|
HC W PHLX CANN HMT LRG 043
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604615
|
|
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 CANN HMT LRG 043
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604615
|
|
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 PHLX CANN HMT LRG 1004
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604611
|
|
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 PHLX CANN HMT LRG 1004
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604611
|
|
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 CANN HMT MD 042
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604614
|
|
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 PHLX CANN HMT MD 042
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604614
|
|
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 CANN HMT SM 041
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604613
|
|
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 CANN HMT SM 041
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604613
|
|
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 PHLX CANN HMT XSM 040
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604612
|
|
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 PHLX CANN HMT XSM 040
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604612
|
|
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 CANN HMT XSM 1001
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604610
|
|
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 CANN HMT XSM 1001
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604610
|
|
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 PIN TEMP FIX 1.1
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Aetna Commercial |
$489.89
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cigna All Commercial |
$489.32
|
| Rate for Payer: CORVEL All Commercial |
$527.31
|
| Rate for Payer: Coventry All Commercial |
$498.96
|
| Rate for Payer: Encore All Commercial |
$521.92
|
| Rate for Payer: Frontpath All Commercial |
$521.64
|
| Rate for Payer: Humana ChoiceCare |
$489.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.30
|
| Rate for Payer: PHCS All Commercial |
$425.25
|
| Rate for Payer: PHP All Commercial |
$430.01
|
| Rate for Payer: Sagamore Health Network All Products |
$437.72
|
| Rate for Payer: Signature Care EPO |
$470.61
|
| Rate for Payer: Signature Care PPO |
$498.96
|
| Rate for Payer: United Healthcare Commercial |
$446.80
|
|
|
HC W PIN TEMP FIX 1.1
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.11 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Aetna Commercial |
$478.55
|
| Rate for Payer: Aetna Medicare |
$187.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$325.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$354.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.82
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Centivo All Commercial |
$289.17
|
| Rate for Payer: Cigna All Commercial |
$489.32
|
| Rate for Payer: CORVEL All Commercial |
$527.31
|
| Rate for Payer: Coventry All Commercial |
$498.96
|
| Rate for Payer: Encore All Commercial |
$521.92
|
| Rate for Payer: Frontpath All Commercial |
$521.64
|
| Rate for Payer: Humana ChoiceCare |
$489.72
|
| Rate for Payer: Humana Medicare |
$289.17
|
| Rate for Payer: Lucent All Commercial |
$289.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$425.25
|
| Rate for Payer: PHP All Commercial |
$430.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$221.13
|
| Rate for Payer: Sagamore Health Network All Products |
$437.72
|
| Rate for Payer: Signature Care EPO |
$470.61
|
| Rate for Payer: Signature Care PPO |
$498.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$481.95
|
| Rate for Payer: United Healthcare Commercial |
$446.80
|
| Rate for Payer: United Healthcare Medicare |
$187.11
|
|
|
HC W PIN TEMP FIX 1.4
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.11 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Aetna Commercial |
$478.55
|
| Rate for Payer: Aetna Medicare |
$187.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$325.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$354.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.82
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Centivo All Commercial |
$289.17
|
| Rate for Payer: Cigna All Commercial |
$489.32
|
| Rate for Payer: CORVEL All Commercial |
$527.31
|
| Rate for Payer: Coventry All Commercial |
$498.96
|
| Rate for Payer: Encore All Commercial |
$521.92
|
| Rate for Payer: Frontpath All Commercial |
$521.64
|
| Rate for Payer: Humana ChoiceCare |
$489.72
|
| Rate for Payer: Humana Medicare |
