|
HC Z ALL POLY PAT 38MM
|
Facility
|
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,589.76
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 38MM DIA
|
Facility
|
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,059.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,026.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,218.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,165.82
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Centivo All Commercial |
$1,801.73
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,059.84
|
| Rate for Payer: Lucent All Commercial |
$1,801.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,059.84
|
|
|
HC Z ALL POLY PAT 38MM DIA
|
Facility
|
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ARCOS 16X210 BRCH STD BODY
|
Facility
|
OP
|
$25,740.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$23,939.00 |
| Rate for Payer: Aetna Commercial |
$21,725.29
|
| Rate for Payer: Aetna Medicare |
$8,237.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7,979.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$14,782.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,090.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,472.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,060.78
|
| Rate for Payer: Cash Price |
$15,444.52
|
| Rate for Payer: Cash Price |
$15,444.52
|
| Rate for Payer: Centivo All Commercial |
$14,003.03
|
| Rate for Payer: Cigna All Commercial |
$22,214.36
|
| Rate for Payer: CORVEL All Commercial |
$23,939.00
|
| Rate for Payer: Coventry All Commercial |
$22,651.96
|
| Rate for Payer: Encore All Commercial |
$23,694.46
|
| Rate for Payer: Frontpath All Commercial |
$23,681.59
|
| Rate for Payer: Humana ChoiceCare |
$22,232.38
|
| Rate for Payer: Humana Medicare |
$8,237.08
|
| Rate for Payer: Lucent All Commercial |
$14,003.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23,166.77
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$19,305.65
|
| Rate for Payer: PHP All Commercial |
$19,521.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,038.94
|
| Rate for Payer: Sagamore Health Network All Products |
$19,871.94
|
| Rate for Payer: Signature Care EPO |
$21,364.91
|
| Rate for Payer: Signature Care PPO |
$22,651.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,879.73
|
| Rate for Payer: United Healthcare Commercial |
$20,283.80
|
| Rate for Payer: United Healthcare Medicare |
$8,237.08
|
|
|
HC Z ARCOS 16X210 BRCH STD BODY
|
Facility
|
IP
|
$25,740.86
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,305.65 |
| Max. Negotiated Rate |
$23,939.00 |
| Rate for Payer: Aetna Commercial |
$22,240.10
|
| Rate for Payer: Cash Price |
$15,444.52
|
| Rate for Payer: Cigna All Commercial |
$22,214.36
|
| Rate for Payer: CORVEL All Commercial |
$23,939.00
|
| Rate for Payer: Coventry All Commercial |
$22,651.96
|
| Rate for Payer: Encore All Commercial |
$23,694.46
|
| Rate for Payer: Frontpath All Commercial |
$23,681.59
|
| Rate for Payer: Humana ChoiceCare |
$22,232.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23,166.77
|
| Rate for Payer: PHCS All Commercial |
$19,305.65
|
| Rate for Payer: PHP All Commercial |
$19,521.87
|
| Rate for Payer: Sagamore Health Network All Products |
$19,871.94
|
| Rate for Payer: Signature Care EPO |
$21,364.91
|
| Rate for Payer: Signature Care PPO |
$22,651.96
|
| Rate for Payer: United Healthcare Commercial |
$20,283.80
|
|
|
HC Z AUG SHLDR GD AND BM R
|
Facility
|
IP
|
$4,104.00
|
|
| Hospital Charge Code |
41608296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,078.00 |
| Max. Negotiated Rate |
$3,816.72 |
| Rate for Payer: Aetna Commercial |
$3,545.86
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cigna All Commercial |
$3,541.75
|
| Rate for Payer: CORVEL All Commercial |
$3,816.72
|
| Rate for Payer: Coventry All Commercial |
$3,611.52
|
| Rate for Payer: Encore All Commercial |
$3,777.73
|
| Rate for Payer: Frontpath All Commercial |
$3,775.68
|
| Rate for Payer: Humana ChoiceCare |
$3,544.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,693.60
|
| Rate for Payer: PHCS All Commercial |
$3,078.00
|
| Rate for Payer: PHP All Commercial |
$3,112.47
|
| Rate for Payer: Sagamore Health Network All Products |
$3,168.29
|
| Rate for Payer: Signature Care EPO |
$3,406.32
|
| Rate for Payer: Signature Care PPO |
$3,611.52
|
| Rate for Payer: United Healthcare Commercial |
$3,233.95
|
|
|
HC Z AUG SHLDR GD AND BM R
|
Facility
|
OP
|
$4,104.00
|
|
| Hospital Charge Code |
41608296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$3,816.72 |
| Rate for Payer: Aetna Commercial |
$3,463.78
|
| Rate for Payer: Aetna Medicare |
