|
HC Z PSN FEM 8 CR NRW L
|
Facility
|
IP
|
$14,051.81
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,538.86 |
| Max. Negotiated Rate |
$13,068.18 |
| Rate for Payer: Aetna Commercial |
$12,140.76
|
| Rate for Payer: Cash Price |
$8,431.09
|
| Rate for Payer: Cigna All Commercial |
$12,126.71
|
| Rate for Payer: CORVEL All Commercial |
$13,068.18
|
| Rate for Payer: Coventry All Commercial |
$12,365.59
|
| Rate for Payer: Encore All Commercial |
$12,934.69
|
| Rate for Payer: Frontpath All Commercial |
$12,927.67
|
| Rate for Payer: Humana ChoiceCare |
$12,136.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,646.63
|
| Rate for Payer: PHCS All Commercial |
$10,538.86
|
| Rate for Payer: PHP All Commercial |
$10,656.89
|
| Rate for Payer: Sagamore Health Network All Products |
$10,848.00
|
| Rate for Payer: Signature Care EPO |
$11,663.00
|
| Rate for Payer: Signature Care PPO |
$12,365.59
|
| Rate for Payer: United Healthcare Commercial |
$11,072.83
|
|
|
HC Z PSN FEM 8 CR NRW L
|
Facility
|
OP
|
$14,051.81
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,068.18 |
| Rate for Payer: Aetna Commercial |
$11,859.73
|
| Rate for Payer: Aetna Medicare |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,356.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,069.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,783.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,171.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,946.24
|
| Rate for Payer: Cash Price |
$8,431.09
|
| Rate for Payer: Cash Price |
$8,431.09
|
| Rate for Payer: Centivo All Commercial |
$7,644.18
|
| Rate for Payer: Cigna All Commercial |
$12,126.71
|
| Rate for Payer: CORVEL All Commercial |
$13,068.18
|
| Rate for Payer: Coventry All Commercial |
$12,365.59
|
| Rate for Payer: Encore All Commercial |
$12,934.69
|
| Rate for Payer: Frontpath All Commercial |
$12,927.67
|
| Rate for Payer: Humana ChoiceCare |
$12,136.55
|
| Rate for Payer: Humana Medicare |
$4,496.58
|
| Rate for Payer: Lucent All Commercial |
$7,644.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,646.63
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,538.86
|
| Rate for Payer: PHP All Commercial |
$10,656.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,480.21
|
| Rate for Payer: Sagamore Health Network All Products |
$10,848.00
|
| Rate for Payer: Signature Care EPO |
$11,663.00
|
| Rate for Payer: Signature Care PPO |
$12,365.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,944.04
|
| Rate for Payer: United Healthcare Commercial |
$11,072.83
|
| Rate for Payer: United Healthcare Medicare |
$4,496.58
|
|
|
HC Z PSN FEM 8 CR STD L
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607633
|
|
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 8 CR STD L
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607633
|
|
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 8 CR STD R
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607053
|
|
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 8 CR STD R
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607053
|
|
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 9 CR NRW L
|
Facility
|
OP
|
$14,051.81
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,068.18 |
| Rate for Payer: Aetna Commercial |
$11,859.73
|
| Rate for Payer: Aetna Medicare |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,356.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,069.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,783.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,171.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,946.24
|
| Rate for Payer: Cash Price |
$8,431.09
|
| Rate for Payer: Cash Price |
$8,431.09
|
| Rate for Payer: Centivo All Commercial |
$7,644.18
|
| Rate for Payer: Cigna All Commercial |
$12,126.71
|
| Rate for Payer: CORVEL All Commercial |
$13,068.18
|
| Rate for Payer: Coventry All Commercial |
$12,365.59
|
| Rate for Payer: Encore All Commercial |
$12,934.69
|
| Rate for Payer: Frontpath All Commercial |
$12,927.67
|
| Rate for Payer: Humana ChoiceCare |
$12,136.55
|
| Rate for Payer: Humana Medicare |
$4,496.58
|
| Rate for Payer: Lucent All Commercial |
$7,644.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,646.63
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,538.86
|
| Rate for Payer: PHP All Commercial |
$10,656.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,480.21
|
| Rate for Payer: Sagamore Health Network All Products |
$10,848.00
|
| Rate for Payer: Signature Care EPO |
$11,663.00
|
| Rate for Payer: Signature Care PPO |
$12,365.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,944.04
|
| Rate for Payer: United Healthcare Commercial |
$11,072.83
|
| Rate for Payer: United Healthcare Medicare |
$4,496.58
|
|
|
HC Z PSN FEM 9 CR NRW L
|
Facility
|
IP
|
$14,051.81
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,538.86 |
| Max. Negotiated Rate |
$13,068.18 |
| Rate for Payer: Aetna Commercial |
$12,140.76
|
| Rate for Payer: Cash Price |
$8,431.09
|
| Rate for Payer: Cigna All Commercial |
$12,126.71
|
| Rate for Payer: CORVEL All Commercial |
$13,068.18
|
| Rate for Payer: Coventry All Commercial |
$12,365.59
|
| Rate for Payer: Encore All Commercial |
$12,934.69
|
| Rate for Payer: Frontpath All Commercial |
$12,927.67
|
| Rate for Payer: Humana ChoiceCare |
$12,136.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,646.63
|
