|
HC Z PSN POLY 14 MC 4-5/CD
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607389
|
|
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 14 MC 4-5/CD
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607389
|
|
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 14 MC 4-5/CD R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608264
|
|
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 14 MC 4-5/CD R
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608264
|
|
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 14 MC 6-7/CD
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607731
|
|
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 14 MC 6-7/CD
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607731
|
|
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 14 MC 6-7/CD L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608042
|
|
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 14 MC 6-7/CD L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608042
|
|
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 14 MC 8-11/GH L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608174
|
|
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 14 MC 8-11/GH L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608174
|
|
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 16 MC 6-7/CD L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608199
|
|
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 16 MC 6-7/CD L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608199
|
|
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 16 MC 8-11/EF L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608077
|
|
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 16 MC 8-11/EF L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608077
|
|
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 16 MC 8-11/GH
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608239
|
|
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 16 MC 8-11/GH
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608239
|
|
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 16 MC 8-11 GH R
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608052
|
|
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 16 MC 8-11 GH R
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608052
|
|
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 18 MC 6-7/CD L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608021
|
|
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 18 MC 6-7/CD L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608021
|
|
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 18 MC 8-11/EF L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608083
|
|
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 18 MC 8-11/EF L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608083
|
|
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 8 F LT
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607517
|
|
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 POLY 8 F LT
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607517
|
|
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 POLY MC 6-7/EF L
|
Facility
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607880
|
|
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
|
|
