|
HC Z PLATE DIST HUM MED 9H L
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606739
|
|
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 9H L
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606739
|
|
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 9H R
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606737
|
|
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 9H R
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606737
|
|
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 POSTLAT 11H L
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606730
|
|
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 POSTLAT 11H L
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606730
|
|
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 POSTLAT 11H R
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606728
|
|
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 POSTLAT 11H R
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606728
|
|
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 POSTLAT 17H R
|
Facility
OP
|
$3,897.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,624.94 |
| Rate for Payer: Aetna Commercial |
$3,289.73
|
| Rate for Payer: Aetna Medicare |
$1,286.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,286.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,238.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,436.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,479.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,414.90
|
| Rate for Payer: Cash Price |
$2,416.63
|
| Rate for Payer: Cash Price |
$2,416.63
|
| Rate for Payer: Centivo All Commercial |
$1,987.87
|
| Rate for Payer: Cigna All Commercial |
$3,363.79
|
| Rate for Payer: CORVEL All Commercial |
$3,624.94
|
| Rate for Payer: Coventry All Commercial |
$3,430.06
|
| Rate for Payer: Encore All Commercial |
$3,587.92
|
| Rate for Payer: Frontpath All Commercial |
$3,585.97
|
| Rate for Payer: Humana ChoiceCare |
$3,366.52
|
| Rate for Payer: Humana Medicare |
$1,987.87
|
| Rate for Payer: Lucent All Commercial |
$1,987.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,508.01
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,923.34
|
| Rate for Payer: PHP All Commercial |
$2,956.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,520.14
|
| Rate for Payer: Sagamore Health Network All Products |
$3,009.09
|
| Rate for Payer: Signature Care EPO |
$3,235.17
|
| Rate for Payer: Signature Care PPO |
$3,430.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,313.12
|
| Rate for Payer: United Healthcare Commercial |
$3,071.46
|
| Rate for Payer: United Healthcare Medicare |
$1,286.27
|
|
|
HC Z PLATE DIST HUM POSTLAT 17H R
|
Facility
IP
|
$3,897.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,923.34 |
| Max. Negotiated Rate |
$3,624.94 |
| Rate for Payer: Aetna Commercial |
$3,367.69
|
| Rate for Payer: Cash Price |
$2,416.63
|
| Rate for Payer: Cigna All Commercial |
$3,363.79
|
| Rate for Payer: CORVEL All Commercial |
$3,624.94
|
| Rate for Payer: Coventry All Commercial |
$3,430.06
|
| Rate for Payer: Encore All Commercial |
$3,587.92
|
| Rate for Payer: Frontpath All Commercial |
$3,585.97
|
| Rate for Payer: Humana ChoiceCare |
$3,366.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,508.01
|
| Rate for Payer: PHCS All Commercial |
$2,923.34
|
| Rate for Payer: PHP All Commercial |
$2,956.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3,009.09
|
| Rate for Payer: Signature Care EPO |
$3,235.17
|
| Rate for Payer: Signature Care PPO |
$3,430.06
|
| Rate for Payer: United Healthcare Commercial |
$3,071.46
|
|
|
HC Z PLATE DIST HUM POSTLAT 9H L
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606729
|
|
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 POSTLAT 9H L
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606729
|
|
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 POSTLAT 9H R
|
Facility
IP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606727
|
|
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 POSTLAT 9H R
|
Facility
OP
|
