|
HC Z PLATE CLAV SUP 12H 125M R
|
Facility
OP
|
$5,479.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,095.89 |
| Rate for Payer: Aetna Commercial |
$4,624.66
|
| Rate for Payer: Aetna Medicare |
$1,808.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,808.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,146.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,425.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,079.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,989.04
|
| Rate for Payer: Cash Price |
$3,397.26
|
| Rate for Payer: Cash Price |
$3,397.26
|
| Rate for Payer: Centivo All Commercial |
$2,794.52
|
| Rate for Payer: Cigna All Commercial |
$4,728.77
|
| Rate for Payer: CORVEL All Commercial |
$5,095.89
|
| Rate for Payer: Coventry All Commercial |
$4,821.92
|
| Rate for Payer: Encore All Commercial |
$5,043.83
|
| Rate for Payer: Frontpath All Commercial |
$5,041.09
|
| Rate for Payer: Humana ChoiceCare |
$4,732.60
|
| Rate for Payer: Humana Medicare |
$2,794.52
|
| Rate for Payer: Lucent All Commercial |
$2,794.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,931.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,109.59
|
| Rate for Payer: PHP All Commercial |
$4,155.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,136.99
|
| Rate for Payer: Sagamore Health Network All Products |
$4,230.14
|
| Rate for Payer: Signature Care EPO |
$4,547.94
|
| Rate for Payer: Signature Care PPO |
$4,821.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,657.53
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$1,808.22
|
|
|
HC Z PLATE CRND L
|
Facility
OP
|
$2,537.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,360.27 |
| Rate for Payer: Aetna Commercial |
$2,142.01
|
| Rate for Payer: Aetna Medicare |
$837.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$837.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,457.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,586.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$963.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$921.27
|
| Rate for Payer: Cash Price |
$1,573.52
|
| Rate for Payer: Cash Price |
$1,573.52
|
| Rate for Payer: Centivo All Commercial |
$1,294.34
|
| Rate for Payer: Cigna All Commercial |
$2,190.23
|
| Rate for Payer: CORVEL All Commercial |
$2,360.27
|
| Rate for Payer: Coventry All Commercial |
$2,233.38
|
| Rate for Payer: Encore All Commercial |
$2,336.16
|
| Rate for Payer: Frontpath All Commercial |
$2,334.90
|
| Rate for Payer: Humana ChoiceCare |
$2,192.01
|
| Rate for Payer: Humana Medicare |
$1,294.34
|
| Rate for Payer: Lucent All Commercial |
$1,294.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,284.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,903.45
|
| Rate for Payer: PHP All Commercial |
$1,924.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$989.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,959.28
|
| Rate for Payer: Signature Care EPO |
$2,106.48
|
| Rate for Payer: Signature Care PPO |
$2,233.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,157.24
|
| Rate for Payer: United Healthcare Commercial |
$1,999.89
|
| Rate for Payer: United Healthcare Medicare |
$837.52
|
|
|
HC Z PLATE CRND L
|
Facility
IP
|
$2,537.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.45 |
| Max. Negotiated Rate |
$2,360.27 |
| Rate for Payer: Aetna Commercial |
$2,192.77
|
| Rate for Payer: Cash Price |
$1,573.52
|
| Rate for Payer: Cigna All Commercial |
$2,190.23
|
| Rate for Payer: CORVEL All Commercial |
$2,360.27
|
| Rate for Payer: Coventry All Commercial |
$2,233.38
|
| Rate for Payer: Encore All Commercial |
$2,336.16
|
| Rate for Payer: Frontpath All Commercial |
$2,334.90
|
| Rate for Payer: Humana ChoiceCare |
$2,192.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,284.14
|
| Rate for Payer: PHCS All Commercial |
$1,903.45
|
| Rate for Payer: PHP All Commercial |
$1,924.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,959.28
|
| Rate for Payer: Signature Care EPO |
$2,106.48
|
| Rate for Payer: Signature Care PPO |
$2,233.38
|
| Rate for Payer: United Healthcare Commercial |
$1,999.89
|
|
|
HC Z PLATE CRND R
|
Facility
OP
|
$2,537.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,360.27 |
| Rate for Payer: Aetna Commercial |
$2,142.01
|
| Rate for Payer: Aetna Medicare |
$837.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$837.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,457.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,586.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$963.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$921.27
