|
HC SIG 7PX ACE BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603610
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX CARAT BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603612
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX CARAT BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603612
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX CELLION BTE HA MON
|
Facility
OP
|
$3,920.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603617
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,645.97 |
| Rate for Payer: Aetna Commercial |
$3,308.82
|
| Rate for Payer: Aetna Medicare |
$1,293.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,293.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,251.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,450.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,487.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,423.11
|
| Rate for Payer: Cash Price |
$2,430.65
|
| Rate for Payer: Cash Price |
$2,430.65
|
| Rate for Payer: Centivo All Commercial |
$1,999.40
|
| Rate for Payer: Cigna All Commercial |
$3,383.31
|
| Rate for Payer: CORVEL All Commercial |
$3,645.97
|
| Rate for Payer: Coventry All Commercial |
$3,449.95
|
| Rate for Payer: Encore All Commercial |
$3,608.73
|
| Rate for Payer: Frontpath All Commercial |
$3,606.77
|
| Rate for Payer: Humana ChoiceCare |
$3,386.05
|
| Rate for Payer: Humana Medicare |
$1,999.40
|
| Rate for Payer: Lucent All Commercial |
$1,999.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,528.36
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,940.30
|
| Rate for Payer: PHP All Commercial |
$2,973.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,528.96
|
| Rate for Payer: Sagamore Health Network All Products |
$3,026.55
|
| Rate for Payer: Signature Care EPO |
$3,253.93
|
| Rate for Payer: Signature Care PPO |
$3,449.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,332.34
|
| Rate for Payer: United Healthcare Commercial |
$3,089.28
|
| Rate for Payer: United Healthcare Medicare |
$1,293.73
|
|
|
HC SIG 7PX CELLION BTE HA MON
|
Facility
IP
|
$3,920.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603617
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,940.30 |
| Max. Negotiated Rate |
$3,645.97 |
| Rate for Payer: Aetna Commercial |
$3,387.23
|
| Rate for Payer: Cash Price |
$2,430.65
|
| Rate for Payer: Cigna All Commercial |
$3,383.31
|
| Rate for Payer: CORVEL All Commercial |
$3,645.97
|
| Rate for Payer: Coventry All Commercial |
$3,449.95
|
| Rate for Payer: Encore All Commercial |
$3,608.73
|
| Rate for Payer: Frontpath All Commercial |
$3,606.77
|
| Rate for Payer: Humana ChoiceCare |
$3,386.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,528.36
|
| Rate for Payer: PHCS All Commercial |
$2,940.30
|
| Rate for Payer: PHP All Commercial |
$2,973.23
|
| Rate for Payer: Sagamore Health Network All Products |
$3,026.55
|
| Rate for Payer: Signature Care EPO |
$3,253.93
|
| Rate for Payer: Signature Care PPO |
$3,449.95
|
| Rate for Payer: United Healthcare Commercial |
$3,089.28
|
|
|
HC SIG 7PX INSIO CUST CIC HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603619
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX INSIO CUST CIC HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603619
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX INSIO CUST ITE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603618
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX INSIO CUST ITE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603618
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX MOTION P BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603615
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX MOTION P BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603615
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX MOTION SA BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603614
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX MOTION SA BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603614
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX MOTION SP BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603616
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX MOTION SP BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603616
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX MOTION SX BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603613
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX MOTION SX BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603613
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX PURE BTE HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603611
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX PURE BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603611
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 7PX SILK CIC HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603609
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX SILK CIC HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603609
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIMULATION-COMPLEX
|
Facility
OP
|
$2,333.76
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
01547290
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$770.14 |
| Max. Negotiated Rate |
$2,170.40 |
| Rate for Payer: Aetna Commercial |
$1,969.69
|
| Rate for Payer: Aetna Medicare |
