|
HC Z HUM STEM 10 STD
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 10 STD
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 12 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 12 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 12 STD
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 12 STD
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 13 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 13 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 14 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 14 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 15 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 15 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 7 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 7 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 8 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM STEM 8 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM ADAP 135
|
Facility
|
OP
|
$2,370.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,204.10 |
| Rate for Payer: Aetna Commercial |
$2,000.28
|
| Rate for Payer: Aetna Medicare |
$758.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$734.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,361.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,481.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.24
|
| Rate for Payer: Cash Price |
$1,422.00
|
| Rate for Payer: Cash Price |
$1,422.00
|
| Rate for Payer: Centivo All Commercial |
$1,289.28
|
| Rate for Payer: Cigna All Commercial |
$2,045.31
|
| Rate for Payer: CORVEL All Commercial |
$2,204.10
|
| Rate for Payer: Coventry All Commercial |
$2,085.60
|
| Rate for Payer: Encore All Commercial |
$2,181.59
|
| Rate for Payer: Frontpath All Commercial |
$2,180.40
|
| Rate for Payer: Humana ChoiceCare |
$2,046.97
|
| Rate for Payer: Humana Medicare |
$758.40
|
| Rate for Payer: Lucent All Commercial |
$1,289.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,133.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,777.50
|
| Rate for Payer: PHP All Commercial |
$1,797.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$924.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,829.64
|
| Rate for Payer: Signature Care EPO |
$1,967.10
|
| Rate for Payer: Signature Care PPO |
$2,085.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,014.50
|
| Rate for Payer: United Healthcare Commercial |
$1,867.56
|
| Rate for Payer: United Healthcare Medicare |
$758.40
|
|
|
HC Z HUM STEM ADAP 135
|
Facility
|
IP
|
$2,370.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.50 |
| Max. Negotiated Rate |
$2,204.10 |
| Rate for Payer: Aetna Commercial |
$2,047.68
|
| Rate for Payer: Cash Price |
$1,422.00
|
| Rate for Payer: Cigna All Commercial |
$2,045.31
|
| Rate for Payer: CORVEL All Commercial |
$2,204.10
|
| Rate for Payer: Coventry All Commercial |
$2,085.60
|
| Rate for Payer: Encore All Commercial |
$2,181.59
|
| Rate for Payer: Frontpath All Commercial |
$2,180.40
|
| Rate for Payer: Humana ChoiceCare |
$2,046.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,133.00
|
| Rate for Payer: PHCS All Commercial |
$1,777.50
|
| Rate for Payer: PHP All Commercial |
$1,797.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,829.64
|
| Rate for Payer: Signature Care EPO |
$1,967.10
|
| Rate for Payer: Signature Care PPO |
$2,085.60
|
| Rate for Payer: United Healthcare Commercial |
$1,867.56
|
|
|
HC Z HUM STEM MICRO 11
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM MICRO 11
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
|
HC Z HUM TRAY -6
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$8,085.42 |
| Rate for Payer: Aetna Commercial |
$7,337.74
|
| Rate for Payer: Aetna Medicare |
$2,782.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,695.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,992.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,434.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,199.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,060.29
|
| Rate for Payer: Cash Price |
$5,216.40
|
| Rate for Payer: Cash Price |
$5,216.40
|
| Rate for Payer: Centivo All Commercial |
$4,729.54
|
| Rate for Payer: Cigna All Commercial |
$7,502.92
|
| Rate for Payer: CORVEL All Commercial |
$8,085.42
|
| Rate for Payer: Coventry All Commercial |
$7,650.72
|
| Rate for Payer: Encore All Commercial |
$8,002.83
|
| Rate for Payer: Frontpath All Commercial |
$7,998.48
|
| Rate for Payer: Humana ChoiceCare |
$7,509.01
|
| Rate for Payer: Humana Medicare |
$2,782.08
|
| Rate for Payer: Lucent All Commercial |
$4,729.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,824.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,520.50
