HC Z G7 NTL LINER 32 B
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605923
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 C
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605924
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 C
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605924
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 32 D
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605925
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 32 D
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605925
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 E
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605926
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 32 E
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605926
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 F
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605927
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 F
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605927
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 32 G
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605928
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 32 G
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605928
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 H
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605929
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 32 H
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605929
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 32 I
|
Facility
OP
|
$4,320.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605930
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$4,017.60 |
Rate for Payer: Aetna Commercial |
$3,646.08
|
Rate for Payer: Aetna Medicare |
$1,425.60
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,425.60
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,480.98
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,700.43
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,639.44
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,568.16
|
Rate for Payer: Cash Price |
$2,678.40
|
Rate for Payer: Cash Price |
$2,678.40
|
Rate for Payer: Centivo All Commercial |
$2,203.20
|
Rate for Payer: Cigna All Commercial |
$3,728.16
|
Rate for Payer: CORVEL All Commercial |
$4,017.60
|
Rate for Payer: Coventry All Commercial |
$3,801.60
|
Rate for Payer: Encore All Commercial |
$3,976.56
|
Rate for Payer: Frontpath All Commercial |
$3,974.40
|
Rate for Payer: Humana ChoiceCare |
$3,731.18
|
Rate for Payer: Humana Medicare |
$2,203.20
|
Rate for Payer: Lucent All Commercial |
$2,203.20
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,888.00
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$3,240.00
|
Rate for Payer: PHP All Commercial |
$3,276.29
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,684.80
|
Rate for Payer: Sagamore Health Network All Products |
$3,335.04
|
Rate for Payer: Signature Care EPO |
$3,585.60
|
Rate for Payer: Signature Care PPO |
$3,801.60
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,672.00
|
Rate for Payer: United Healthcare Commercial |
$3,404.16
|
Rate for Payer: United Healthcare Medicare |
$1,425.60
|
|
HC Z G7 NTL LINER 32 I
|
Facility
IP
|
$4,320.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605930
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,240.00 |
Max. Negotiated Rate |
$4,017.60 |
Rate for Payer: Aetna Commercial |
$3,732.48
|
Rate for Payer: Cash Price |
$2,678.40
|
Rate for Payer: Cigna All Commercial |
$3,728.16
|
Rate for Payer: CORVEL All Commercial |
$4,017.60
|
Rate for Payer: Coventry All Commercial |
$3,801.60
|
Rate for Payer: Encore All Commercial |
$3,976.56
|
Rate for Payer: Frontpath All Commercial |
$3,974.40
|
Rate for Payer: Humana ChoiceCare |
$3,731.18
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,888.00
|
Rate for Payer: PHCS All Commercial |
$3,240.00
|
Rate for Payer: PHP All Commercial |
$3,276.29
|
Rate for Payer: Sagamore Health Network All Products |
$3,335.04
|
Rate for Payer: Signature Care EPO |
$3,585.60
|
Rate for Payer: Signature Care PPO |
$3,801.60
|
Rate for Payer: United Healthcare Commercial |
$3,404.16
|
|
HC Z G7 NTL LINER 36 D
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605931
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 36 D
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605931
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 36 E
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605932
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 36 E
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605932
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 36 F
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605933
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 36 F
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605933
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 36 G
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605934
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
HC Z G7 NTL LINER 36 G
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605934
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 36 H
|
Facility
IP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605935
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,980.80 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,433.88
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
HC Z G7 NTL LINER 36 H
|
Facility
OP
|
$3,974.40
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605935
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$3,696.19 |
Rate for Payer: Aetna Commercial |
$3,354.39
|
Rate for Payer: Aetna Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Cash Price |
$2,464.13
|
Rate for Payer: Centivo All Commercial |
$2,026.94
|
Rate for Payer: Cigna All Commercial |
$3,429.91
|
Rate for Payer: CORVEL All Commercial |
$3,696.19
|
Rate for Payer: Coventry All Commercial |
$3,497.47
|
Rate for Payer: Encore All Commercial |
$3,658.44
|
Rate for Payer: Frontpath All Commercial |
$3,656.45
|
Rate for Payer: Humana ChoiceCare |
$3,432.69
|
Rate for Payer: Humana Medicare |
$2,026.94
|
Rate for Payer: Lucent All Commercial |
$2,026.94
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$2,980.80
|
Rate for Payer: PHP All Commercial |
$3,014.18
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
Rate for Payer: Signature Care EPO |
$3,298.75
|
Rate for Payer: Signature Care PPO |
$3,497.47
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
Rate for Payer: United Healthcare Commercial |
$3,131.83
|
Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|