$289.17
|
| Rate for Payer: Lucent All Commercial |
$289.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$425.25
|
| Rate for Payer: PHP All Commercial |
$430.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$221.13
|
| Rate for Payer: Sagamore Health Network All Products |
$437.72
|
| Rate for Payer: Signature Care EPO |
$470.61
|
| Rate for Payer: Signature Care PPO |
$498.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$481.95
|
| Rate for Payer: United Healthcare Commercial |
$446.80
|
| Rate for Payer: United Healthcare Medicare |
$187.11
|
|
|
HC W PIN TEMP FIX 1.4
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Aetna Commercial |
$489.89
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cigna All Commercial |
$489.32
|
| Rate for Payer: CORVEL All Commercial |
$527.31
|
| Rate for Payer: Coventry All Commercial |
$498.96
|
| Rate for Payer: Encore All Commercial |
$521.92
|
| Rate for Payer: Frontpath All Commercial |
$521.64
|
| Rate for Payer: Humana ChoiceCare |
$489.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.30
|
| Rate for Payer: PHCS All Commercial |
$425.25
|
| Rate for Payer: PHP All Commercial |
$430.01
|
| Rate for Payer: Sagamore Health Network All Products |
$437.72
|
| Rate for Payer: Signature Care EPO |
$470.61
|
| Rate for Payer: Signature Care PPO |
$498.96
|
| Rate for Payer: United Healthcare Commercial |
$446.80
|
|
|
HC W PIN TEMP FIX 1.4 LRG
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Aetna Commercial |
$489.89
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cigna All Commercial |
$489.32
|
| Rate for Payer: CORVEL All Commercial |
$527.31
|
| Rate for Payer: Coventry All Commercial |
$498.96
|
| Rate for Payer: Encore All Commercial |
$521.92
|
| Rate for Payer: Frontpath All Commercial |
$521.64
|
| Rate for Payer: Humana ChoiceCare |
$489.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.30
|
| Rate for Payer: PHCS All Commercial |
$425.25
|
| Rate for Payer: PHP All Commercial |
$430.01
|
| Rate for Payer: Sagamore Health Network All Products |
$437.72
|
| Rate for Payer: Signature Care EPO |
$470.61
|
| Rate for Payer: Signature Care PPO |
$498.96
|
| Rate for Payer: United Healthcare Commercial |
$446.80
|
|
|
HC W PIN TEMP FIX 1.4 LRG
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.11 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Aetna Commercial |
$478.55
|
| Rate for Payer: Aetna Medicare |
$187.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$325.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$354.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.82
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Cash Price |
$351.54
|
| Rate for Payer: Centivo All Commercial |
$289.17
|
| Rate for Payer: Cigna All Commercial |
$489.32
|
| Rate for Payer: CORVEL All Commercial |
$527.31
|
| Rate for Payer: Coventry All Commercial |
$498.96
|
| Rate for Payer: Encore All Commercial |
$521.92
|
| Rate for Payer: Frontpath All Commercial |
$521.64
|
| Rate for Payer: Humana ChoiceCare |
$489.72
|
| Rate for Payer: Humana Medicare |
$289.17
|
| Rate for Payer: Lucent All Commercial |
$289.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.30
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$425.25
|
| Rate for Payer: PHP All Commercial |
$430.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$221.13
|
| Rate for Payer: Sagamore Health Network All Products |
$437.72
|
| Rate for Payer: Signature Care EPO |
$470.61
|
| Rate for Payer: Signature Care PPO |
$498.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$481.95
|
| Rate for Payer: United Healthcare Commercial |
$446.80
|
| Rate for Payer: United Healthcare Medicare |
$187.11
|
|
|
HC W PIN TEMP FIX 2.0
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$566.37 |
| Rate for Payer: Aetna Commercial |
$526.18
|
| Rate for Payer: Cash Price |
$377.58
|
| Rate for Payer: Cigna All Commercial |
$525.57
|
| Rate for Payer: CORVEL All Commercial |
$566.37
|
| Rate for Payer: Coventry All Commercial |
$535.92
|
| Rate for Payer: Encore All Commercial |
$560.58
|
| Rate for Payer: Frontpath All Commercial |
$560.28
|
| Rate for Payer: Humana ChoiceCare |
$525.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$548.10
|
| Rate for Payer: PHCS All Commercial |
$456.75
|
| Rate for Payer: PHP All Commercial |
$461.87
|
| Rate for Payer: Sagamore Health Network All Products |
$470.15
|
| Rate for Payer: Signature Care EPO |
$505.47
|
| Rate for Payer: Signature Care PPO |
$535.92
|
| Rate for Payer: United Healthcare Commercial |
$479.89
|
|
|
HC W PIN TEMP FIX 2.0
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.97 |
