|
HC Z G7 10 DEG E1 LINER 28 E
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 28 E
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 28 F
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 28 F
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 28 G
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 28 G
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 B
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 B
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 C
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 C
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 D
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 D
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 E
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 E
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 F
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 F
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 G
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 32 G
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 H
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 32 H
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 36 D
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 36 D
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 36 E
|
Facility
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G7 10 DEG E1 LINER 36 E
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
|
HC Z G7 10 DEG E1 LINER 36 F
|
Facility
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,858.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,136.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,043.84
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Cash Price |
$3,490.85
|
| Rate for Payer: Centivo All Commercial |
$2,871.50
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$2,871.50
|
| Rate for Payer: Lucent All Commercial |
$2,871.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,858.03
|
|