|
| Rate for Payer: Cash Price |
$1,573.52
|
| Rate for Payer: Cash Price |
$1,573.52
|
| Rate for Payer: Centivo All Commercial |
$1,294.34
|
| Rate for Payer: Cigna All Commercial |
$2,190.23
|
| Rate for Payer: CORVEL All Commercial |
$2,360.27
|
| Rate for Payer: Coventry All Commercial |
$2,233.38
|
| Rate for Payer: Encore All Commercial |
$2,336.16
|
| Rate for Payer: Frontpath All Commercial |
$2,334.90
|
| Rate for Payer: Humana ChoiceCare |
$2,192.01
|
| Rate for Payer: Humana Medicare |
$1,294.34
|
| Rate for Payer: Lucent All Commercial |
$1,294.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,284.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,903.45
|
| Rate for Payer: PHP All Commercial |
$1,924.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$989.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,959.28
|
| Rate for Payer: Signature Care EPO |
$2,106.48
|
| Rate for Payer: Signature Care PPO |
$2,233.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,157.24
|
| Rate for Payer: United Healthcare Commercial |
$1,999.89
|
| Rate for Payer: United Healthcare Medicare |
$837.52
|
|
|
HC Z PLATE CRND R
|
Facility
IP
|
$2,537.93
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.45 |
| Max. Negotiated Rate |
$2,360.27 |
| Rate for Payer: Aetna Commercial |
$2,192.77
|
| Rate for Payer: Cash Price |
$1,573.52
|
| Rate for Payer: Cigna All Commercial |
$2,190.23
|
| Rate for Payer: CORVEL All Commercial |
$2,360.27
|
| Rate for Payer: Coventry All Commercial |
$2,233.38
|
| Rate for Payer: Encore All Commercial |
$2,336.16
|
| Rate for Payer: Frontpath All Commercial |
$2,334.90
|
| Rate for Payer: Humana ChoiceCare |
$2,192.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,284.14
|
| Rate for Payer: PHCS All Commercial |
$1,903.45
|
| Rate for Payer: PHP All Commercial |
$1,924.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,959.28
|
| Rate for Payer: Signature Care EPO |
$2,106.48
|
| Rate for Payer: Signature Care PPO |
$2,233.38
|
| Rate for Payer: United Healthcare Commercial |
$1,999.89
|
|
|
HC Z PLATE DIST FEM NCB 238 L
|
Facility
IP
|
$4,506.08
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,379.56 |
| Max. Negotiated Rate |
$4,190.65 |
| Rate for Payer: Aetna Commercial |
$3,893.25
|
| Rate for Payer: Cash Price |
$2,793.77
|
| Rate for Payer: Cigna All Commercial |
$3,888.75
|
| Rate for Payer: CORVEL All Commercial |
$4,190.65
|
| Rate for Payer: Coventry All Commercial |
$3,965.35
|
| Rate for Payer: Encore All Commercial |
$4,147.85
|
| Rate for Payer: Frontpath All Commercial |
$4,145.59
|
| Rate for Payer: Humana ChoiceCare |
$3,891.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,055.47
|
| Rate for Payer: PHCS All Commercial |
$3,379.56
|
| Rate for Payer: PHP All Commercial |
$3,417.41
|
| Rate for Payer: Sagamore Health Network All Products |
$3,478.69
|
| Rate for Payer: Signature Care EPO |
$3,740.05
|
| Rate for Payer: Signature Care PPO |
$3,965.35
|
| Rate for Payer: United Healthcare Commercial |
$3,550.79
|
|
|
HC Z PLATE DIST FEM NCB 238 L
|
Facility
OP
|
$4,506.08
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,190.65 |
| Rate for Payer: Aetna Commercial |
$3,803.13
|
| Rate for Payer: Aetna Medicare |
$1,487.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,487.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,587.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,816.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,710.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,635.71
|
| Rate for Payer: Cash Price |
$2,793.77
|
| Rate for Payer: Cash Price |
$2,793.77
|
| Rate for Payer: Centivo All Commercial |
$2,298.10
|
| Rate for Payer: Cigna All Commercial |
$3,888.75
|
| Rate for Payer: CORVEL All Commercial |
$4,190.65
|
| Rate for Payer: Coventry All Commercial |
$3,965.35
|
| Rate for Payer: Encore All Commercial |
$4,147.85
|
| Rate for Payer: Frontpath All Commercial |
$4,145.59
|
| Rate for Payer: Humana ChoiceCare |
$3,891.90
|
| Rate for Payer: Humana Medicare |
$2,298.10
|
| Rate for Payer: Lucent All Commercial |
$2,298.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,055.47
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,379.56
|
| Rate for Payer: PHP All Commercial |
$3,417.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,757.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,478.69
|
| Rate for Payer: Signature Care EPO |
$3,740.05
|
| Rate for Payer: Signature Care PPO |
$3,965.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,830.17
|
| Rate for Payer: United Healthcare Commercial |
