|
HC Z PSN PART FEM 4 LM
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,967.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,967.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,262.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,164.06
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Centivo All Commercial |
$3,040.42
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$3,040.42
|
| Rate for Payer: Lucent All Commercial |
$3,040.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,967.33
|
|
|
HC Z PSN PART FEM 4 RM
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,471.20 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,150.82
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
|
|
HC Z PSN PART FEM 4 RM
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,967.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,967.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,262.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,164.06
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Centivo All Commercial |
$3,040.42
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$3,040.42
|
| Rate for Payer: Lucent All Commercial |
$3,040.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,967.33
|
|
|
HC Z PSN PART FEM 5 LM
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,471.20 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,150.82
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
|
|
HC Z PSN PART FEM 5 LM
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,967.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,967.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,262.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,164.06
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Cash Price |
$3,696.19
|
| Rate for Payer: Centivo All Commercial |
$3,040.42
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$3,040.42
|
| Rate for Payer: Lucent All Commercial |
$3,040.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,967.33
|
|
|
HC Z PSN PART POLY 10 RM D R
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z PSN PART POLY 10 RM D R
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z PSN PART POLY 8 RM G
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z PSN PART POLY 8 RM G
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z PSN PART POLY 9 LM G
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z PSN PART POLY 9 LM G
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z PSN PART TIB D R
|
Facility
IP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,726.00 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,292.35
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
|
|
HC Z PSN PART TIB D R
|
Facility
OP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,192.99
|
| Rate for Payer: Aetna Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,853.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,105.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,885.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,803.38
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Centivo All Commercial |
$2,533.68
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Humana Medicare |
$2,533.68
|
| Rate for Payer: Lucent All Commercial |
$2,533.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,937.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,222.80
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
| Rate for Payer: United Healthcare Medicare |
$1,639.44
|
|
|
HC Z PSN PART TIB F L
|
Facility
IP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,726.00 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,292.35
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
|
|
HC Z PSN PART TIB F L
|
Facility
OP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,192.99
|
| Rate for Payer: Aetna Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,853.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,105.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,885.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,803.38
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Centivo All Commercial |
$2,533.68
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Humana Medicare |
$2,533.68
|
| Rate for Payer: Lucent All Commercial |
$2,533.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,937.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,222.80
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
| Rate for Payer: United Healthcare Medicare |
$1,639.44
|
|
|
HC Z PSN PART TIB G LM
|
Facility
OP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,192.99
|
| Rate for Payer: Aetna Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,853.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,105.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,885.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,803.38
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Centivo All Commercial |
$2,533.68
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Humana Medicare |
$2,533.68
|
| Rate for Payer: Lucent All Commercial |
$2,533.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,937.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,222.80
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
| Rate for Payer: United Healthcare Medicare |
$1,639.44
|
|
|
HC Z PSN PART TIB G LM
|
Facility
IP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,726.00 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,292.35
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
|
|
HC Z PSN PART TIB G RM
|
Facility
OP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,192.99
|
| Rate for Payer: Aetna Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,639.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,853.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,105.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,885.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,803.38
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Centivo All Commercial |
$2,533.68
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Humana Medicare |
$2,533.68
|
| Rate for Payer: Lucent All Commercial |
$2,533.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,937.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,222.80
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
| Rate for Payer: United Healthcare Medicare |
$1,639.44
|
|
|
HC Z PSN PART TIB G RM
|
Facility
IP
|
$4,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,726.00 |
| Max. Negotiated Rate |
$4,620.24 |
| Rate for Payer: Aetna Commercial |
$4,292.35
|
| Rate for Payer: Cash Price |
$3,080.16
|
| Rate for Payer: Cigna All Commercial |
$4,287.38
|
| Rate for Payer: CORVEL All Commercial |
$4,620.24
|
| Rate for Payer: Coventry All Commercial |
$4,371.84
|
| Rate for Payer: Encore All Commercial |
$4,573.04
|
| Rate for Payer: Frontpath All Commercial |
$4,570.56
|
| Rate for Payer: Humana ChoiceCare |
$4,290.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,471.20
|
| Rate for Payer: PHCS All Commercial |
$3,726.00
|
| Rate for Payer: PHP All Commercial |
$3,767.73
|
| Rate for Payer: Sagamore Health Network All Products |
$3,835.30
|
| Rate for Payer: Signature Care EPO |
$4,123.44
|
| Rate for Payer: Signature Care PPO |
$4,371.84
|
| Rate for Payer: United Healthcare Commercial |
$3,914.78
|
|
|
HC Z PSN POLY 10 MC 4-5/CD
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z PSN POLY 10 MC 4-5/CD
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z PSN POLY 10 MC 4-5/EF R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z PSN POLY 10 MC 4-5/EF R
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z PSN POLY 10 MC 6-11/CD R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC Z PSN POLY 10 MC 6-11/CD R
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
