|
HC Z PLATE PROX TIB 7H L
|
Facility
|
OP
|
$4,497.73
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,182.89 |
| Rate for Payer: Aetna Commercial |
$3,796.08
|
| Rate for Payer: Aetna Medicare |
$1,439.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,394.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,583.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,811.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,655.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,583.20
|
| Rate for Payer: Cash Price |
$2,698.64
|
| Rate for Payer: Cash Price |
$2,698.64
|
| Rate for Payer: Centivo All Commercial |
$2,446.77
|
| Rate for Payer: Cigna All Commercial |
$3,881.54
|
| Rate for Payer: CORVEL All Commercial |
$4,182.89
|
| Rate for Payer: Coventry All Commercial |
$3,958.00
|
| Rate for Payer: Encore All Commercial |
$4,140.16
|
| Rate for Payer: Frontpath All Commercial |
$4,137.91
|
| Rate for Payer: Humana ChoiceCare |
$3,884.69
|
| Rate for Payer: Humana Medicare |
$1,439.27
|
| Rate for Payer: Lucent All Commercial |
$2,446.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,047.96
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,373.30
|
| Rate for Payer: PHP All Commercial |
$3,411.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,754.11
|
| Rate for Payer: Sagamore Health Network All Products |
$3,472.25
|
| Rate for Payer: Signature Care EPO |
$3,733.12
|
| Rate for Payer: Signature Care PPO |
$3,958.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,823.07
|
| Rate for Payer: United Healthcare Commercial |
$3,544.21
|
| Rate for Payer: United Healthcare Medicare |
$1,439.27
|
|
|
HC Z PLATE PROX TIB 7H L
|
Facility
|
IP
|
$4,497.73
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.30 |
| Max. Negotiated Rate |
$4,182.89 |
| Rate for Payer: Aetna Commercial |
$3,886.04
|
| Rate for Payer: Cash Price |
$2,698.64
|
| Rate for Payer: Cigna All Commercial |
$3,881.54
|
| Rate for Payer: CORVEL All Commercial |
$4,182.89
|
| Rate for Payer: Coventry All Commercial |
$3,958.00
|
| Rate for Payer: Encore All Commercial |
$4,140.16
|
| Rate for Payer: Frontpath All Commercial |
$4,137.91
|
| Rate for Payer: Humana ChoiceCare |
$3,884.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,047.96
|
| Rate for Payer: PHCS All Commercial |
$3,373.30
|
| Rate for Payer: PHP All Commercial |
$3,411.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3,472.25
|
| Rate for Payer: Signature Care EPO |
$3,733.12
|
| Rate for Payer: Signature Care PPO |
$3,958.00
|
| Rate for Payer: United Healthcare Commercial |
$3,544.21
|
|
|
HC Z PLATE STD LOCK L
|
Facility
|
IP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,233.41 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,572.89
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
|
|
HC Z PLATE STD LOCK L
|
Facility
|
OP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,513.33
|
| Rate for Payer: Aetna Medicare |
$952.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$923.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,710.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,861.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.21
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Centivo All Commercial |
$1,619.97
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Humana Medicare |
$952.92
|
| Rate for Payer: Lucent All Commercial |
$1,619.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,161.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
| Rate for Payer: United Healthcare Medicare |
$952.92
|
|
|
HC Z PLATE STD LOCK R
|
Facility
|
OP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,513.33
|
| Rate for Payer: Aetna Medicare |
$952.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$923.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,710.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,861.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.21
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Centivo All Commercial |
$1,619.97
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Humana Medicare |
$952.92
|
| Rate for Payer: Lucent All Commercial |
$1,619.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,161.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
| Rate for Payer: United Healthcare Medicare |
$952.92
|
|
|
HC Z PLATE STD LOCK R
|
Facility
|
IP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,233.41 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,572.89
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
|
|
HC Z PLATE WIDE LOCK L
|
Facility
|
OP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,513.33
|
| Rate for Payer: Aetna Medicare |
$952.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$923.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,710.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,861.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.21
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Centivo All Commercial |
$1,619.97
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Humana Medicare |
$952.92
|
| Rate for Payer: Lucent All Commercial |
$1,619.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,161.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
| Rate for Payer: United Healthcare Medicare |
$952.92
|
|
|
HC Z PLATE WIDE LOCK L
|
Facility
|
IP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,233.41 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,572.89
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
|
|
HC Z PLATE WIDE LOCK R
|
Facility
|
IP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,233.41 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,572.89
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
|
|
HC Z PLATE WIDE LOCK R
|
Facility
|
OP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,513.33
|
| Rate for Payer: Aetna Medicare |
$952.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$923.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,710.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,861.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.21
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Centivo All Commercial |
$1,619.97