$3,550.79
|
| Rate for Payer: United Healthcare Medicare |
$1,487.01
|
|
|
HC Z PLATE DIST FEM NCB 278 L
|
Facility
OP
|
$4,745.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,413.57 |
| Rate for Payer: Aetna Commercial |
$4,005.43
|
| Rate for Payer: Aetna Medicare |
$1,566.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,566.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,725.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,966.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,801.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,722.71
|
| Rate for Payer: Cash Price |
$2,942.38
|
| Rate for Payer: Cash Price |
$2,942.38
|
| Rate for Payer: Centivo All Commercial |
$2,420.34
|
| Rate for Payer: Cigna All Commercial |
$4,095.60
|
| Rate for Payer: CORVEL All Commercial |
$4,413.57
|
| Rate for Payer: Coventry All Commercial |
$4,176.28
|
| Rate for Payer: Encore All Commercial |
$4,368.48
|
| Rate for Payer: Frontpath All Commercial |
$4,366.11
|
| Rate for Payer: Humana ChoiceCare |
$4,098.92
|
| Rate for Payer: Humana Medicare |
$2,420.34
|
| Rate for Payer: Lucent All Commercial |
$2,420.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,271.19
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,559.33
|
| Rate for Payer: PHP All Commercial |
$3,599.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,850.85
|
| Rate for Payer: Sagamore Health Network All Products |
$3,663.73
|
| Rate for Payer: Signature Care EPO |
$3,938.99
|
| Rate for Payer: Signature Care PPO |
$4,176.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,033.90
|
| Rate for Payer: United Healthcare Commercial |
$3,739.67
|
| Rate for Payer: United Healthcare Medicare |
$1,566.10
|
|
|
HC Z PLATE DIST FEM NCB 278 L
|
Facility
IP
|
$4,745.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,559.33 |
| Max. Negotiated Rate |
$4,413.57 |
| Rate for Payer: Aetna Commercial |
$4,100.35
|
| Rate for Payer: Cash Price |
$2,942.38
|
| Rate for Payer: Cigna All Commercial |
$4,095.60
|
| Rate for Payer: CORVEL All Commercial |
$4,413.57
|
| Rate for Payer: Coventry All Commercial |
$4,176.28
|
| Rate for Payer: Encore All Commercial |
$4,368.48
|
| Rate for Payer: Frontpath All Commercial |
$4,366.11
|
| Rate for Payer: Humana ChoiceCare |
$4,098.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,271.19
|
| Rate for Payer: PHCS All Commercial |
$3,559.33
|
| Rate for Payer: PHP All Commercial |
$3,599.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,663.73
|
| Rate for Payer: Signature Care EPO |
$3,938.99
|
| Rate for Payer: Signature Care PPO |
$4,176.28
|
| Rate for Payer: United Healthcare Commercial |
$3,739.67
|
|
|
HC Z PLATE DIST FEM NCB 278 R
|
Facility
OP
|
$4,745.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,413.57 |
| Rate for Payer: Aetna Commercial |
$4,005.43
|
| Rate for Payer: Aetna Medicare |
$1,566.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,566.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,725.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,966.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,801.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,722.71
|
| Rate for Payer: Cash Price |
$2,942.38
|
| Rate for Payer: Cash Price |
$2,942.38
|
| Rate for Payer: Centivo All Commercial |
$2,420.34
|
| Rate for Payer: Cigna All Commercial |
$4,095.60
|
| Rate for Payer: CORVEL All Commercial |
$4,413.57
|
| Rate for Payer: Coventry All Commercial |
$4,176.28
|
| Rate for Payer: Encore All Commercial |
$4,368.48
|
| Rate for Payer: Frontpath All Commercial |
$4,366.11
|
| Rate for Payer: Humana ChoiceCare |
$4,098.92
|
| Rate for Payer: Humana Medicare |
$2,420.34
|
| Rate for Payer: Lucent All Commercial |
$2,420.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,271.19
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,559.33
|
| Rate for Payer: PHP All Commercial |
$3,599.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,850.85
|
| Rate for Payer: Sagamore Health Network All Products |
$3,663.73
|
| Rate for Payer: Signature Care EPO |
$3,938.99
|
| Rate for Payer: Signature Care PPO |
$4,176.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,033.90
|
| Rate for Payer: United Healthcare Commercial |
$3,739.67
|
| Rate for Payer: United Healthcare Medicare |
$1,566.10
|
|
|
HC Z PLATE DIST FEM NCB 278 R
|
Facility
IP
|
$4,745.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,559.33 |
| Max. Negotiated Rate |
$4,413.57 |
| Rate for Payer: Aetna Commercial |
$4,100.35
|
| Rate for Payer: Cash Price |
$2,942.38
|
| Rate for Payer: Cigna All Commercial |