| Max. Negotiated Rate |
$566.37 |
| Rate for Payer: Aetna Commercial |
$514.00
|
| Rate for Payer: Aetna Medicare |
$200.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$349.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.07
|
| Rate for Payer: Cash Price |
$377.58
|
| Rate for Payer: Cash Price |
$377.58
|
| Rate for Payer: Centivo All Commercial |
$310.59
|
| Rate for Payer: Cigna All Commercial |
$525.57
|
| Rate for Payer: CORVEL All Commercial |
$566.37
|
| Rate for Payer: Coventry All Commercial |
$535.92
|
| Rate for Payer: Encore All Commercial |
$560.58
|
| Rate for Payer: Frontpath All Commercial |
$560.28
|
| Rate for Payer: Humana ChoiceCare |
$525.99
|
| Rate for Payer: Humana Medicare |
$310.59
|
| Rate for Payer: Lucent All Commercial |
$310.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$548.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$456.75
|
| Rate for Payer: PHP All Commercial |
$461.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$237.51
|
| Rate for Payer: Sagamore Health Network All Products |
$470.15
|
| Rate for Payer: Signature Care EPO |
$505.47
|
| Rate for Payer: Signature Care PPO |
$535.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$517.65
|
| Rate for Payer: United Healthcare Commercial |
$479.89
|
| Rate for Payer: United Healthcare Medicare |
$200.97
|
|
|
HC W PLATE 0 BOW
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
|
HC W PLATE 0 BOW
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.25
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Centivo All Commercial |
$2,496.96
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$2,496.96
|
| Rate for Payer: Lucent All Commercial |
$2,496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,615.68
|
|
|
HC W PLATE 0 COTTON WEDGE
|
Facility
|
IP
|
$5,338.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,004.10 |
| Max. Negotiated Rate |
$4,965.08 |
| Rate for Payer: Aetna Commercial |
$4,612.72
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Cigna All Commercial |
$4,607.38
|
| Rate for Payer: CORVEL All Commercial |
$4,965.08
|
| Rate for Payer: Coventry All Commercial |
$4,698.14
|
| Rate for Payer: Encore All Commercial |
$4,914.37
|
| Rate for Payer: Frontpath All Commercial |
$4,911.70
|
| Rate for Payer: Humana ChoiceCare |
$4,611.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,804.92
|
| Rate for Payer: PHCS All Commercial |
$4,004.10
|
| Rate for Payer: PHP All Commercial |
$4,048.95
|
| Rate for Payer: Sagamore Health Network All Products |
$4,121.55
|
| Rate for Payer: Signature Care EPO |
$4,431.20
|
| Rate for Payer: Signature Care PPO |
$4,698.14
|
| Rate for Payer: United Healthcare Commercial |
$4,206.97
|
|
|
HC W PLATE 0 COTTON WEDGE
|
Facility
|
OP
|
$5,338.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,965.08 |
| Rate for Payer: Aetna Commercial |
$4,505.95
|
| Rate for Payer: Aetna Medicare |
$1,761.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,761.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,066.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,337.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,026.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,937.98
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Centivo All Commercial |
$2,722.79
|
| Rate for Payer: Cigna All Commercial |
$4,607.38
|
| Rate for Payer: CORVEL All Commercial |
$4,965.08
|
| Rate for Payer: Coventry All Commercial |
$4,698.14
|
| Rate for Payer: Encore All Commercial |
$4,914.37
|
| Rate for Payer: Frontpath All Commercial |
$4,911.70
|
| Rate for Payer: Humana ChoiceCare |
$4,611.12
|
| Rate for Payer: Humana Medicare |
$2,722.79
|
| Rate for Payer: Lucent All Commercial |
$2,722.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,804.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,004.10
|
| Rate for Payer: PHP All Commercial |
$4,048.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,082.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4,121.55
|
| Rate for Payer: Signature Care EPO |
$4,431.20
|
| Rate for Payer: Signature Care PPO |
$4,698.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,537.98
|
| Rate for Payer: United Healthcare Commercial |
$4,206.97
|
| Rate for Payer: United Healthcare Medicare |
$1,761.80
|
|
|
HC W PLATE 0DG MTP MED L
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.25
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Centivo All Commercial |
$2,496.96
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$2,496.96
|
| Rate for Payer: Lucent All Commercial |
$2,496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,615.68
|
|
