|
HC DS ATT FEM POR CR SZ 3 R
|
Facility
|
OP
|
$10,620.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,876.60 |
| Rate for Payer: Aetna Commercial |
$8,963.28
|
| Rate for Payer: Aetna Medicare |
$3,398.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,099.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,638.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,908.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,738.24
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Centivo All Commercial |
$5,777.28
|
| Rate for Payer: Cigna All Commercial |
$9,165.06
|
| Rate for Payer: CORVEL All Commercial |
$9,876.60
|
| Rate for Payer: Coventry All Commercial |
$9,345.60
|
| Rate for Payer: Encore All Commercial |
$9,775.71
|
| Rate for Payer: Frontpath All Commercial |
$9,770.40
|
| Rate for Payer: Humana ChoiceCare |
$9,172.49
|
| Rate for Payer: Humana Medicare |
$3,398.40
|
| Rate for Payer: Lucent All Commercial |
$5,777.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,558.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,965.00
|
| Rate for Payer: PHP All Commercial |
$8,054.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,141.80
|
| Rate for Payer: Sagamore Health Network All Products |
$8,198.64
|
| Rate for Payer: Signature Care EPO |
$8,814.60
|
| Rate for Payer: Signature Care PPO |
$9,345.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,027.00
|
| Rate for Payer: United Healthcare Commercial |
$8,368.56
|
| Rate for Payer: United Healthcare Medicare |
$3,398.40
|
|
|
HC DS ATT FEM POR CR SZ 3 R
|
Facility
|
IP
|
$10,620.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.00 |
| Max. Negotiated Rate |
$9,876.60 |
| Rate for Payer: Aetna Commercial |
$9,175.68
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Cigna All Commercial |
$9,165.06
|
| Rate for Payer: CORVEL All Commercial |
$9,876.60
|
| Rate for Payer: Coventry All Commercial |
$9,345.60
|
| Rate for Payer: Encore All Commercial |
$9,775.71
|
| Rate for Payer: Frontpath All Commercial |
$9,770.40
|
| Rate for Payer: Humana ChoiceCare |
$9,172.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,558.00
|
| Rate for Payer: PHCS All Commercial |
$7,965.00
|
| Rate for Payer: PHP All Commercial |
$8,054.21
|
| Rate for Payer: Sagamore Health Network All Products |
$8,198.64
|
| Rate for Payer: Signature Care EPO |
$8,814.60
|
| Rate for Payer: Signature Care PPO |
$9,345.60
|
| Rate for Payer: United Healthcare Commercial |
$8,368.56
|
|
|
HC DS ATT FEM POR CR SZ 6 L
|
Facility
|
OP
|
$10,620.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,876.60 |
| Rate for Payer: Aetna Commercial |
$8,963.28
|
| Rate for Payer: Aetna Medicare |
$3,398.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,099.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,638.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,908.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,738.24
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Centivo All Commercial |
$5,777.28
|
| Rate for Payer: Cigna All Commercial |
$9,165.06
|
| Rate for Payer: CORVEL All Commercial |
$9,876.60
|
| Rate for Payer: Coventry All Commercial |
$9,345.60
|
| Rate for Payer: Encore All Commercial |
$9,775.71
|
| Rate for Payer: Frontpath All Commercial |
$9,770.40
|
| Rate for Payer: Humana ChoiceCare |
$9,172.49
|
| Rate for Payer: Humana Medicare |
$3,398.40
|
| Rate for Payer: Lucent All Commercial |
$5,777.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,558.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,965.00
|
| Rate for Payer: PHP All Commercial |
$8,054.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,141.80
|
| Rate for Payer: Sagamore Health Network All Products |
$8,198.64
|
| Rate for Payer: Signature Care EPO |
$8,814.60
|
| Rate for Payer: Signature Care PPO |
$9,345.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,027.00
|
| Rate for Payer: United Healthcare Commercial |
$8,368.56
|
| Rate for Payer: United Healthcare Medicare |
$3,398.40
|
|
|
HC DS ATT FEM POR CR SZ 6 L
|
Facility
|
IP
|
$10,620.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.00 |
| Max. Negotiated Rate |
$9,876.60 |
| Rate for Payer: Aetna Commercial |
$9,175.68
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Cigna All Commercial |
$9,165.06
|
| Rate for Payer: CORVEL All Commercial |
$9,876.60
|
| Rate for Payer: Coventry All Commercial |
$9,345.60
|
| Rate for Payer: Encore All Commercial |
$9,775.71
|
| Rate for Payer: Frontpath All Commercial |
$9,770.40
|
| Rate for Payer: Humana ChoiceCare |
$9,172.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,558.00
|
| Rate for Payer: PHCS All Commercial |
$7,965.00
|
| Rate for Payer: PHP All Commercial |
$8,054.21
|
| Rate for Payer: Sagamore Health Network All Products |
$8,198.64
|
| Rate for Payer: Signature Care EPO |
$8,814.60
|
| Rate for Payer: Signature Care PPO |
$9,345.60
|
| Rate for Payer: United Healthcare Commercial |
$8,368.56
|
|
|
HC DS ATT FEM POR CR SZ 8 L
|
Facility
|
IP
|
$10,620.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.00 |
| Max. Negotiated Rate |
$9,876.60 |
| Rate for Payer: Aetna Commercial |
$9,175.68
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Cigna All Commercial |
$9,165.06
|
| Rate for Payer: CORVEL All Commercial |
$9,876.60
|
| Rate for Payer: Coventry All Commercial |
$9,345.60
|
| Rate for Payer: Encore All Commercial |
$9,775.71
|
| Rate for Payer: Frontpath All Commercial |
$9,770.40
|
| Rate for Payer: Humana ChoiceCare |
$9,172.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,558.00
|
| Rate for Payer: PHCS All Commercial |
$7,965.00
|
| Rate for Payer: PHP All Commercial |
$8,054.21
|