$3,497.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606727
|
|
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 LAT FEM 10H LK R
|
Facility
OP
|
$5,033.38
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606945
|
|
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 LAT FEM 10H LK R
|
Facility
IP
|
$5,033.38
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606945
|
|
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 LAT HUM 5H LT
|
Facility
OP
|
$2,948.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,741.78 |
| Rate for Payer: Aetna Commercial |
$2,488.24
|
| Rate for Payer: Aetna Medicare |
$972.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$972.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,693.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,842.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,118.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,070.18
|
| Rate for Payer: Cash Price |
$1,827.85
|
| Rate for Payer: Cash Price |
$1,827.85
|
| Rate for Payer: Centivo All Commercial |
$1,503.56
|
| Rate for Payer: Cigna All Commercial |
$2,544.25
|
| Rate for Payer: CORVEL All Commercial |
$2,741.78
|
| Rate for Payer: Coventry All Commercial |
$2,594.37
|
| Rate for Payer: Encore All Commercial |
$2,713.77
|
| Rate for Payer: Frontpath All Commercial |
$2,712.30
|
| Rate for Payer: Humana ChoiceCare |
$2,546.32
|
| Rate for Payer: Humana Medicare |
$1,503.56
|
| Rate for Payer: Lucent All Commercial |
$1,503.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,653.34
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,211.11
|
| Rate for Payer: PHP All Commercial |
$2,235.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,149.78
|
| Rate for Payer: Sagamore Health Network All Products |
$2,275.97
|
| Rate for Payer: Signature Care EPO |
$2,446.96
|
| Rate for Payer: Signature Care PPO |
$2,594.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,505.93
|
| Rate for Payer: United Healthcare Commercial |
$2,323.14
|
| Rate for Payer: United Healthcare Medicare |
$972.89
|
|
|
HC Z PLATE DIST LAT HUM 5H LT
|
Facility
IP
|
$2,948.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,211.11 |
| Max. Negotiated Rate |
$2,741.78 |
| Rate for Payer: Aetna Commercial |
$2,547.20
|
| Rate for Payer: Cash Price |
$1,827.85
|
| Rate for Payer: Cigna All Commercial |
$2,544.25
|
| Rate for Payer: CORVEL All Commercial |
$2,741.78
|
| Rate for Payer: Coventry All Commercial |
$2,594.37
|
| Rate for Payer: Encore All Commercial |
$2,713.77
|
| Rate for Payer: Frontpath All Commercial |
$2,712.30
|
| Rate for Payer: Humana ChoiceCare |
$2,546.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,653.34
|
| Rate for Payer: PHCS All Commercial |
$2,211.11
|
| Rate for Payer: PHP All Commercial |
$2,235.88
|
| Rate for Payer: Sagamore Health Network All Products |
$2,275.97
|
| Rate for Payer: Signature Care EPO |
$2,446.96
|
| Rate for Payer: Signature Care PPO |
$2,594.37
|
| Rate for Payer: United Healthcare Commercial |
$2,323.14
|
|
|
HC Z PLATE DIST MED HUM 3H LT
|
Facility
OP
|
$2,828.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,630.32 |
| Rate for Payer: Aetna Commercial |
$2,387.09
|
| Rate for Payer: Aetna Medicare |
$933.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$933.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,624.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,767.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,073.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,026.67
|
| Rate for Payer: Cash Price |
$1,753.55
|
| Rate for Payer: Cash Price |
$1,753.55
|
| Rate for Payer: Centivo All Commercial |
$1,442.43
|
| Rate for Payer: Cigna All Commercial |
$2,440.82
|
| Rate for Payer: CORVEL All Commercial |
$2,630.32
|
| Rate for Payer: Coventry All Commercial |
$2,488.90
|
| Rate for Payer: Encore All Commercial |
$2,603.45
|
| Rate for Payer: Frontpath All Commercial |
$2,602.04
|
| Rate for Payer: Humana ChoiceCare |
$2,442.80
|
| Rate for Payer: Humana Medicare |
$1,442.43
|
| Rate for Payer: Lucent All Commercial |
$1,442.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,545.47
