|
HC SN SYNERGY POR FEM COMP 16X170
|
Facility
OP
|
$1,222.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.26 |
| Max. Negotiated Rate |
$1,136.46 |
| Rate for Payer: Aetna Commercial |
$1,031.37
|
| Rate for Payer: Aetna Medicare |
$403.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$403.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$701.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$763.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$463.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$443.59
|
| Rate for Payer: Cash Price |
$757.64
|
| Rate for Payer: Cash Price |
$757.64
|
| Rate for Payer: Centivo All Commercial |
$623.22
|
| Rate for Payer: Cigna All Commercial |
$1,054.59
|
| Rate for Payer: CORVEL All Commercial |
$1,136.46
|
| Rate for Payer: Coventry All Commercial |
$1,075.36
|
| Rate for Payer: Encore All Commercial |
$1,124.85
|
| Rate for Payer: Frontpath All Commercial |
$1,124.24
|
| Rate for Payer: Humana ChoiceCare |
$1,055.44
|
| Rate for Payer: Humana Medicare |
$623.22
|
| Rate for Payer: Lucent All Commercial |
$623.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,099.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$916.50
|
| Rate for Payer: PHP All Commercial |
$926.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$476.58
|
| Rate for Payer: Sagamore Health Network All Products |
$943.38
|
| Rate for Payer: Signature Care EPO |
$1,014.26
|
| Rate for Payer: Signature Care PPO |
$1,075.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,038.70
|
| Rate for Payer: United Healthcare Commercial |
$962.94
|
| Rate for Payer: United Healthcare Medicare |
$403.26
|
|
|
HC SN TAN UNI HIP COB CHR 42
|
Facility
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,067.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,250.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,366.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,306.80
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Centivo All Commercial |
$1,836.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Humana Medicare |
$1,836.00
|
| Rate for Payer: Lucent All Commercial |
$1,836.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,404.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
|
|
HC SN TAN UNI HIP COB CHR 42
|
Facility
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
|
|
HC SN TAN UNI HIP COB CHR 43
|
Facility
OP
|
$3,499.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,254.26 |
| Rate for Payer: Aetna Commercial |
$2,953.32
|
| Rate for Payer: Aetna Medicare |
$1,154.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,009.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,187.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,270.21
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Centivo All Commercial |
$1,784.59
|
| Rate for Payer: Cigna All Commercial |
$3,019.81
|
| Rate for Payer: CORVEL All Commercial |
$3,254.26
|
| Rate for Payer: Coventry All Commercial |
$3,079.30
|
| Rate for Payer: Encore All Commercial |
$3,221.01
|
| Rate for Payer: Frontpath All Commercial |
$3,219.26
|
| Rate for Payer: Humana ChoiceCare |
$3,022.26
|
| Rate for Payer: Humana Medicare |
$1,784.59
|
| Rate for Payer: Lucent All Commercial |
$1,784.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,149.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,624.40
|
| Rate for Payer: PHP All Commercial |
$2,653.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,701.38
|
| Rate for Payer: Signature Care EPO |
$2,904.34
|
| Rate for Payer: Signature Care PPO |
$3,079.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,974.32
|
| Rate for Payer: United Healthcare Commercial |
$2,757.37
|
| Rate for Payer: United Healthcare Medicare |
$1,154.74
|
|
|
HC SN TAN UNI HIP COB CHR 43
|
Facility
IP
|
$3,499.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.40 |
| Max. Negotiated Rate |
$3,254.26 |
| Rate for Payer: Aetna Commercial |
$3,023.31
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cigna All Commercial |
$3,019.81
|
| Rate for Payer: CORVEL All Commercial |
$3,254.26
|
| Rate for Payer: Coventry All Commercial |
$3,079.30
|
| Rate for Payer: Encore All Commercial |
$3,221.01
|
| Rate for Payer: Frontpath All Commercial |
$3,219.26
|
| Rate for Payer: Humana ChoiceCare |
$3,022.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,149.28
|
| Rate for Payer: PHCS All Commercial |
$2,624.40
|
| Rate for Payer: PHP All Commercial |
$2,653.79
|
| Rate for Payer: Sagamore Health Network All Products |
$2,701.38
|
| Rate for Payer: Signature Care EPO |
$2,904.34
|
| Rate for Payer: Signature Care PPO |
$3,079.30
|
| Rate for Payer: United Healthcare Commercial |