| Rate for Payer: Sagamore Health Network All Products |
$8,198.64
|
| Rate for Payer: Signature Care EPO |
$8,814.60
|
| Rate for Payer: Signature Care PPO |
$9,345.60
|
| Rate for Payer: United Healthcare Commercial |
$8,368.56
|
|
|
HC DS ATT FEM POR CR SZ 8 L
|
Facility
|
OP
|
$10,620.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,876.60 |
| Rate for Payer: Aetna Commercial |
$8,963.28
|
| Rate for Payer: Aetna Medicare |
$3,398.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,099.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,638.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,908.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,738.24
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Cash Price |
$6,372.00
|
| Rate for Payer: Centivo All Commercial |
$5,777.28
|
| Rate for Payer: Cigna All Commercial |
$9,165.06
|
| Rate for Payer: CORVEL All Commercial |
$9,876.60
|
| Rate for Payer: Coventry All Commercial |
$9,345.60
|
| Rate for Payer: Encore All Commercial |
$9,775.71
|
| Rate for Payer: Frontpath All Commercial |
$9,770.40
|
| Rate for Payer: Humana ChoiceCare |
$9,172.49
|
| Rate for Payer: Humana Medicare |
$3,398.40
|
| Rate for Payer: Lucent All Commercial |
$5,777.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,558.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,965.00
|
| Rate for Payer: PHP All Commercial |
$8,054.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,141.80
|
| Rate for Payer: Sagamore Health Network All Products |
$8,198.64
|
| Rate for Payer: Signature Care EPO |
$8,814.60
|
| Rate for Payer: Signature Care PPO |
$9,345.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,027.00
|
| Rate for Payer: United Healthcare Commercial |
$8,368.56
|
| Rate for Payer: United Healthcare Medicare |
$3,398.40
|
|
|
HC DS ATT PAT MD DOME 35MM
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
|
|
HC DS ATT PAT MD DOME 35MM
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$800.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$775.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$920.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$880.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Centivo All Commercial |
$1,360.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$800.00
|
| Rate for Payer: Lucent All Commercial |
$1,360.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$800.00
|
|
|
HC DS ATT PAT MD DONE 35 MM
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
|
|
HC DS ATT PAT MD DONE 35 MM
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$800.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$775.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$920.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$880.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Centivo All Commercial |
$1,360.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$800.00
|
| Rate for Payer: Lucent All Commercial |
$1,360.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$800.00
|
|
|
HC DS ATT PIN SYSTEM
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna All Commercial |
$1,510.25
|
| Rate for Payer: CORVEL All Commercial |
$1,627.50
|
| Rate for Payer: Coventry All Commercial |
$1,540.00
|
| Rate for Payer: Encore All Commercial |
$1,610.88
|
| Rate for Payer: Frontpath All Commercial |
$1,610.00
|
| Rate for Payer: Humana ChoiceCare |
$1,511.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.00
|
| Rate for Payer: PHCS All Commercial |
$1,312.50
|
| Rate for Payer: PHP All Commercial |
$1,327.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.00
|
| Rate for Payer: Signature Care EPO |
$1,452.50
|
| Rate for Payer: Signature Care PPO |
$1,540.00
|
| Rate for Payer: United Healthcare Commercial |
$1,379.00
|
|
|
HC DS ATT PIN SYSTEM
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,477.00
|
| Rate for Payer: Aetna Medicare |
$560.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$542.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,005.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,093.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$644.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$616.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Centivo All Commercial |
$952.00
|
| Rate for Payer: Cigna All Commercial |
$1,510.25
|
| Rate for Payer: CORVEL All Commercial |
$1,627.50
|
| Rate for Payer: Coventry All Commercial |
$1,540.00
|
| Rate for Payer: Encore All Commercial |
$1,610.88
|
| Rate for Payer: Frontpath All Commercial |
$1,610.00
|
| Rate for Payer: Humana ChoiceCare |
$1,511.47
|
| Rate for Payer: Humana Medicare |
$560.00
|
| Rate for Payer: Lucent All Commercial |
$952.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,312.50
|
| Rate for Payer: PHP All Commercial |
$1,327.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.00
|
| Rate for Payer: Signature Care EPO |
$1,452.50
|
| Rate for Payer: Signature Care PPO |
$1,540.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,487.50
|
| Rate for Payer: United Healthcare Commercial |
$1,379.00
|
| Rate for Payer: United Healthcare Medicare |
$560.00
|
|
|
HC DS ATT TIB BASE SZ 3 POR
|
Facility
|
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,176.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,583.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,471.04
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Centivo All Commercial |
$3,818.88
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$2,246.40
|
| Rate for Payer: Lucent All Commercial |
$3,818.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,246.40
|
|
|
HC DS ATT TIB BASE SZ 3 POR
|
Facility
|