| Rate for Payer: PHCS All Commercial |
$10,538.86
|
| Rate for Payer: PHP All Commercial |
$10,656.89
|
| Rate for Payer: Sagamore Health Network All Products |
$10,848.00
|
| Rate for Payer: Signature Care EPO |
$11,663.00
|
| Rate for Payer: Signature Care PPO |
$12,365.59
|
| Rate for Payer: United Healthcare Commercial |
$11,072.83
|
|
|
HC Z PSN FEM 9 CR STD L
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608046
|
|
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 9 CR STD L
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608046
|
|
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 9 CR STD R
|
Facility
|
OP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608053
|
|
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 9 CR STD R
|
Facility
|
IP
|
$14,791.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608053
|
|
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 9 PS STD L
|
Facility
|
OP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608292
|
|
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 PSN FEM 9 PS STD L
|
Facility
|
IP
|
$13,135.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608292
|
|
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 PSN PAT 3 PEG 32 R
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Medicare |
$1,728.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,987.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,900.80
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Centivo All Commercial |
$2,937.60
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Humana Medicare |
$1,728.00
|
| Rate for Payer: Lucent All Commercial |
$2,937.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
| Rate for Payer: United Healthcare Medicare |
$1,728.00
|
|
|
HC Z PSN PAT 3 PEG 32 R
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
|
HC Z PSN POLY 10 MC 12/GH
|
Facility
|
OP
|
$6,292.80
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,311.12
|
| Rate for Payer: Aetna Medicare |
$2,013.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,950.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,613.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,933.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,315.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,215.07
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Centivo All Commercial |
$3,423.28
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Humana Medicare |
$2,013.70
|
| Rate for Payer: Lucent All Commercial |
$3,423.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,454.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,348.88
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
| Rate for Payer: United Healthcare Medicare |
$2,013.70
|
|
|
HC Z PSN POLY 10 MC 12/GH
|
Facility
|
IP
|
$6,292.80
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,719.60 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,436.98
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
|
|
HC Z PSN POLY 10 MC 4-5/EF R
|
Facility
|
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z PSN POLY 10 MC 4-5/EF R
|
Facility
|
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,119.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,053.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,437.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,331.65
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Centivo All Commercial |
$3,603.46
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$2,119.68
|
| Rate for Payer: Lucent All Commercial |
$3,603.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,119.68
|
|
|
HC Z PSN POLY 10 MC 6-11/CD R
|
Facility
|
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,119.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,053.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,437.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,331.65
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Centivo All Commercial |
$3,603.46
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$2,119.68
|
| Rate for Payer: Lucent All Commercial |
$3,603.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,119.68
|
|
|
HC Z PSN POLY 10 MC 6-11/CD R
|
Facility
|
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z PSN POLY 10 MC 6-7/CD
|
Facility
|
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z PSN POLY 10 MC 6-7/CD
|
Facility
|
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,119.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,053.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,437.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,331.65
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Centivo All Commercial |
$3,603.46
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$2,119.68
|
| Rate for Payer: Lucent All Commercial |
$3,603.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,119.68
|
|
|
HC Z PSN POLY 10 MC 6-7/EF
|
Facility
|
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,119.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,053.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,437.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,331.65
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Centivo All Commercial |
$3,603.46
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$2,119.68
|
| Rate for Payer: Lucent All Commercial |
$3,603.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,119.68
|
|
