|
HC WOUND CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC W P-D BONE GRAFT INJ 10 ML
|
Facility
|
IP
|
$13,294.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,971.10 |
| Max. Negotiated Rate |
$12,364.16 |
| Rate for Payer: Aetna Commercial |
$11,486.71
|
| Rate for Payer: Cash Price |
$8,242.78
|
| Rate for Payer: Cigna All Commercial |
$11,473.41
|
| Rate for Payer: CORVEL All Commercial |
$12,364.16
|
| Rate for Payer: Coventry All Commercial |
$11,699.42
|
| Rate for Payer: Encore All Commercial |
$12,237.86
|
| Rate for Payer: Frontpath All Commercial |
$12,231.22
|
| Rate for Payer: Humana ChoiceCare |
$11,482.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,965.32
|
| Rate for Payer: PHCS All Commercial |
$9,971.10
|
| Rate for Payer: PHP All Commercial |
$10,082.78
|
| Rate for Payer: Sagamore Health Network All Products |
$10,263.59
|
| Rate for Payer: Signature Care EPO |
$11,034.68
|
| Rate for Payer: Signature Care PPO |
$11,699.42
|
| Rate for Payer: United Healthcare Commercial |
$10,476.30
|
|
|
HC W P-D BONE GRAFT INJ 10 ML
|
Facility
|
OP
|
$13,294.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,364.16 |
| Rate for Payer: Aetna Commercial |
$11,220.81
|
| Rate for Payer: Aetna Medicare |
$4,387.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,387.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,635.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,310.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,045.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,826.01
|
| Rate for Payer: Cash Price |
$8,242.78
|
| Rate for Payer: Cash Price |
$8,242.78
|
| Rate for Payer: Centivo All Commercial |
$6,780.35
|
| Rate for Payer: Cigna All Commercial |
$11,473.41
|
| Rate for Payer: CORVEL All Commercial |
$12,364.16
|
| Rate for Payer: Coventry All Commercial |
$11,699.42
|
| Rate for Payer: Encore All Commercial |
$12,237.86
|
| Rate for Payer: Frontpath All Commercial |
$12,231.22
|
| Rate for Payer: Humana ChoiceCare |
$11,482.72
|
| Rate for Payer: Humana Medicare |
$6,780.35
|
| Rate for Payer: Lucent All Commercial |
$6,780.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,965.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,971.10
|
| Rate for Payer: PHP All Commercial |
$10,082.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,184.97
|
| Rate for Payer: Sagamore Health Network All Products |
$10,263.59
|
| Rate for Payer: Signature Care EPO |
$11,034.68
|
| Rate for Payer: Signature Care PPO |
$11,699.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.58
|
| Rate for Payer: United Healthcare Commercial |
$10,476.30
|
| Rate for Payer: United Healthcare Medicare |
$4,387.28
|
|
|
HC W P-D BONE GRAFT INJ 20 ML
|
Facility
|
IP
|
$20,149.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,111.90 |
| Max. Negotiated Rate |
$18,738.76 |
| Rate for Payer: Aetna Commercial |
$17,408.91
|
| Rate for Payer: Cash Price |
$12,492.50
|
| Rate for Payer: Cigna All Commercial |
$17,388.76
|
| Rate for Payer: CORVEL All Commercial |
$18,738.76
|
| Rate for Payer: Coventry All Commercial |
$17,731.30
|
| Rate for Payer: Encore All Commercial |
$18,547.34
|
| Rate for Payer: Frontpath All Commercial |
$18,537.26
|
| Rate for Payer: Humana ChoiceCare |
$17,402.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18,134.28
|
| Rate for Payer: PHCS All Commercial |
$15,111.90
|
| Rate for Payer: PHP All Commercial |
$15,281.15
|
| Rate for Payer: Sagamore Health Network All Products |
$15,555.18
|
| Rate for Payer: Signature Care EPO |
$16,723.84
|
| Rate for Payer: Signature Care PPO |
$17,731.30
|
| Rate for Payer: United Healthcare Commercial |
$15,877.57
|
|
|
HC W P-D BONE GRAFT INJ 20 ML
|
Facility
|
OP
|
$20,149.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$18,738.76 |
| Rate for Payer: Aetna Commercial |
$17,005.92
|
| Rate for Payer: Aetna Medicare |
$6,649.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,649.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11,571.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,595.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,646.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,314.16
|
| Rate for Payer: Cash Price |
$12,492.50
|
| Rate for Payer: Cash Price |
$12,492.50
|
| Rate for Payer: Centivo All Commercial |
$10,276.09
|
| Rate for Payer: Cigna All Commercial |