$2,757.37
|
|
|
HC SN TAN UNI HIP COB CHR 44
|
Facility
OP
|
$3,499.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,254.26 |
| Rate for Payer: Aetna Commercial |
$2,953.32
|
| Rate for Payer: Aetna Medicare |
$1,154.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,009.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,187.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,270.21
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Centivo All Commercial |
$1,784.59
|
| Rate for Payer: Cigna All Commercial |
$3,019.81
|
| Rate for Payer: CORVEL All Commercial |
$3,254.26
|
| Rate for Payer: Coventry All Commercial |
$3,079.30
|
| Rate for Payer: Encore All Commercial |
$3,221.01
|
| Rate for Payer: Frontpath All Commercial |
$3,219.26
|
| Rate for Payer: Humana ChoiceCare |
$3,022.26
|
| Rate for Payer: Humana Medicare |
$1,784.59
|
| Rate for Payer: Lucent All Commercial |
$1,784.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,149.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,624.40
|
| Rate for Payer: PHP All Commercial |
$2,653.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,701.38
|
| Rate for Payer: Signature Care EPO |
$2,904.34
|
| Rate for Payer: Signature Care PPO |
$3,079.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,974.32
|
| Rate for Payer: United Healthcare Commercial |
$2,757.37
|
| Rate for Payer: United Healthcare Medicare |
$1,154.74
|
|
|
HC SN TAN UNI HIP COB CHR 44
|
Facility
IP
|
$3,499.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.40 |
| Max. Negotiated Rate |
$3,254.26 |
| Rate for Payer: Aetna Commercial |
$3,023.31
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cigna All Commercial |
$3,019.81
|
| Rate for Payer: CORVEL All Commercial |
$3,254.26
|
| Rate for Payer: Coventry All Commercial |
$3,079.30
|
| Rate for Payer: Encore All Commercial |
$3,221.01
|
| Rate for Payer: Frontpath All Commercial |
$3,219.26
|
| Rate for Payer: Humana ChoiceCare |
$3,022.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,149.28
|
| Rate for Payer: PHCS All Commercial |
$2,624.40
|
| Rate for Payer: PHP All Commercial |
$2,653.79
|
| Rate for Payer: Sagamore Health Network All Products |
$2,701.38
|
| Rate for Payer: Signature Care EPO |
$2,904.34
|
| Rate for Payer: Signature Care PPO |
$3,079.30
|
| Rate for Payer: United Healthcare Commercial |
$2,757.37
|
|
|
HC SN TAN UNI HIP COB CHR 46
|
Facility
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,067.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,250.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,366.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,306.80
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Centivo All Commercial |
$1,836.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Humana Medicare |
$1,836.00
|
| Rate for Payer: Lucent All Commercial |
$1,836.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,404.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
|
|
HC SN TAN UNI HIP COB CHR 46
|
Facility
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
|
|
HC SN TAN UNI HIP COB CHR 47
|
Facility
OP
|
$3,499.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,254.26 |
| Rate for Payer: Aetna Commercial |
$2,953.32
|
| Rate for Payer: Aetna Medicare |
$1,154.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,009.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,187.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,270.21
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Centivo All Commercial |
$1,784.59
|
| Rate for Payer: Cigna All Commercial |
$3,019.81
|
| Rate for Payer: CORVEL All Commercial |
$3,254.26
|
| Rate for Payer: Coventry All Commercial |
$3,079.30
|
| Rate for Payer: Encore All Commercial |
$3,221.01
|
| Rate for Payer: Frontpath All Commercial |
$3,219.26
|
| Rate for Payer: Humana ChoiceCare |
$3,022.26
|
| Rate for Payer: Humana Medicare |
$1,784.59
|
| Rate for Payer: Lucent All Commercial |
$1,784.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,149.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,624.40
|
| Rate for Payer: PHP All Commercial |
$2,653.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,701.38
|
| Rate for Payer: Signature Care EPO |
$2,904.34
|
| Rate for Payer: Signature Care PPO |
$3,079.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,974.32
|
| Rate for Payer: United Healthcare Commercial |
$2,757.37
|
| Rate for Payer: United Healthcare Medicare |
$1,154.74
|
|
|
HC SN TAN UNI HIP COB CHR 47
|
Facility
IP
|
$3,499.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.40 |
| Max. Negotiated Rate |
$3,254.26 |
| Rate for Payer: Aetna Commercial |
$3,023.31