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,121.22
|
| Rate for Payer: PHP All Commercial |
$2,144.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,103.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,183.45
|
| Rate for Payer: Signature Care EPO |
$2,347.49
|
| Rate for Payer: Signature Care PPO |
$2,488.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,404.06
|
| Rate for Payer: United Healthcare Commercial |
$2,228.70
|
| Rate for Payer: United Healthcare Medicare |
$933.34
|
|
|
HC Z PLATE DIST MED HUM 3H LT
|
Facility
IP
|
$2,828.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.22 |
| Max. Negotiated Rate |
$2,630.32 |
| Rate for Payer: Aetna Commercial |
$2,443.65
|
| Rate for Payer: Cash Price |
$1,753.55
|
| Rate for Payer: Cigna All Commercial |
$2,440.82
|
| Rate for Payer: CORVEL All Commercial |
$2,630.32
|
| Rate for Payer: Coventry All Commercial |
$2,488.90
|
| Rate for Payer: Encore All Commercial |
$2,603.45
|
| Rate for Payer: Frontpath All Commercial |
$2,602.04
|
| Rate for Payer: Humana ChoiceCare |
$2,442.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,545.47
|
| Rate for Payer: PHCS All Commercial |
$2,121.22
|
| Rate for Payer: PHP All Commercial |
$2,144.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,183.45
|
| Rate for Payer: Signature Care EPO |
$2,347.49
|
| Rate for Payer: Signature Care PPO |
$2,488.90
|
| Rate for Payer: United Healthcare Commercial |
$2,228.70
|
|
|
HC Z PLATE DIST MED TIB 6H RT
|
Facility
IP
|
$4,865.62
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,649.22 |
| Max. Negotiated Rate |
$4,525.03 |
| Rate for Payer: Aetna Commercial |
$4,203.90
|
| Rate for Payer: Cash Price |
$3,016.68
|
| Rate for Payer: Cigna All Commercial |
$4,199.03
|
| Rate for Payer: CORVEL All Commercial |
$4,525.03
|
| Rate for Payer: Coventry All Commercial |
$4,281.75
|
| Rate for Payer: Encore All Commercial |
$4,478.80
|
| Rate for Payer: Frontpath All Commercial |
$4,476.37
|
| Rate for Payer: Humana ChoiceCare |
$4,202.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,379.06
|
| Rate for Payer: PHCS All Commercial |
$3,649.22
|
| Rate for Payer: PHP All Commercial |
$3,690.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.26
|
| Rate for Payer: Signature Care EPO |
$4,038.46
|
| Rate for Payer: Signature Care PPO |
$4,281.75
|
| Rate for Payer: United Healthcare Commercial |
$3,834.11
|
|
|
HC Z PLATE DIST MED TIB 6H RT
|
Facility
OP
|
$4,865.62
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,525.03 |
| Rate for Payer: Aetna Commercial |
$4,106.58
|
| Rate for Payer: Aetna Medicare |
$1,605.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,605.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,794.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,846.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,766.22
|
| Rate for Payer: Cash Price |
$3,016.68
|
| Rate for Payer: Cash Price |
$3,016.68
|
| Rate for Payer: Centivo All Commercial |
$2,481.47
|
| Rate for Payer: Cigna All Commercial |
$4,199.03
|
| Rate for Payer: CORVEL All Commercial |
$4,525.03
|
| Rate for Payer: Coventry All Commercial |
$4,281.75
|
| Rate for Payer: Encore All Commercial |
$4,478.80
|
| Rate for Payer: Frontpath All Commercial |
$4,476.37
|
| Rate for Payer: Humana ChoiceCare |
$4,202.44
|
| Rate for Payer: Humana Medicare |
$2,481.47
|
| Rate for Payer: Lucent All Commercial |
$2,481.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,379.06
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,649.22
|
| Rate for Payer: PHP All Commercial |
$3,690.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.26
|
| Rate for Payer: Signature Care EPO |
$4,038.46
|
| Rate for Payer: Signature Care PPO |
$4,281.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.78
|
| Rate for Payer: United Healthcare Commercial |
$3,834.11
|
| Rate for Payer: United Healthcare Medicare |
$1,605.65
|
|
|
HC Z PLATE DIST MED TIB 9H L
|
Facility
OP
|
$5,121.07
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,762.60 |
| Rate for Payer: Aetna Commercial |