$4,095.60
|
| Rate for Payer: CORVEL All Commercial |
$4,413.57
|
| Rate for Payer: Coventry All Commercial |
$4,176.28
|
| Rate for Payer: Encore All Commercial |
$4,368.48
|
| Rate for Payer: Frontpath All Commercial |
$4,366.11
|
| Rate for Payer: Humana ChoiceCare |
$4,098.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,271.19
|
| Rate for Payer: PHCS All Commercial |
$3,559.33
|
| Rate for Payer: PHP All Commercial |
$3,599.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,663.73
|
| Rate for Payer: Signature Care EPO |
$3,938.99
|
| Rate for Payer: Signature Care PPO |
$4,176.28
|
| Rate for Payer: United Healthcare Commercial |
$3,739.67
|
|
|
HC Z PLATE DIST FEM NCB 317 L
|
Facility
IP
|
$5,033.38
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.04 |
| Max. Negotiated Rate |
$4,681.04 |
| Rate for Payer: Aetna Commercial |
$4,348.84
|
| Rate for Payer: Cash Price |
$3,120.70
|
| Rate for Payer: Cigna All Commercial |
$4,343.81
|
| Rate for Payer: CORVEL All Commercial |
$4,681.04
|
| Rate for Payer: Coventry All Commercial |
$4,429.37
|
| Rate for Payer: Encore All Commercial |
$4,633.23
|
| Rate for Payer: Frontpath All Commercial |
$4,630.71
|
| Rate for Payer: Humana ChoiceCare |
$4,347.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,530.04
|
| Rate for Payer: PHCS All Commercial |
$3,775.04
|
| Rate for Payer: PHP All Commercial |
$3,817.32
|
| Rate for Payer: Sagamore Health Network All Products |
$3,885.77
|
| Rate for Payer: Signature Care EPO |
$4,177.71
|
| Rate for Payer: Signature Care PPO |
$4,429.37
|
| Rate for Payer: United Healthcare Commercial |
$3,966.30
|
|
|
HC Z PLATE DIST FEM NCB 317 L
|
Facility
OP
|
$5,033.38
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,681.04 |
| Rate for Payer: Aetna Commercial |
$4,248.17
|
| Rate for Payer: Aetna Medicare |
$1,661.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,661.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,890.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,146.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,910.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,827.12
|
| Rate for Payer: Cash Price |
$3,120.70
|
| Rate for Payer: Cash Price |
$3,120.70
|
| Rate for Payer: Centivo All Commercial |
$2,567.02
|
| Rate for Payer: Cigna All Commercial |
$4,343.81
|
| Rate for Payer: CORVEL All Commercial |
$4,681.04
|
| Rate for Payer: Coventry All Commercial |
$4,429.37
|
| Rate for Payer: Encore All Commercial |
$4,633.23
|
| Rate for Payer: Frontpath All Commercial |
$4,630.71
|
| Rate for Payer: Humana ChoiceCare |
$4,347.33
|
| Rate for Payer: Humana Medicare |
$2,567.02
|
| Rate for Payer: Lucent All Commercial |
$2,567.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,530.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,775.04
|
| Rate for Payer: PHP All Commercial |
$3,817.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,963.02
|
| Rate for Payer: Sagamore Health Network All Products |
$3,885.77
|
| Rate for Payer: Signature Care EPO |
$4,177.71
|
| Rate for Payer: Signature Care PPO |
$4,429.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,278.37
|
| Rate for Payer: United Healthcare Commercial |
$3,966.30
|
| Rate for Payer: United Healthcare Medicare |
$1,661.02
|
|
|
HC Z PLATE DIST HUM LAT 7H L
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.37 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$3,022.13
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
|
|
HC Z PLATE DIST HUM LAT 7H L
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$2,952.17
|
| Rate for Payer: Aetna Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,186.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,269.71
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Centivo All Commercial |
$1,783.89
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Humana Medicare |
$1,783.89
|
| Rate for Payer: Lucent All Commercial |
$1,783.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,973.16
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
| Rate for Payer: United Healthcare Medicare |
$1,154.28
|
|
|
HC Z PLATE DIST HUM LAT 7H R
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$2,952.17
|
| Rate for Payer: Aetna Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,186.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,269.71
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Centivo All Commercial |
$1,783.89
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Humana Medicare |
$1,783.89
|
| Rate for Payer: Lucent All Commercial |