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cigna All Commercial |
$3,019.81
|
| Rate for Payer: CORVEL All Commercial |
$3,254.26
|
| Rate for Payer: Coventry All Commercial |
$3,079.30
|
| Rate for Payer: Encore All Commercial |
$3,221.01
|
| Rate for Payer: Frontpath All Commercial |
$3,219.26
|
| Rate for Payer: Humana ChoiceCare |
$3,022.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,149.28
|
| Rate for Payer: PHCS All Commercial |
$2,624.40
|
| Rate for Payer: PHP All Commercial |
$2,653.79
|
| Rate for Payer: Sagamore Health Network All Products |
$2,701.38
|
| Rate for Payer: Signature Care EPO |
$2,904.34
|
| Rate for Payer: Signature Care PPO |
$3,079.30
|
| Rate for Payer: United Healthcare Commercial |
$2,757.37
|
|
|
HC SN TAN UNI HIP COB CHR 49
|
Facility
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
|
|
HC SN TAN UNI HIP COB CHR 49
|
Facility
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,067.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,250.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,366.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,306.80
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Centivo All Commercial |
$1,836.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Humana Medicare |
$1,836.00
|
| Rate for Payer: Lucent All Commercial |
$1,836.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,404.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
|
|
HC SN TAN UNI HIP COB CHR 51
|
Facility
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,067.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,250.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,366.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,306.80
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Centivo All Commercial |
$1,836.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Humana Medicare |
$1,836.00
|
| Rate for Payer: Lucent All Commercial |
$1,836.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,404.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
|
|
HC SN TAN UNI HIP COB CHR 51
|
Facility
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
|
|
HC SN TAN UNI HIP COB CHR 52
|
Facility
OP
|
$8,246.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,668.93 |
| Rate for Payer: Aetna Commercial |
$6,959.76
|
| Rate for Payer: Aetna Medicare |
$2,721.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,721.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,735.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,154.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,129.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,993.36
|
| Rate for Payer: Cash Price |
$5,112.62
|
| Rate for Payer: Cash Price |
$5,112.62
|
| Rate for Payer: Centivo All Commercial |
$4,205.54
|
| Rate for Payer: Cigna All Commercial |
$7,116.44
|
| Rate for Payer: CORVEL All Commercial |
$7,668.93
|
| Rate for Payer: Coventry All Commercial |
$7,256.62
|
| Rate for Payer: Encore All Commercial |
$7,590.59
|
| Rate for Payer: Frontpath All Commercial |
$7,586.47
|
| Rate for Payer: Humana ChoiceCare |
$7,122.21
|
| Rate for Payer: Humana Medicare |
$4,205.54
|
| Rate for Payer: Lucent All Commercial |
$4,205.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,421.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,184.62
|
| Rate for Payer: PHP All Commercial |
$6,253.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,216.00
|
| Rate for Payer: Sagamore Health Network All Products |
$6,366.04
|
| Rate for Payer: Signature Care EPO |
$6,844.31
|
| Rate for Payer: Signature Care PPO |
$7,256.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,009.24
|
| Rate for Payer: United Healthcare Commercial |
$6,497.97
|
| Rate for Payer: United Healthcare Medicare |
$2,721.23
|
|
|
HC SN TAN UNI HIP COB CHR 52
|
Facility
IP
|
$8,246.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,184.62 |
| Max. Negotiated Rate |
$7,668.93 |
| Rate for Payer: Aetna Commercial |
$7,124.68
|
| Rate for Payer: Cash Price |
$5,112.62
|
| Rate for Payer: Cigna All Commercial |
$7,116.44
|
| Rate for Payer: CORVEL All Commercial |
$7,668.93
|
| Rate for Payer: Coventry All Commercial |
$7,256.62
|
| Rate for Payer: Encore All Commercial |
$7,590.59
|
| Rate for Payer: Frontpath All Commercial |
$7,586.47
|
| Rate for Payer: Humana ChoiceCare |
$7,122.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,421.54
|
| Rate for Payer: PHCS All Commercial |
$6,184.62
|
| Rate for Payer: PHP All Commercial |
$6,253.89
|
| Rate for Payer: Sagamore Health Network All Products |
$6,366.04
|
| Rate for Payer: Signature Care EPO |
$6,844.31
|
| Rate for Payer: Signature Care PPO |
$7,256.62
|
| Rate for Payer: United Healthcare Commercial |