$4,322.18
|
| Rate for Payer: Aetna Medicare |
$1,689.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,689.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,941.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,201.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,943.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,858.95
|
| Rate for Payer: Cash Price |
$3,175.06
|
| Rate for Payer: Cash Price |
$3,175.06
|
| Rate for Payer: Centivo All Commercial |
$2,611.75
|
| Rate for Payer: Cigna All Commercial |
$4,419.48
|
| Rate for Payer: CORVEL All Commercial |
$4,762.60
|
| Rate for Payer: Coventry All Commercial |
$4,506.54
|
| Rate for Payer: Encore All Commercial |
$4,713.94
|
| Rate for Payer: Frontpath All Commercial |
$4,711.38
|
| Rate for Payer: Humana ChoiceCare |
$4,423.07
|
| Rate for Payer: Humana Medicare |
$2,611.75
|
| Rate for Payer: Lucent All Commercial |
$2,611.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,608.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,840.80
|
| Rate for Payer: PHP All Commercial |
$3,883.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,997.22
|
| Rate for Payer: Sagamore Health Network All Products |
$3,953.47
|
| Rate for Payer: Signature Care EPO |
$4,250.49
|
| Rate for Payer: Signature Care PPO |
$4,506.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,352.91
|
| Rate for Payer: United Healthcare Commercial |
$4,035.40
|
| Rate for Payer: United Healthcare Medicare |
$1,689.95
|
|
|
HC Z PLATE DIST MED TIB 9H L
|
Facility
IP
|
$5,121.07
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,840.80 |
| Max. Negotiated Rate |
$4,762.60 |
| Rate for Payer: Aetna Commercial |
$4,424.60
|
| Rate for Payer: Cash Price |
$3,175.06
|
| Rate for Payer: Cigna All Commercial |
$4,419.48
|
| Rate for Payer: CORVEL All Commercial |
$4,762.60
|
| Rate for Payer: Coventry All Commercial |
$4,506.54
|
| Rate for Payer: Encore All Commercial |
$4,713.94
|
| Rate for Payer: Frontpath All Commercial |
$4,711.38
|
| Rate for Payer: Humana ChoiceCare |
$4,423.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,608.96
|
| Rate for Payer: PHCS All Commercial |
$3,840.80
|
| Rate for Payer: PHP All Commercial |
$3,883.82
|
| Rate for Payer: Sagamore Health Network All Products |
$3,953.47
|
| Rate for Payer: Signature Care EPO |
$4,250.49
|
| Rate for Payer: Signature Care PPO |
$4,506.54
|
| Rate for Payer: United Healthcare Commercial |
$4,035.40
|
|
|
HC Z PLATE DIST MED TIB 9H R
|
Facility
OP
|
$5,121.07
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,762.60 |
| Rate for Payer: Aetna Commercial |
$4,322.18
|
| Rate for Payer: Aetna Medicare |
$1,689.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,689.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,941.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,201.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,943.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,858.95
|
| Rate for Payer: Cash Price |
$3,175.06
|
| Rate for Payer: Cash Price |
$3,175.06
|
| Rate for Payer: Centivo All Commercial |
$2,611.75
|
| Rate for Payer: Cigna All Commercial |
$4,419.48
|
| Rate for Payer: CORVEL All Commercial |
$4,762.60
|
| Rate for Payer: Coventry All Commercial |
$4,506.54
|
| Rate for Payer: Encore All Commercial |
$4,713.94
|
| Rate for Payer: Frontpath All Commercial |
$4,711.38
|
| Rate for Payer: Humana ChoiceCare |
$4,423.07
|
| Rate for Payer: Humana Medicare |
$2,611.75
|
| Rate for Payer: Lucent All Commercial |
$2,611.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,608.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,840.80
|
| Rate for Payer: PHP All Commercial |
$3,883.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,997.22
|
| Rate for Payer: Sagamore Health Network All Products |
$3,953.47
|
| Rate for Payer: Signature Care EPO |
$4,250.49
|
| Rate for Payer: Signature Care PPO |
$4,506.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,352.91
|
| Rate for Payer: United Healthcare Commercial |
$4,035.40
|
| Rate for Payer: United Healthcare Medicare |
$1,689.95
|
|