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Humana Medicare |
$952.92
|
| Rate for Payer: Lucent All Commercial |
$1,619.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,161.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
| Rate for Payer: United Healthcare Medicare |
$952.92
|
|
|
HC Z PSN FEM 10 CR STD L
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
|
HC Z PSN FEM 10 CR STD L
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,093.54 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,779.76
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
|
|
HC Z PSN FEM 10 CR STD R
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
|
HC Z PSN FEM 10 CR STD R
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,093.54 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,779.76
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
|
|
HC Z PSN FEM 11 CR STD L
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
|
HC Z PSN FEM 11 CR STD L
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,093.54 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,779.76
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
|
|
HC Z PSN FEM 11 CR STD R
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,093.54 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,779.76
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
|
|
HC Z PSN FEM 11 CR STD R
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
|
HC Z PSN FEM 12 CR STD R
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,093.54 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,779.76
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
|
|
HC Z PSN FEM 12 CR STD R
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
|
HC Z PSN FEM 5 CR NRW R
|
Facility
|
IP
|
$12,478.61
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,358.96 |
| Max. Negotiated Rate |
$11,605.11 |
| Rate for Payer: Aetna Commercial |
$10,781.52
|
| Rate for Payer: Cash Price |
$7,487.17
|
| Rate for Payer: Cigna All Commercial |
$10,769.04
|
| Rate for Payer: CORVEL All Commercial |
$11,605.11
|
| Rate for Payer: Coventry All Commercial |
$10,981.18
|
| Rate for Payer: Encore All Commercial |
$11,486.56
|
| Rate for Payer: Frontpath All Commercial |
$11,480.32
|
| Rate for Payer: Humana ChoiceCare |
$10,777.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,230.75
|
| Rate for Payer: PHCS All Commercial |
$9,358.96
|
| Rate for Payer: PHP All Commercial |
$9,463.78
|
| Rate for Payer: Sagamore Health Network All Products |
$9,633.49
|
| Rate for Payer: Signature Care EPO |
$10,357.25
|
| Rate for Payer: Signature Care PPO |
$10,981.18
|
| Rate for Payer: United Healthcare Commercial |
$9,833.14
|
|
|
HC Z PSN FEM 5 CR NRW R
|
Facility
|
OP
|
$12,478.61
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,605.11 |
| Rate for Payer: Aetna Commercial |
$10,531.95
|
| Rate for Payer: Aetna Medicare |
$3,993.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,868.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,166.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,800.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,592.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,392.47
|
| Rate for Payer: Cash Price |
$7,487.17
|
| Rate for Payer: Cash Price |
$7,487.17
|
| Rate for Payer: Centivo All Commercial |
$6,788.36
|
| Rate for Payer: Cigna All Commercial |
$10,769.04
|
| Rate for Payer: CORVEL All Commercial |
$11,605.11
|
| Rate for Payer: Coventry All Commercial |
$10,981.18
|
| Rate for Payer: Encore All Commercial |
$11,486.56
|
| Rate for Payer: Frontpath All Commercial |
$11,480.32
|
| Rate for Payer: Humana ChoiceCare |
$10,777.78
|
| Rate for Payer: Humana Medicare |
$3,993.16
|
| Rate for Payer: Lucent All Commercial |
$6,788.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,230.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,358.96
|
| Rate for Payer: PHP All Commercial |
$9,463.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,866.66
|
| Rate for Payer: Sagamore Health Network All Products |
$9,633.49
|
| Rate for Payer: Signature Care EPO |
$10,357.25
|
| Rate for Payer: Signature Care PPO |
$10,981.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,606.82
|
| Rate for Payer: United Healthcare Commercial |
$9,833.14
|
| Rate for Payer: United Healthcare Medicare |
$3,993.16
|
|
|
HC Z PSN FEM 5 CR STD L
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,093.54 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,779.76
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
|
|
HC Z PSN FEM 5 CR STD L
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
|
HC Z PSN FEM 5 CR STD R
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,755.99 |
| Rate for Payer: Aetna Commercial |
$12,483.93
|
| Rate for Payer: Aetna Medicare |
$4,733.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,585.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,494.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,246.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,443.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,206.57
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Cash Price |
$8,874.83
|
| Rate for Payer: Centivo All Commercial |
$8,046.52
|
| Rate for Payer: Cigna All Commercial |
$12,764.97
|
| Rate for Payer: CORVEL All Commercial |
$13,755.99
|
| Rate for Payer: Coventry All Commercial |
$13,016.42
|
| Rate for Payer: Encore All Commercial |
$13,615.47
|
| Rate for Payer: Frontpath All Commercial |
$13,608.08
|
| Rate for Payer: Humana ChoiceCare |
$12,775.32
|
| Rate for Payer: Humana Medicare |
$4,733.24
|
| Rate for Payer: Lucent All Commercial |
$8,046.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,312.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,093.54
|
| Rate for Payer: PHP All Commercial |
$11,217.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,768.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11,418.95
|
| Rate for Payer: Signature Care EPO |
$12,276.85
|
| Rate for Payer: Signature Care PPO |
$13,016.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,572.68
|
| Rate for Payer: United Healthcare Commercial |
$11,655.62
|
| Rate for Payer: United Healthcare Medicare |
$4,733.24
|
|
