|
HC Z FEM 6 CR STD R
|
Facility
|
OP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,086.27
|
| Rate for Payer: Aetna Medicare |
$4,203.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,071.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,543.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,210.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,833.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,623.66
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Centivo All Commercial |
$7,145.65
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Humana Medicare |
$4,203.32
|
| Rate for Payer: Lucent All Commercial |
$7,145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,122.80
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,165.08
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
| Rate for Payer: United Healthcare Medicare |
$4,203.32
|
|
|
HC Z FEM 6 CR STD R
|
Facility
|
IP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,851.54 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,348.98
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
|
|
HC Z FEM 7 CR STD L
|
Facility
|
OP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,086.27
|
| Rate for Payer: Aetna Medicare |
$4,203.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,071.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,543.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,210.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,833.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,623.66
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Centivo All Commercial |
$7,145.65
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Humana Medicare |
$4,203.32
|
| Rate for Payer: Lucent All Commercial |
$7,145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,122.80
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,165.08
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
| Rate for Payer: United Healthcare Medicare |
$4,203.32
|
|
|
HC Z FEM 7 CR STD L
|
Facility
|
IP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,851.54 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,348.98
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
|
|
HC Z FEM 7 CR STD R
|
Facility
|
OP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,086.27
|
| Rate for Payer: Aetna Medicare |
$4,203.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,071.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,543.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,210.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,833.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,623.66
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Centivo All Commercial |
$7,145.65
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Humana Medicare |
$4,203.32
|
| Rate for Payer: Lucent All Commercial |
$7,145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,122.80
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,165.08
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
| Rate for Payer: United Healthcare Medicare |
$4,203.32
|
|
|
HC Z FEM 7 CR STD R
|
Facility
|
IP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,851.54 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,348.98
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
|
|
HC Z FEM 8 CR STD R
|
Facility
|
IP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,851.54 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,348.98
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
|
|
HC Z FEM 8 CR STD R
|
Facility
|
OP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,086.27
|
| Rate for Payer: Aetna Medicare |
$4,203.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,071.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,543.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,210.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,833.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,623.66
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Centivo All Commercial |
$7,145.65
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Humana Medicare |
$4,203.32
|
| Rate for Payer: Lucent All Commercial |
$7,145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,122.80
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,165.08
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
| Rate for Payer: United Healthcare Medicare |
$4,203.32
|
|
|
HC Z FEM 9 CR STD R
|
Facility
|
OP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,086.27
|
| Rate for Payer: Aetna Medicare |
$4,203.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,071.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,543.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,210.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,833.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,623.66
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Centivo All Commercial |
$7,145.65
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Humana Medicare |
$4,203.32
|
| Rate for Payer: Lucent All Commercial |
$7,145.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,122.80
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,165.08
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
| Rate for Payer: United Healthcare Medicare |
$4,203.32
|
|
|
HC Z FEM 9 CR STD R
|
Facility
|
IP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,851.54 |
| Max. Negotiated Rate |
$12,215.91 |
| Rate for Payer: Aetna Commercial |
$11,348.98
|
| Rate for Payer: Cash Price |
$7,881.23
|
| Rate for Payer: Cigna All Commercial |
$11,335.84
|
| Rate for Payer: CORVEL All Commercial |
$12,215.91
|
| Rate for Payer: Coventry All Commercial |
$11,559.14
|
| Rate for Payer: Encore All Commercial |
$12,091.13
|
| Rate for Payer: Frontpath All Commercial |
$12,084.56
|
| Rate for Payer: Humana ChoiceCare |
$11,345.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,821.85
|
| Rate for Payer: PHCS All Commercial |
$9,851.54
|
| Rate for Payer: PHP All Commercial |
$9,961.88
|
| Rate for Payer: Sagamore Health Network All Products |
$10,140.52
|
| Rate for Payer: Signature Care EPO |
$10,902.37
|
| Rate for Payer: Signature Care PPO |
$11,559.14
|
| Rate for Payer: United Healthcare Commercial |
$10,350.69
|
|
|
HC Z FEM HD CER 12/14 +3.5X28 L
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608338
|
|
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 FEM HD CER 12/14 +3.5X28 L
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608338
|
|
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 G7 ACETAB LINER 36 E
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G7 ACETAB LINER 36 E
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 ACETAB LNR NTL 32 B
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 ACETAB LNR NTL 32 B
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G7 ACETAB LNR NTL 32 C
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G7 ACETAB LNR NTL 32 C
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 ACETAB LNR NTL 36 D
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 ACETAB LNR NTL 36 D
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G7 ACETAB LNR NTL 36 F
|
Facility
|
OP
|
$5,348.88
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,974.46 |
| Rate for Payer: Aetna Commercial |
$4,514.45
|
| Rate for Payer: Aetna Medicare |
$1,711.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,658.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,071.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,343.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,968.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,882.81
|
| Rate for Payer: Cash Price |
$3,209.33
|
| Rate for Payer: Cash Price |
$3,209.33
|
| Rate for Payer: Centivo All Commercial |
$2,909.79
|
| Rate for Payer: Cigna All Commercial |
$4,616.08
|
| Rate for Payer: CORVEL All Commercial |
$4,974.46
|
| Rate for Payer: Coventry All Commercial |
$4,707.01
|
| Rate for Payer: Encore All Commercial |
$4,923.64
|
| Rate for Payer: Frontpath All Commercial |
$4,920.97
|
| Rate for Payer: Humana ChoiceCare |
$4,619.83
|
| Rate for Payer: Humana Medicare |
$1,711.64
|
| Rate for Payer: Lucent All Commercial |
$2,909.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,813.99
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,011.66
|
| Rate for Payer: PHP All Commercial |
$4,056.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,086.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,129.34
|
| Rate for Payer: Signature Care EPO |
$4,439.57
|
| Rate for Payer: Signature Care PPO |
$4,707.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,546.55
|
| Rate for Payer: United Healthcare Commercial |
$4,214.92
|
| Rate for Payer: United Healthcare Medicare |
$1,711.64
|
|
|
HC Z G7 ACETAB LNR NTL 36 F
|
Facility
|
IP
|
$5,348.88
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,011.66 |
| Max. Negotiated Rate |
$4,974.46 |
| Rate for Payer: Aetna Commercial |
$4,621.43
|
| Rate for Payer: Cash Price |
$3,209.33
|
| Rate for Payer: Cigna All Commercial |
$4,616.08
|
| Rate for Payer: CORVEL All Commercial |
$4,974.46
|
| Rate for Payer: Coventry All Commercial |
$4,707.01
|
| Rate for Payer: Encore All Commercial |
$4,923.64
|
| Rate for Payer: Frontpath All Commercial |
$4,920.97
|
| Rate for Payer: Humana ChoiceCare |
$4,619.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,813.99
|
| Rate for Payer: PHCS All Commercial |
$4,011.66
|
| Rate for Payer: PHP All Commercial |
$4,056.59
|
| Rate for Payer: Sagamore Health Network All Products |
$4,129.34
|
| Rate for Payer: Signature Care EPO |
$4,439.57
|
| Rate for Payer: Signature Care PPO |
$4,707.01
|
| Rate for Payer: United Healthcare Commercial |
$4,214.92
|
|
|
HC Z G7 ACETAB LNR NTL 40 F
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G7 ACETAB LNR NTL 40 F
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 ACETAB LNR NTL 40 G
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
