|
HC Z1 CV COL CMTLESS SZ 1
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 10
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 10
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 11
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 11
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 12
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 12
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 2
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 2
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 3
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 3
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 4
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 4
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 5
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 5
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 6
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 6
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 7
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 7
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 8
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 8
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 CV COL CMTLESS SZ 9
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 CV COL CMTLESS SZ 9
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
|
HC Z1 HO COL CMTLESS SZ 0
|
Facility
|
OP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,596.84
|
| Rate for Payer: Aetna Medicare |
$5,155.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,994.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,251.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,070.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,928.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,670.72
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Centivo All Commercial |
$8,763.84
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Humana Medicare |
$5,155.20
|
| Rate for Payer: Lucent All Commercial |
$8,763.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,693.50
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
| Rate for Payer: United Healthcare Medicare |
$5,155.20
|
|
|
HC Z1 HO COL CMTLESS SZ 0
|
Facility
|
IP
|
$16,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,082.50 |
| Max. Negotiated Rate |
$14,982.30 |
| Rate for Payer: Aetna Commercial |
$13,919.04
|
| Rate for Payer: Cash Price |
$9,666.00
|
| Rate for Payer: Cigna All Commercial |
$13,902.93
|
| Rate for Payer: CORVEL All Commercial |
$14,982.30
|
| Rate for Payer: Coventry All Commercial |
$14,176.80
|
| Rate for Payer: Encore All Commercial |
$14,829.25
|
| Rate for Payer: Frontpath All Commercial |
$14,821.20
|
| Rate for Payer: Humana ChoiceCare |
$13,914.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,499.00
|
| Rate for Payer: PHCS All Commercial |
$12,082.50
|
| Rate for Payer: PHP All Commercial |
$12,217.82
|
| Rate for Payer: Sagamore Health Network All Products |
$12,436.92
|
| Rate for Payer: Signature Care EPO |
$13,371.30
|
| Rate for Payer: Signature Care PPO |
$14,176.80
|
| Rate for Payer: United Healthcare Commercial |
$12,694.68
|
|
