|
HC Z E1 VNGD AS TIB BRG 12X71
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 12X71
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 12X75
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 12X75
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 14X63
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 14X63
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 14X67
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 14X67
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 14X71
|
Facility
OP
|
$6,048.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,624.64 |
| Rate for Payer: Aetna Commercial |
$5,104.51
|
| Rate for Payer: Aetna Medicare |
$1,995.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,995.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,473.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,780.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,295.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,195.42
|
| Rate for Payer: Cash Price |
$3,749.76
|
| Rate for Payer: Cash Price |
$3,749.76
|
| Rate for Payer: Centivo All Commercial |
$3,084.48
|
| Rate for Payer: Cigna All Commercial |
$5,219.42
|
| Rate for Payer: CORVEL All Commercial |
$5,624.64
|
| Rate for Payer: Coventry All Commercial |
$5,322.24
|
| Rate for Payer: Encore All Commercial |
$5,567.18
|
| Rate for Payer: Frontpath All Commercial |
$5,564.16
|
| Rate for Payer: Humana ChoiceCare |
$5,223.66
|
| Rate for Payer: Humana Medicare |
$3,084.48
|
| Rate for Payer: Lucent All Commercial |
$3,084.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,443.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,536.00
|
| Rate for Payer: PHP All Commercial |
$4,586.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,358.72
|
| Rate for Payer: Sagamore Health Network All Products |
$4,669.06
|
| Rate for Payer: Signature Care EPO |
$5,019.84
|
| Rate for Payer: Signature Care PPO |
$5,322.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,140.80
|
| Rate for Payer: United Healthcare Commercial |
$4,765.82
|
| Rate for Payer: United Healthcare Medicare |
$1,995.84
|
|
|
HC Z E1 VNGD AS TIB BRG 14X71
|
Facility
IP
|
$6,048.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,536.00 |
| Max. Negotiated Rate |
$5,624.64 |
| Rate for Payer: Aetna Commercial |
$5,225.47
|
| Rate for Payer: Cash Price |
$3,749.76
|
| Rate for Payer: Cigna All Commercial |
$5,219.42
|
| Rate for Payer: CORVEL All Commercial |
$5,624.64
|
| Rate for Payer: Coventry All Commercial |
$5,322.24
|
| Rate for Payer: Encore All Commercial |
$5,567.18
|
| Rate for Payer: Frontpath All Commercial |
$5,564.16
|
| Rate for Payer: Humana ChoiceCare |
$5,223.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,443.20
|
| Rate for Payer: PHCS All Commercial |
$4,536.00
|
| Rate for Payer: PHP All Commercial |
$4,586.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,669.06
|
| Rate for Payer: Signature Care EPO |
$5,019.84
|
| Rate for Payer: Signature Care PPO |
$5,322.24
|
| Rate for Payer: United Healthcare Commercial |
$4,765.82
|
|
|
HC Z E1 VNGD AS TIB BRG 14X75
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 14X75
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 14X83
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 14X83
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 16X63
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 16X63
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 16X67
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 16X67
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 16X71
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 16X71
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 16X83
|
Facility
OP
|
$8,260.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,682.32 |
| Rate for Payer: Aetna Commercial |
$6,971.91
|
| Rate for Payer: Aetna Medicare |
$2,725.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,725.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,744.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,163.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,134.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,998.58
|
| Rate for Payer: Cash Price |
$5,121.55
|
| Rate for Payer: Cash Price |
$5,121.55
|
| Rate for Payer: Centivo All Commercial |
$4,212.89
|
| Rate for Payer: Cigna All Commercial |
$7,128.86
|
| Rate for Payer: CORVEL All Commercial |
$7,682.32
|
| Rate for Payer: Coventry All Commercial |
$7,269.29
|
| Rate for Payer: Encore All Commercial |
$7,603.85
|
| Rate for Payer: Frontpath All Commercial |
$7,599.72
|
| Rate for Payer: Humana ChoiceCare |
$7,134.65
|
| Rate for Payer: Humana Medicare |
$4,212.89
|
| Rate for Payer: Lucent All Commercial |
$4,212.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,434.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,195.42
|
| Rate for Payer: PHP All Commercial |
$6,264.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,221.62
|
| Rate for Payer: Sagamore Health Network All Products |
$6,377.15
|
| Rate for Payer: Signature Care EPO |
$6,856.26
|
| Rate for Payer: Signature Care PPO |
$7,269.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,021.48
|
| Rate for Payer: United Healthcare Commercial |
$6,509.32
|
| Rate for Payer: United Healthcare Medicare |
$2,725.98
|
|
|
HC Z E1 VNGD AS TIB BRG 16X83
|
Facility
IP
|
$8,260.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,195.42 |
| Max. Negotiated Rate |
$7,682.32 |
| Rate for Payer: Aetna Commercial |
$7,137.12
|
| Rate for Payer: Cash Price |
$5,121.55
|
| Rate for Payer: Cigna All Commercial |
$7,128.86
|
| Rate for Payer: CORVEL All Commercial |
$7,682.32
|
| Rate for Payer: Coventry All Commercial |
$7,269.29
|
| Rate for Payer: Encore All Commercial |
$7,603.85
|
| Rate for Payer: Frontpath All Commercial |
$7,599.72
|
| Rate for Payer: Humana ChoiceCare |
$7,134.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,434.50
|
| Rate for Payer: PHCS All Commercial |
$6,195.42
|
| Rate for Payer: PHP All Commercial |
$6,264.81
|
| Rate for Payer: Sagamore Health Network All Products |
$6,377.15
|
| Rate for Payer: Signature Care EPO |
$6,856.26
|
| Rate for Payer: Signature Care PPO |
$7,269.29
|
| Rate for Payer: United Healthcare Commercial |
$6,509.32
|
|
|
HC Z E1 VNGD AS TIB BRG 18X63
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z E1 VNGD AS TIB BRG 18X63
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z E1 VNGD AS TIB BRG 18X67
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
