|
HC LEAD ICD RELIANCE DF4 0265
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE DF4 0265
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE DF4 0266
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE DF4 0266
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE DF4 0275
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE DF4 0275
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE DF4 0276
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE DF4 0276
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0282
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0282
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0283
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0283
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0285
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0285
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0286
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0286
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0292
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0292
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0293
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0293
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0295
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0295
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0296
|
Facility
IP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,374.40
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
|
|
HC LEAD ICD RELIANCE GOR DF4 0296
|
Facility
OP
|
$10,850.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
41607231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,090.50 |
| Rate for Payer: Aetna Commercial |
$9,157.40
|
| Rate for Payer: Aetna Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,580.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,231.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,782.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,117.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,938.55
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Cash Price |
$6,727.00
|
| Rate for Payer: Centivo All Commercial |
$5,533.50
|
| Rate for Payer: Cigna All Commercial |
$9,363.55
|
| Rate for Payer: CORVEL All Commercial |
$10,090.50
|
| Rate for Payer: Coventry All Commercial |
$9,548.00
|
| Rate for Payer: Encore All Commercial |
$9,987.42
|
| Rate for Payer: Frontpath All Commercial |
$9,982.00
|
| Rate for Payer: Humana ChoiceCare |
$9,371.14
|
| Rate for Payer: Humana Medicare |
$5,533.50
|
| Rate for Payer: Lucent All Commercial |
$5,533.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,137.50
|
| Rate for Payer: PHP All Commercial |
$8,228.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,231.50
|
| Rate for Payer: Sagamore Health Network All Products |
$8,376.20
|
| Rate for Payer: Signature Care EPO |
$9,005.50
|
| Rate for Payer: Signature Care PPO |
$9,548.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,222.50
|
| Rate for Payer: United Healthcare Commercial |
$8,549.80
|
| Rate for Payer: United Healthcare Medicare |
$3,580.50
|
|
|
HC LEAD ICD SPRINT QUAT 6935M 55
|
Facility
IP
|
$12,257.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
41607346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,192.75 |
| Max. Negotiated Rate |
$11,399.01 |
| Rate for Payer: Aetna Commercial |
$10,590.05
|
| Rate for Payer: Cash Price |
$7,599.34
|
| Rate for Payer: Cigna All Commercial |
$10,577.79
|
| Rate for Payer: CORVEL All Commercial |
$11,399.01
|
| Rate for Payer: Coventry All Commercial |
$10,786.16
|
| Rate for Payer: Encore All Commercial |
$11,282.57
|
| Rate for Payer: Frontpath All Commercial |
$11,276.44
|
| Rate for Payer: Humana ChoiceCare |
$10,586.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,031.30
|
| Rate for Payer: PHCS All Commercial |
$9,192.75
|
| Rate for Payer: PHP All Commercial |
$9,295.71
|
| Rate for Payer: Sagamore Health Network All Products |
$9,462.40
|
| Rate for Payer: Signature Care EPO |
$10,173.31
|
| Rate for Payer: Signature Care PPO |
$10,786.16
|
| Rate for Payer: United Healthcare Commercial |
$9,658.52
|
|