|
| Rate for Payer: PHP All Commercial |
$6,593.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,390.66
|
| Rate for Payer: Sagamore Health Network All Products |
$6,711.77
|
| Rate for Payer: Signature Care EPO |
$7,216.02
|
| Rate for Payer: Signature Care PPO |
$7,650.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,389.90
|
| Rate for Payer: United Healthcare Commercial |
$6,850.87
|
| Rate for Payer: United Healthcare Medicare |
$2,782.08
|
|
|
HC Z HUM TRAY -6
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,520.50 |
| Max. Negotiated Rate |
$8,085.42 |
| Rate for Payer: Aetna Commercial |
$7,511.62
|
| Rate for Payer: Cash Price |
$5,216.40
|
| Rate for Payer: Cigna All Commercial |
$7,502.92
|
| Rate for Payer: CORVEL All Commercial |
$8,085.42
|
| Rate for Payer: Coventry All Commercial |
$7,650.72
|
| Rate for Payer: Encore All Commercial |
$8,002.83
|
| Rate for Payer: Frontpath All Commercial |
$7,998.48
|
| Rate for Payer: Humana ChoiceCare |
$7,509.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,824.60
|
| Rate for Payer: PHCS All Commercial |
$6,520.50
|
| Rate for Payer: PHP All Commercial |
$6,593.53
|
| Rate for Payer: Sagamore Health Network All Products |
$6,711.77
|
| Rate for Payer: Signature Care EPO |
$7,216.02
|
| Rate for Payer: Signature Care PPO |
$7,650.72
|
| Rate for Payer: United Healthcare Commercial |
$6,850.87
|
|
|
HC ZINC
|
Facility
|
IP
|
$153.67
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
63001718
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.25 |
| Max. Negotiated Rate |
$142.91 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Cigna All Commercial |
$132.62
|
| Rate for Payer: CORVEL All Commercial |
$142.91
|
| Rate for Payer: Coventry All Commercial |
$135.23
|
| Rate for Payer: Encore All Commercial |
$141.45
|
| Rate for Payer: Frontpath All Commercial |
$141.38
|
| Rate for Payer: Humana ChoiceCare |
$132.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.30
|
| Rate for Payer: PHCS All Commercial |
$115.25
|
| Rate for Payer: PHP All Commercial |
$116.54
|
| Rate for Payer: Sagamore Health Network All Products |
$118.63
|
| Rate for Payer: Signature Care EPO |
$127.55
|
| Rate for Payer: Signature Care PPO |
$135.23
|
| Rate for Payer: United Healthcare Commercial |
$121.09
|
|
|
HC ZINC
|
Facility
|
OP
|
$153.67
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
63001718
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$142.91 |
| Rate for Payer: Aetna Commercial |
$129.70
|
| Rate for Payer: Aetna Medicare |
$49.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.09
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Centivo All Commercial |
$83.60
|
| Rate for Payer: Cigna All Commercial |
$132.62
|
| Rate for Payer: CORVEL All Commercial |
$142.91
|
| Rate for Payer: Coventry All Commercial |
$135.23
|
| Rate for Payer: Encore All Commercial |
$141.45
|
| Rate for Payer: Frontpath All Commercial |
$141.38
|
| Rate for Payer: Humana ChoiceCare |
$132.72
|
| Rate for Payer: Humana Medicare |
$49.17
|
| Rate for Payer: Lucent All Commercial |
$83.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.30
|
| Rate for Payer: Managed Health Services Medicaid |
$11.39
|
| Rate for Payer: MDWise Medicaid |
$11.39
|
| Rate for Payer: PHCS All Commercial |
$115.25
|
| Rate for Payer: PHP All Commercial |
$116.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.93
|
| Rate for Payer: Sagamore Health Network All Products |
$118.63
|
| Rate for Payer: Signature Care EPO |
$127.55
|
| Rate for Payer: Signature Care PPO |
$135.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.62
|
| Rate for Payer: United Healthcare Commercial |
$121.09
|
| Rate for Payer: United Healthcare Medicare |
$49.17
|
|
|
HC ZINC, RBC
|
Facility
|
IP
|
$153.67
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
63001719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.25 |
| Max. Negotiated Rate |
$142.91 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Cigna All Commercial |
$132.62
|
| Rate for Payer: CORVEL All Commercial |
$142.91
|
| Rate for Payer: Coventry All Commercial |
$135.23
|
| Rate for Payer: Encore All Commercial |
$141.45
|
| Rate for Payer: Frontpath All Commercial |
$141.38
|
| Rate for Payer: Humana ChoiceCare |
$132.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.30
|
| Rate for Payer: PHCS All Commercial |
$115.25
|
| Rate for Payer: PHP All Commercial |
$116.54
|
| Rate for Payer: Sagamore Health Network All Products |
$118.63
|
| Rate for Payer: Signature Care EPO |
$127.55
|
| Rate for Payer: Signature Care PPO |
$135.23
|
| Rate for Payer: United Healthcare Commercial |
$121.09
|
|