$6,497.97
|
|
|
HC SN TAN UNI SLV HIP 12/14 +0
|
Facility
IP
|
$1,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna Commercial |
$1,123.20
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cigna All Commercial |
$1,121.90
|
| Rate for Payer: CORVEL All Commercial |
$1,209.00
|
| Rate for Payer: Coventry All Commercial |
$1,144.00
|
| Rate for Payer: Encore All Commercial |
$1,196.65
|
| Rate for Payer: Frontpath All Commercial |
$1,196.00
|
| Rate for Payer: Humana ChoiceCare |
$1,122.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,170.00
|
| Rate for Payer: PHCS All Commercial |
$975.00
|
| Rate for Payer: PHP All Commercial |
$985.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.60
|
| Rate for Payer: Signature Care EPO |
$1,079.00
|
| Rate for Payer: Signature Care PPO |
$1,144.00
|
| Rate for Payer: United Healthcare Commercial |
$1,024.40
|
|
|
HC SN TAN UNI SLV HIP 12/14 +0
|
Facility
OP
|
$1,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna Commercial |
$1,097.20
|
| Rate for Payer: Aetna Medicare |
$429.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$746.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$812.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$493.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$471.90
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Centivo All Commercial |
$663.00
|
| Rate for Payer: Cigna All Commercial |
$1,121.90
|
| Rate for Payer: CORVEL All Commercial |
$1,209.00
|
| Rate for Payer: Coventry All Commercial |
$1,144.00
|
| Rate for Payer: Encore All Commercial |
$1,196.65
|
| Rate for Payer: Frontpath All Commercial |
$1,196.00
|
| Rate for Payer: Humana ChoiceCare |
$1,122.81
|
| Rate for Payer: Humana Medicare |
$663.00
|
| Rate for Payer: Lucent All Commercial |
$663.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,170.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$975.00
|
| Rate for Payer: PHP All Commercial |
$985.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$507.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.60
|
| Rate for Payer: Signature Care EPO |
$1,079.00
|
| Rate for Payer: Signature Care PPO |
$1,144.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare Commercial |
$1,024.40
|
| Rate for Payer: United Healthcare Medicare |
$429.00
|
|
|
HC SN TAN UNI SLV HIP 12/14 +12
|
Facility
OP
|
$1,340.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.20 |
| Max. Negotiated Rate |
$1,246.20 |
| Rate for Payer: Aetna Commercial |
$1,130.96
|
| Rate for Payer: Aetna Medicare |
$442.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$769.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$837.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$508.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$486.42
|
| Rate for Payer: Cash Price |
$830.80
|
| Rate for Payer: Cash Price |
$830.80
|
| Rate for Payer: Centivo All Commercial |
$683.40
|
| Rate for Payer: Cigna All Commercial |
$1,156.42
|
| Rate for Payer: CORVEL All Commercial |
$1,246.20
|
| Rate for Payer: Coventry All Commercial |
$1,179.20
|
| Rate for Payer: Encore All Commercial |
$1,233.47
|
| Rate for Payer: Frontpath All Commercial |
$1,232.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.36
|
| Rate for Payer: Humana Medicare |
$683.40
|
| Rate for Payer: Lucent All Commercial |
$683.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,005.00
|
| Rate for Payer: PHP All Commercial |
$1,016.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$522.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.48
|
| Rate for Payer: Signature Care EPO |
$1,112.20
|
| Rate for Payer: Signature Care PPO |
$1,179.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,139.00
|
| Rate for Payer: United Healthcare Commercial |
$1,055.92
|
| Rate for Payer: United Healthcare Medicare |
$442.20
|
|
|
HC SN TAN UNI SLV HIP 12/14 +12
|
Facility
IP
|
$1,340.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,246.20 |
| Rate for Payer: Aetna Commercial |
$1,157.76
|
| Rate for Payer: Cash Price |
$830.80
|
| Rate for Payer: Cigna All Commercial |
$1,156.42
|
| Rate for Payer: CORVEL All Commercial |
$1,246.20
|
| Rate for Payer: Coventry All Commercial |
$1,179.20
|
| Rate for Payer: Encore All Commercial |
$1,233.47
|
| Rate for Payer: Frontpath All Commercial |
$1,232.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,206.00
|
| Rate for Payer: PHCS All Commercial |
$1,005.00
|
| Rate for Payer: PHP All Commercial |
$1,016.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.48
|
| Rate for Payer: Signature Care EPO |
$1,112.20
|
| Rate for Payer: Signature Care PPO |
$1,179.20
|
| Rate for Payer: United Healthcare Commercial |
