge Code 41601866
Hospital Revenue Code 272
Min. Negotiated Rate $98.79
Max. Negotiated Rate $278.40
Rate for Payer: Aetna Commercial $252.66
Rate for Payer: Aetna Medicare $98.79
Rate for Payer: Anthem Blue Cross of IN Medicare $98.79
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $171.92
Rate for Payer: Anthem Blue Cross of IN Traditional $187.13
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $113.61
Rate for Payer: CareSource Indiana of IN Medicare $108.67
Rate for Payer: Cash Price $185.60
Rate for Payer: Cash Price $185.60
Rate for Payer: Centivo All Commercial $152.67
Rate for Payer: Cigna All Commercial $258.35
Rate for Payer: CORVEL All Commercial $278.40
Rate for Payer: Coventry All Commercial $263.44
Rate for Payer: Encore All Commercial $275.56
Rate for Payer: Frontpath All Commercial $275.41
Rate for Payer: Humana ChoiceCare $258.56
Rate for Payer: Humana Medicare $152.67
Rate for Payer: Lucent All Commercial $152.67
Rate for Payer: Lutheran Preferred All Commercial $269.42
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $224.52
Rate for Payer: PHP All Commercial $227.03
Rate for Payer: Plain Church Group Ministry All Commercial $116.75
Rate for Payer: Sagamore Health Network All Products $231.11
Rate for Payer: Signature Care EPO $248.47
Rate for Payer: Signature Care PPO $263.44
Rate for Payer: Three Rivers Preferred All Commercial $254.46
Rate for Payer: United Healthcare Commercial $235.90
Rate for Payer: United Healthcare Medicare $98.79