$770.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$770.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,340.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,458.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,149.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$885.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$847.15
|
| Rate for Payer: Cash Price |
$1,446.93
|
| Rate for Payer: Cash Price |
$1,446.93
|
| Rate for Payer: Centivo All Commercial |
$1,190.22
|
| Rate for Payer: Cigna All Commercial |
$2,014.03
|
| Rate for Payer: CORVEL All Commercial |
$2,170.40
|
| Rate for Payer: Coventry All Commercial |
$2,053.71
|
| Rate for Payer: Encore All Commercial |
$2,148.23
|
| Rate for Payer: Frontpath All Commercial |
$2,147.06
|
| Rate for Payer: Humana ChoiceCare |
$2,015.67
|
| Rate for Payer: Humana Medicare |
$1,190.22
|
| Rate for Payer: Lucent All Commercial |
$1,190.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,100.38
|
| Rate for Payer: Managed Health Services Medicaid |
$1,149.33
|
| Rate for Payer: MDWise Medicaid |
$1,149.33
|
| Rate for Payer: PHCS All Commercial |
$1,750.32
|
| Rate for Payer: PHP All Commercial |
$1,769.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,801.66
|
| Rate for Payer: Signature Care EPO |
$1,937.02
|
| Rate for Payer: Signature Care PPO |
$2,053.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,983.70
|
| Rate for Payer: United Healthcare Commercial |
$1,839.00
|
| Rate for Payer: United Healthcare Medicare |
$770.14
|
|
|
HC SIMULATION-COMPLEX
|
Facility
IP
|
$2,333.76
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
01547290
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,750.32 |
| Max. Negotiated Rate |
$2,170.40 |
| Rate for Payer: Aetna Commercial |
$2,016.37
|
| Rate for Payer: Cash Price |
$1,446.93
|
| Rate for Payer: Cigna All Commercial |
$2,014.03
|
| Rate for Payer: CORVEL All Commercial |
$2,170.40
|
| Rate for Payer: Coventry All Commercial |
$2,053.71
|
| Rate for Payer: Encore All Commercial |
$2,148.23
|
| Rate for Payer: Frontpath All Commercial |
$2,147.06
|
| Rate for Payer: Humana ChoiceCare |
$2,015.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,100.38
|
| Rate for Payer: PHCS All Commercial |
$1,750.32
|
| Rate for Payer: PHP All Commercial |
$1,769.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,801.66
|
| Rate for Payer: Signature Care EPO |
$1,937.02
|
| Rate for Payer: Signature Care PPO |
$2,053.71
|
| Rate for Payer: United Healthcare Commercial |
$1,839.00
|
|
|
HC SIMULATION-INTERMEDIATE
|
Facility
OP
|
$2,121.60
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
01547285
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$700.13 |
| Max. Negotiated Rate |
$1,973.09 |
| Rate for Payer: Aetna Commercial |
$1,790.63
|
| Rate for Payer: Aetna Medicare |
$700.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$700.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,218.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,326.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$993.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$805.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$770.14
|
| Rate for Payer: Cash Price |
$1,315.39
|
| Rate for Payer: Cash Price |
$1,315.39
|
| Rate for Payer: Centivo All Commercial |
$1,082.02
|
| Rate for Payer: Cigna All Commercial |
$1,830.94
|
| Rate for Payer: CORVEL All Commercial |
$1,973.09
|
| Rate for Payer: Coventry All Commercial |
$1,867.01
|
| Rate for Payer: Encore All Commercial |
$1,952.93
|
| Rate for Payer: Frontpath All Commercial |
$1,951.87
|
| Rate for Payer: Humana ChoiceCare |
$1,832.43
|
| Rate for Payer: Humana Medicare |
$1,082.02
|
| Rate for Payer: Lucent All Commercial |
$1,082.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,909.44
|
| Rate for Payer: Managed Health Services Medicaid |
$993.80
|
| Rate for Payer: MDWise Medicaid |
$993.80
|
| Rate for Payer: PHCS All Commercial |
$1,591.20
|
| Rate for Payer: PHP All Commercial |
$1,609.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$827.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,637.88
|
| Rate for Payer: Signature Care EPO |
$1,760.93
|
| Rate for Payer: Signature Care PPO |
$1,867.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare Commercial |
$1,671.82
|
| Rate for Payer: United Healthcare Medicare |
$700.13
|
|
|
HC SIMULATION-INTERMEDIATE
|
Facility
IP
|
$2,121.60
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
01547285
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,591.20 |
| Max. Negotiated Rate |
$1,973.09 |
| Rate for Payer: Aetna Commercial |
$1,833.06
|
| Rate for Payer: Cash Price |
$1,315.39
|
| Rate for Payer: Cigna All Commercial |
$1,830.94
|
| Rate for Payer: CORVEL All Commercial |
$1,973.09
|
| Rate for Payer: Coventry All Commercial |
$1,867.01
|
| Rate for Payer: Encore All Commercial |
$1,952.93
|
| Rate for Payer: Frontpath All Commercial |
$1,951.87
|
| Rate for Payer: Humana ChoiceCare |
$1,832.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,909.44
|
| Rate for Payer: PHCS All Commercial |
$1,591.20
|
| Rate for Payer: PHP All Commercial |
$1,609.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,637.88
|
| Rate for Payer: Signature Care EPO |
$1,760.93
|
| Rate for Payer: Signature Care PPO |
$1,867.01
|
| Rate for Payer: United Healthcare Commercial |
$1,671.82
|
|