$1,055.92
|
|
|
HC SN TAN UNI SLV HIP 12/14 +4
|
Facility
IP
|
$1,340.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,246.20 |
| Rate for Payer: Aetna Commercial |
$1,157.76
|
| Rate for Payer: Cash Price |
$830.80
|
| Rate for Payer: Cigna All Commercial |
$1,156.42
|
| Rate for Payer: CORVEL All Commercial |
$1,246.20
|
| Rate for Payer: Coventry All Commercial |
$1,179.20
|
| Rate for Payer: Encore All Commercial |
$1,233.47
|
| Rate for Payer: Frontpath All Commercial |
$1,232.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,206.00
|
| Rate for Payer: PHCS All Commercial |
$1,005.00
|
| Rate for Payer: PHP All Commercial |
$1,016.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.48
|
| Rate for Payer: Signature Care EPO |
$1,112.20
|
| Rate for Payer: Signature Care PPO |
$1,179.20
|
| Rate for Payer: United Healthcare Commercial |
$1,055.92
|
|
|
HC SN TAN UNI SLV HIP 12/14 +4
|
Facility
OP
|
$1,340.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.20 |
| Max. Negotiated Rate |
$1,246.20 |
| Rate for Payer: Aetna Commercial |
$1,130.96
|
| Rate for Payer: Aetna Medicare |
$442.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$769.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$837.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$508.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$486.42
|
| Rate for Payer: Cash Price |
$830.80
|
| Rate for Payer: Cash Price |
$830.80
|
| Rate for Payer: Centivo All Commercial |
$683.40
|
| Rate for Payer: Cigna All Commercial |
$1,156.42
|
| Rate for Payer: CORVEL All Commercial |
$1,246.20
|
| Rate for Payer: Coventry All Commercial |
$1,179.20
|
| Rate for Payer: Encore All Commercial |
$1,233.47
|
| Rate for Payer: Frontpath All Commercial |
$1,232.80
|
| Rate for Payer: Humana ChoiceCare |
$1,157.36
|
| Rate for Payer: Humana Medicare |
$683.40
|
| Rate for Payer: Lucent All Commercial |
$683.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,005.00
|
| Rate for Payer: PHP All Commercial |
$1,016.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$522.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.48
|
| Rate for Payer: Signature Care EPO |
$1,112.20
|
| Rate for Payer: Signature Care PPO |
$1,179.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,139.00
|
| Rate for Payer: United Healthcare Commercial |
$1,055.92
|
| Rate for Payer: United Healthcare Medicare |
$442.20
|
|
|
HC SN TAN UNI SLV HIP 12/14 +8
|
Facility
IP
|
$1,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna Commercial |
$1,123.20
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cigna All Commercial |
$1,121.90
|
| Rate for Payer: CORVEL All Commercial |
$1,209.00
|
| Rate for Payer: Coventry All Commercial |
$1,144.00
|
| Rate for Payer: Encore All Commercial |
$1,196.65
|
| Rate for Payer: Frontpath All Commercial |
$1,196.00
|
| Rate for Payer: Humana ChoiceCare |
$1,122.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,170.00
|
| Rate for Payer: PHCS All Commercial |
$975.00
|
| Rate for Payer: PHP All Commercial |
$985.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.60
|
| Rate for Payer: Signature Care EPO |
$1,079.00
|
| Rate for Payer: Signature Care PPO |
$1,144.00
|
| Rate for Payer: United Healthcare Commercial |
$1,024.40
|
|
|
HC SN TAN UNI SLV HIP 12/14 +8
|
Facility
OP
|
$1,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna Commercial |
$1,097.20
|
| Rate for Payer: Aetna Medicare |
$429.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$746.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$812.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$493.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$471.90
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Centivo All Commercial |
$663.00
|
| Rate for Payer: Cigna All Commercial |
$1,121.90
|
| Rate for Payer: CORVEL All Commercial |
$1,209.00
|
| Rate for Payer: Coventry All Commercial |
$1,144.00
|
| Rate for Payer: Encore All Commercial |
$1,196.65
|
| Rate for Payer: Frontpath All Commercial |
$1,196.00
|
| Rate for Payer: Humana ChoiceCare |
$1,122.81
|
| Rate for Payer: Humana Medicare |
$663.00
|
| Rate for Payer: Lucent All Commercial |
$663.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,170.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$975.00
|
| Rate for Payer: PHP All Commercial |
$985.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$507.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.60
|
| Rate for Payer: Signature Care EPO |
$1,079.00
|
| Rate for Payer: Signature Care PPO |
$1,144.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare Commercial |
$1,024.40
|
| Rate for Payer: United Healthcare Medicare |
$429.00
|
|
