|
HC Z AVENIR FEM STEM COL T2
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608186
|
|
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 T2
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608186
|
|
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 SO T5
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607506
|
|
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 SO T5
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607506
|
|
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 SO T6
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607509
|
|
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 SO T6
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607509
|
|
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 STEM STD CEM 1
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607637
|
|
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 STEM STD CEM 1
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607637
|
|
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 STEM STD CEM 3
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607674
|
|
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 STEM STD CEM 3
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607674
|
|
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 STEM STD CM 4 L
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608081
|
|
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 STEM STD CM 4 L
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608081
|
|
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 BACTISURE WOUND LAVAGE
|
Facility
|
IP
|
$2,700.00
|
|
| Hospital Charge Code |
41603595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna Commercial |
$2,332.80
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cigna All Commercial |
$2,330.10
|
| Rate for Payer: CORVEL All Commercial |
$2,511.00
|
| Rate for Payer: Coventry All Commercial |
$2,376.00
|
| Rate for Payer: Encore All Commercial |
$2,485.35
|
| Rate for Payer: Frontpath All Commercial |
$2,484.00
|
| Rate for Payer: Humana ChoiceCare |
$2,331.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,430.00
|
| Rate for Payer: PHCS All Commercial |
$2,025.00
|
| Rate for Payer: PHP All Commercial |
$2,047.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,084.40
|
| Rate for Payer: Signature Care EPO |
$2,241.00
|
| Rate for Payer: Signature Care PPO |
$2,376.00
|
| Rate for Payer: United Healthcare Commercial |
$2,127.60
|
|
|
HC Z BACTISURE WOUND LAVAGE
|
Facility
|
OP
|
$2,700.00
|
|
| Hospital Charge Code |
41603595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna Commercial |
$2,278.80
|
| Rate for Payer: Aetna Medicare |
$864.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$837.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,550.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,687.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$993.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$950.40
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Centivo All Commercial |
$1,468.80
|
| Rate for Payer: Cigna All Commercial |
$2,330.10
|
| Rate for Payer: CORVEL All Commercial |
$2,511.00
|
| Rate for Payer: Coventry All Commercial |
$2,376.00
|
| Rate for Payer: Encore All Commercial |
$2,485.35
|
| Rate for Payer: Frontpath All Commercial |
$2,484.00
|
| Rate for Payer: Humana ChoiceCare |
$2,331.99
|
| Rate for Payer: Humana Medicare |
$864.00
|
| Rate for Payer: Lucent All Commercial |
$1,468.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,430.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$2,025.00
|
| Rate for Payer: PHP All Commercial |
$2,047.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,053.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,084.40
|
| Rate for Payer: Signature Care EPO |
$2,241.00
|
| Rate for Payer: Signature Care PPO |
$2,376.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,295.00
|
| Rate for Payer: United Healthcare Commercial |
$2,127.60
|
| Rate for Payer: United Healthcare Medicare |
$864.00
|
|
|
HC Z BIOLOX 28 FEM HD -3.5 L
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BIOLOX 28 FEM HD -3.5 L
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 32 FEM HD -3.5
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 32 FEM HD -3.5
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BIOLOX 32N FEM HD +0
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 32N FEM HD +0
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BIOLOX 36 FEM HD +3.5
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BIOLOX 36 FEM HD +3.5
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 36 FEM HD -3.5
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 36 FEM HD -3.5
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BIOLOX 36 FEM HO +0
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