$1,313.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,272.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,356.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,565.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,510.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,444.61
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Centivo All Commercial |
$2,232.58
|
| Rate for Payer: Cigna All Commercial |
$3,541.75
|
| Rate for Payer: CORVEL All Commercial |
$3,816.72
|
| Rate for Payer: Coventry All Commercial |
$3,611.52
|
| Rate for Payer: Encore All Commercial |
$3,777.73
|
| Rate for Payer: Frontpath All Commercial |
$3,775.68
|
| Rate for Payer: Humana ChoiceCare |
$3,544.62
|
| Rate for Payer: Humana Medicare |
$1,313.28
|
| Rate for Payer: Lucent All Commercial |
$2,232.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,693.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,078.00
|
| Rate for Payer: PHP All Commercial |
$3,112.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,600.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3,168.29
|
| Rate for Payer: Signature Care EPO |
$3,406.32
|
| Rate for Payer: Signature Care PPO |
$3,611.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,488.40
|
| Rate for Payer: United Healthcare Commercial |
$3,233.95
|
| Rate for Payer: United Healthcare Medicare |
$1,313.28
|
|
|
HC Z AUG SHLDR GD AND BN
|
Facility
|
OP
|
$4,809.02
|
|
| Hospital Charge Code |
41606613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,058.81
|
| Rate for Payer: Aetna Medicare |
$1,538.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,490.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,761.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,006.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,769.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,692.78
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Centivo All Commercial |
$2,616.11
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Humana Medicare |
$1,538.89
|
| Rate for Payer: Lucent All Commercial |
$2,616.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,875.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,087.67
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
| Rate for Payer: United Healthcare Medicare |
$1,538.89
|
|
|
HC Z AUG SHLDR GD AND BN
|
Facility
|
IP
|
$4,809.02
|
|
| Hospital Charge Code |
41606613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,606.76 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,154.99
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
|
|
HC Z AUG SHLDR GD AND BN 1
|
Facility
|
OP
|
$4,809.02
|
|
| Hospital Charge Code |
41606580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,058.81
|
| Rate for Payer: Aetna Medicare |
$1,538.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,490.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,761.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,006.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,769.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,692.78
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Centivo All Commercial |
$2,616.11
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Humana Medicare |
$1,538.89
|
| Rate for Payer: Lucent All Commercial |
$2,616.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,875.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,087.67
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
| Rate for Payer: United Healthcare Medicare |
$1,538.89
|
|
|
HC Z AUG SHLDR GD AND BN 1
|
Facility
|
IP
|
$4,809.02
|
|
| Hospital Charge Code |
41606580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,606.76 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,154.99
|
| Rate for Payer: Cash Price |
$2,885.41
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
|
|
HC Z AVENIR FEM STEM COL HO T5
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM COL HO T5
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL SO T2
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM COL SO T2
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL SO T3
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM COL SO T3
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL SO T4
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM COL SO T4
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL SO T7
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM COL SO T7
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL SO T7.5
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL SO T7.5
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM COL STD T5
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC Z AVENIR FEM STEM COL STD T5
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