$1,783.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,973.16
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
| Rate for Payer: United Healthcare Medicare |
$1,154.28
|
|
|
HC Z PLATE DIST HUM LAT 7H R
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.37 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$3,022.13
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
|
|
HC Z PLATE DIST HUM LAT 9H L
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$2,952.17
|
| Rate for Payer: Aetna Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,186.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,269.71
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Centivo All Commercial |
$1,783.89
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Humana Medicare |
$1,783.89
|
| Rate for Payer: Lucent All Commercial |
$1,783.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,973.16
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
| Rate for Payer: United Healthcare Medicare |
$1,154.28
|
|
|
HC Z PLATE DIST HUM LAT 9H L
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.37 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$3,022.13
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
|
|
HC Z PLATE DIST HUM LAT 9H R
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$2,952.17
|
| Rate for Payer: Aetna Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,186.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,269.71
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Centivo All Commercial |
$1,783.89
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Humana Medicare |
$1,783.89
|
| Rate for Payer: Lucent All Commercial |
$1,783.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,973.16
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
| Rate for Payer: United Healthcare Medicare |
$1,154.28
|
|
|
HC Z PLATE DIST HUM LAT 9H R
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.37 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$3,022.13
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
|
|
HC Z PLATE DIST HUM MED 10H L
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.37 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$3,022.13
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
|
|
HC Z PLATE DIST HUM MED 10H L
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$2,952.17
|
| Rate for Payer: Aetna Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,186.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,269.71
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Centivo All Commercial |
$1,783.89
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Humana Medicare |
$1,783.89
|
| Rate for Payer: Lucent All Commercial |
$1,783.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,973.16
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
| Rate for Payer: United Healthcare Medicare |
$1,154.28
|
|
|
HC Z PLATE DIST HUM MED 10H R
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$2,952.17
|
| Rate for Payer: Aetna Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,154.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,186.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,327.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,269.71
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Centivo All Commercial |
$1,783.89
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Humana Medicare |
$1,783.89
|
| Rate for Payer: Lucent All Commercial |
$1,783.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,364.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,973.16
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
| Rate for Payer: United Healthcare Medicare |
$1,154.28
|
|
|
HC Z PLATE DIST HUM MED 10H R
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.37 |
| Max. Negotiated Rate |
$3,252.98 |
| Rate for Payer: Aetna Commercial |
$3,022.13
|
| Rate for Payer: Cash Price |
$2,168.66
|
| Rate for Payer: Cigna All Commercial |
$3,018.63
|
| Rate for Payer: CORVEL All Commercial |
$3,252.98
|
| Rate for Payer: Coventry All Commercial |
$3,078.09
|
| Rate for Payer: Encore All Commercial |
$3,219.75
|
| Rate for Payer: Frontpath All Commercial |
$3,218.00
|
| Rate for Payer: Humana ChoiceCare |
$3,021.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,148.05
|
| Rate for Payer: PHCS All Commercial |
$2,623.37
|
| Rate for Payer: PHP All Commercial |
$2,652.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,700.32
|
| Rate for Payer: Signature Care EPO |
$2,903.20
|
| Rate for Payer: Signature Care PPO |
$3,078.09
|
| Rate for Payer: United Healthcare Commercial |
$2,756.29
|
|