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC DS ATT TIB BASE SZ 5
|
Facility
|
OP
|
$6,660.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,193.80 |
| Rate for Payer: Aetna Commercial |
$5,621.04
|
| Rate for Payer: Aetna Medicare |
$2,131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,064.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,824.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,163.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,450.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,344.32
|
| Rate for Payer: Cash Price |
$3,996.00
|
| Rate for Payer: Cash Price |
$3,996.00
|
| Rate for Payer: Centivo All Commercial |
$3,623.04
|
| Rate for Payer: Cigna All Commercial |
$5,747.58
|
| Rate for Payer: CORVEL All Commercial |
$6,193.80
|
| Rate for Payer: Coventry All Commercial |
$5,860.80
|
| Rate for Payer: Encore All Commercial |
$6,130.53
|
| Rate for Payer: Frontpath All Commercial |
$6,127.20
|
| Rate for Payer: Humana ChoiceCare |
$5,752.24
|
| Rate for Payer: Humana Medicare |
$2,131.20
|
| Rate for Payer: Lucent All Commercial |
$3,623.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,994.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,995.00
|
| Rate for Payer: PHP All Commercial |
$5,050.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,597.40
|
| Rate for Payer: Sagamore Health Network All Products |
$5,141.52
|
| Rate for Payer: Signature Care EPO |
$5,527.80
|
| Rate for Payer: Signature Care PPO |
$5,860.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,661.00
|
| Rate for Payer: United Healthcare Commercial |
$5,248.08
|
| Rate for Payer: United Healthcare Medicare |
$2,131.20
|
|
|
HC DS ATT TIB BASE SZ 5
|
Facility
|
IP
|
$6,660.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,995.00 |
| Max. Negotiated Rate |
$6,193.80 |
| Rate for Payer: Aetna Commercial |
$5,754.24
|
| Rate for Payer: Cash Price |
$3,996.00
|
| Rate for Payer: Cigna All Commercial |
$5,747.58
|
| Rate for Payer: CORVEL All Commercial |
$6,193.80
|
| Rate for Payer: Coventry All Commercial |
$5,860.80
|
| Rate for Payer: Encore All Commercial |
$6,130.53
|
| Rate for Payer: Frontpath All Commercial |
$6,127.20
|
| Rate for Payer: Humana ChoiceCare |
$5,752.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,994.00
|
| Rate for Payer: PHCS All Commercial |
$4,995.00
|
| Rate for Payer: PHP All Commercial |
$5,050.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,141.52
|
| Rate for Payer: Signature Care EPO |
$5,527.80
|
| Rate for Payer: Signature Care PPO |
$5,860.80
|
| Rate for Payer: United Healthcare Commercial |
$5,248.08
|
|
|
HC DS ATT TIB BASE SZ 5 POR
|
Facility
|
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC DS ATT TIB BASE SZ 5 POR
|
Facility
|
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,176.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,583.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,471.04
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Centivo All Commercial |
$3,818.88
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$2,246.40
|
| Rate for Payer: Lucent All Commercial |
$3,818.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,246.40
|
|
|
HC DS ATT TIB BASE SZ 7 POR
|
Facility
|
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC DS ATT TIB BASE SZ 7 POR
|
Facility
|
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,176.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,583.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,471.04
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Centivo All Commercial |
$3,818.88
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$2,246.40
|
| Rate for Payer: Lucent All Commercial |
$3,818.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,246.40
|
|
|
HC DS ATT TIB BASE SZ 8 POR
|
Facility
|
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,176.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,583.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,471.04
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Centivo All Commercial |
$3,818.88
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$2,246.40
|
| Rate for Payer: Lucent All Commercial |
$3,818.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,246.40
|
|
|
HC DS ATT TIB BASE SZ 8 POR
|
Facility
|
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC DS ATT TIB MS SZ 3X7 R
|
Facility
|
OP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,772.96
|
| Rate for Payer: Aetna Medicare |
$2,188.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,120.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,928.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,275.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,517.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,407.68
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Centivo All Commercial |
$3,720.96
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Humana Medicare |
$2,188.80
|
| Rate for Payer: Lucent All Commercial |
$3,720.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,667.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,814.00
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
| Rate for Payer: United Healthcare Medicare |
$2,188.80
|
|
|
HC DS ATT TIB MS SZ 3X7 R
|
Facility
|
IP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.00 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,909.76
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
|
|
HC DS ATT TIB MS SZ 6X5 R
|
Facility
|
IP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.00 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,909.76
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
|