$17,388.76
|
| Rate for Payer: CORVEL All Commercial |
$18,738.76
|
| Rate for Payer: Coventry All Commercial |
$17,731.30
|
| Rate for Payer: Encore All Commercial |
$18,547.34
|
| Rate for Payer: Frontpath All Commercial |
$18,537.26
|
| Rate for Payer: Humana ChoiceCare |
$17,402.86
|
| Rate for Payer: Humana Medicare |
$10,276.09
|
| Rate for Payer: Lucent All Commercial |
$10,276.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18,134.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$15,111.90
|
| Rate for Payer: PHP All Commercial |
$15,281.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,858.19
|
| Rate for Payer: Sagamore Health Network All Products |
$15,555.18
|
| Rate for Payer: Signature Care EPO |
$16,723.84
|
| Rate for Payer: Signature Care PPO |
$17,731.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,126.82
|
| Rate for Payer: United Healthcare Commercial |
$15,877.57
|
| Rate for Payer: United Healthcare Medicare |
$6,649.24
|
|
|
HC W P-D BONE GRAFT INJ 4 ML
|
Facility
|
OP
|
$6,541.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,083.32 |
| Rate for Payer: Aetna Commercial |
$5,520.77
|
| Rate for Payer: Aetna Medicare |
$2,158.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,158.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,756.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,088.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,482.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,374.46
|
| Rate for Payer: Cash Price |
$4,055.54
|
| Rate for Payer: Cash Price |
$4,055.54
|
| Rate for Payer: Centivo All Commercial |
$3,336.01
|
| Rate for Payer: Cigna All Commercial |
$5,645.06
|
| Rate for Payer: CORVEL All Commercial |
$6,083.32
|
| Rate for Payer: Coventry All Commercial |
$5,756.26
|
| Rate for Payer: Encore All Commercial |
$6,021.17
|
| Rate for Payer: Frontpath All Commercial |
$6,017.90
|
| Rate for Payer: Humana ChoiceCare |
$5,649.63
|
| Rate for Payer: Humana Medicare |
$3,336.01
|
| Rate for Payer: Lucent All Commercial |
$3,336.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,887.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,905.90
|
| Rate for Payer: PHP All Commercial |
$4,960.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,551.07
|
| Rate for Payer: Sagamore Health Network All Products |
$5,049.81
|
| Rate for Payer: Signature Care EPO |
$5,429.20
|
| Rate for Payer: Signature Care PPO |
$5,756.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,560.02
|
| Rate for Payer: United Healthcare Commercial |
$5,154.47
|
| Rate for Payer: United Healthcare Medicare |
$2,158.60
|
|
|
HC W P-D BONE GRAFT INJ 4 ML
|
Facility
|
IP
|
$6,541.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,905.90 |
| Max. Negotiated Rate |
$6,083.32 |
| Rate for Payer: Aetna Commercial |
$5,651.60
|
| Rate for Payer: Cash Price |
$4,055.54
|
| Rate for Payer: Cigna All Commercial |
$5,645.06
|
| Rate for Payer: CORVEL All Commercial |
$6,083.32
|
| Rate for Payer: Coventry All Commercial |
$5,756.26
|
| Rate for Payer: Encore All Commercial |
$6,021.17
|
| Rate for Payer: Frontpath All Commercial |
$6,017.90
|
| Rate for Payer: Humana ChoiceCare |
$5,649.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,887.08
|
| Rate for Payer: PHCS All Commercial |
$4,905.90
|
| Rate for Payer: PHP All Commercial |
$4,960.85
|
| Rate for Payer: Sagamore Health Network All Products |
$5,049.81
|
| Rate for Payer: Signature Care EPO |
$5,429.20
|
| Rate for Payer: Signature Care PPO |
$5,756.26
|
| Rate for Payer: United Healthcare Commercial |
$5,154.47
|
|
|
HC W PHALINX HAMMERTOE MED
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.10 |
| Max. Negotiated Rate |
$3,291.08 |
| Rate for Payer: Aetna Commercial |
$3,057.52
|
| Rate for Payer: Cash Price |
$2,194.06
|
| Rate for Payer: Cigna All Commercial |
$3,053.98
|
| Rate for Payer: CORVEL All Commercial |
$3,291.08
|
| Rate for Payer: Coventry All Commercial |
$3,114.14
|
| Rate for Payer: Encore All Commercial |
$3,257.47
|
| Rate for Payer: Frontpath All Commercial |
$3,255.70
|
| Rate for Payer: Humana ChoiceCare |
$3,056.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,184.92
|
| Rate for Payer: PHCS All Commercial |
$2,654.10
|
| Rate for Payer: PHP All Commercial |
$2,683.83
|
| Rate for Payer: Sagamore Health Network All Products |
$2,731.95
|
