|
HC Z CR 14MM VE 3-11 EF R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z CR 14MM VE 3-9 CD L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z CR 14MM VE 3-9 CD L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z CR 14MM VE 3-9 CD R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z CR 14MM VE 3-9 CD R
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z CR 14MM VE 7-12 GH L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z CR 14MM VE 7-12 GH L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z CR 14MM VE 7-12 GH R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z CR 14MM VE 7-12 GH R
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z CR 16MM PLY 1-2 CD L
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 1-2 CD L
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 1-2 CD R
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 1-2 CD R
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 3-11 EF L
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 3-11 EF L
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 3-11 EF R
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 3-11 EF R
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 3-9 CD L
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 3-9 CD L
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 3-9 CD R
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 3-9 CD R
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 7-12 GH L
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 7-12 GH L
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 16MM PLY 7-12 GH R
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 16MM PLY 7-12 GH R
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