| Rate for Payer: Signature Care EPO |
$2,937.20
|
| Rate for Payer: Signature Care PPO |
$3,114.14
|
| Rate for Payer: United Healthcare Commercial |
$2,788.57
|
|
|
HC W PHALINX HAMMERTOE MED
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,291.08 |
| Rate for Payer: Aetna Commercial |
$2,986.75
|
| Rate for Payer: Aetna Medicare |
$1,167.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,167.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,032.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,212.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,342.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,284.58
|
| Rate for Payer: Cash Price |
$2,194.06
|
| Rate for Payer: Cash Price |
$2,194.06
|
| Rate for Payer: Centivo All Commercial |
$1,804.79
|
| Rate for Payer: Cigna All Commercial |
$3,053.98
|
| Rate for Payer: CORVEL All Commercial |
$3,291.08
|
| Rate for Payer: Coventry All Commercial |
$3,114.14
|
| Rate for Payer: Encore All Commercial |
$3,257.47
|
| Rate for Payer: Frontpath All Commercial |
$3,255.70
|
| Rate for Payer: Humana ChoiceCare |
$3,056.46
|
| Rate for Payer: Humana Medicare |
$1,804.79
|
| Rate for Payer: Lucent All Commercial |
$1,804.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,184.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,654.10
|
| Rate for Payer: PHP All Commercial |
$2,683.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,380.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,731.95
|
| Rate for Payer: Signature Care EPO |
$2,937.20
|
| Rate for Payer: Signature Care PPO |
$3,114.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,007.98
|
| Rate for Payer: United Healthcare Commercial |
$2,788.57
|
| Rate for Payer: United Healthcare Medicare |
$1,167.80
|
|
|
HC W PHLX ANG HMT LRG 053
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT LRG 053
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT LRG 1014
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT LRG 1014
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT MD 052
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT MD 052
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT MD 1013
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT MD 1013
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT SM 051
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT SM 051
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT SM 1012
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT SM 1012
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT XSM 050
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT XSM 050
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
|
HC W PHLX ANG HMT XSM 1011
|
Facility
|
OP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,777.10
|
| Rate for Payer: Aetna Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,085.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,889.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,248.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,194.42
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Centivo All Commercial |
$1,678.10
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Humana Medicare |
$1,678.10
|
| Rate for Payer: Lucent All Commercial |
$1,678.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.84
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
| Rate for Payer: United Healthcare Medicare |
$1,085.83
|
|
|
HC W PHLX ANG HMT XSM 1011
|
Facility
|
IP
|
$3,290.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.80 |
| Max. Negotiated Rate |
$3,060.07 |
| Rate for Payer: Aetna Commercial |
$2,842.91
|
| Rate for Payer: Cash Price |
$2,040.05
|
| Rate for Payer: Cigna All Commercial |
$2,839.62
|
| Rate for Payer: CORVEL All Commercial |
$3,060.07
|
| Rate for Payer: Coventry All Commercial |
$2,895.55
|
| Rate for Payer: Encore All Commercial |
$3,028.81
|
| Rate for Payer: Frontpath All Commercial |
$3,027.17
|
| Rate for Payer: Humana ChoiceCare |
$2,841.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,961.36
|
| Rate for Payer: PHCS All Commercial |
$2,467.80
|
| Rate for Payer: PHP All Commercial |
$2,495.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,540.19
|
| Rate for Payer: Signature Care EPO |
$2,731.03
|
| Rate for Payer: Signature Care PPO |
$2,895.55
|
| Rate for Payer: United Healthcare Commercial |
$2,592.84
|
|
