|
HC Z PSN POLY MC 6-7/EF L
|
Facility
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607880
|
|
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 STEM 12X175
|
Facility
OP
|
$9,472.32
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,809.26 |
| Rate for Payer: Aetna Commercial |
$7,994.64
|
| Rate for Payer: Aetna Medicare |
$3,125.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,125.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,439.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,921.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,594.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,438.45
|
| Rate for Payer: Cash Price |
$5,872.84
|
| Rate for Payer: Cash Price |
$5,872.84
|
| Rate for Payer: Centivo All Commercial |
$4,830.88
|
| Rate for Payer: Cigna All Commercial |
$8,174.61
|
| Rate for Payer: CORVEL All Commercial |
$8,809.26
|
| Rate for Payer: Coventry All Commercial |
$8,335.64
|
| Rate for Payer: Encore All Commercial |
$8,719.27
|
| Rate for Payer: Frontpath All Commercial |
$8,714.53
|
| Rate for Payer: Humana ChoiceCare |
$8,181.24
|
| Rate for Payer: Humana Medicare |
$4,830.88
|
| Rate for Payer: Lucent All Commercial |
$4,830.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,525.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,104.24
|
| Rate for Payer: PHP All Commercial |
$7,183.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,694.20
|
| Rate for Payer: Sagamore Health Network All Products |
$7,312.63
|
| Rate for Payer: Signature Care EPO |
$7,862.03
|
| Rate for Payer: Signature Care PPO |
$8,335.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,051.47
|
| Rate for Payer: United Healthcare Commercial |
$7,464.19
|
| Rate for Payer: United Healthcare Medicare |
$3,125.87
|
|
|
HC Z PSN STEM 12X175
|
Facility
IP
|
$9,472.32
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,104.24 |
| Max. Negotiated Rate |
$8,809.26 |
| Rate for Payer: Aetna Commercial |
$8,184.08
|
| Rate for Payer: Cash Price |
$5,872.84
|
| Rate for Payer: Cigna All Commercial |
$8,174.61
|
| Rate for Payer: CORVEL All Commercial |
$8,809.26
|
| Rate for Payer: Coventry All Commercial |
$8,335.64
|
| Rate for Payer: Encore All Commercial |
$8,719.27
|
| Rate for Payer: Frontpath All Commercial |
$8,714.53
|
| Rate for Payer: Humana ChoiceCare |
$8,181.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,525.09
|
| Rate for Payer: PHCS All Commercial |
$7,104.24
|
| Rate for Payer: PHP All Commercial |
$7,183.81
|
| Rate for Payer: Sagamore Health Network All Products |
$7,312.63
|
| Rate for Payer: Signature Care EPO |
$7,862.03
|
| Rate for Payer: Signature Care PPO |
$8,335.64
|
| Rate for Payer: United Healthcare Commercial |
$7,464.19
|
|
|
HC Z PSN STEM 14X30
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607386
|
|
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 STEM 14X30
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607386
|
|
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 TIB FIXED E L
|
Facility
OP
|
$9,290.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,639.85 |
| Rate for Payer: Aetna Commercial |
$7,840.90
|
| Rate for Payer: Aetna Medicare |
$3,065.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,065.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,335.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,807.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,525.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,372.33
|
| Rate for Payer: Cash Price |
$5,759.90
|
| Rate for Payer: Cash Price |
$5,759.90
|
| Rate for Payer: Centivo All Commercial |
$4,737.98
|
| Rate for Payer: Cigna All Commercial |
$8,017.41
|
| Rate for Payer: CORVEL All Commercial |
$8,639.85
|
| Rate for Payer: Coventry All Commercial |
$8,175.34
|
| Rate for Payer: Encore All Commercial |
$8,551.59
|
| Rate for Payer: Frontpath All Commercial |
$8,546.95
|
| Rate for Payer: Humana ChoiceCare |
$8,023.91
|
| Rate for Payer: Humana Medicare |
$4,737.98
|
| Rate for Payer: Lucent All Commercial |
$4,737.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,361.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,967.62
|
| Rate for Payer: PHP All Commercial |
$7,045.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,623.16
|
| Rate for Payer: Sagamore Health Network All Products |
$7,172.00
|
| Rate for Payer: Signature Care EPO |
$7,710.83
|
| Rate for Payer: Signature Care PPO |
$8,175.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,896.64
|
| Rate for Payer: United Healthcare Commercial |
$7,320.65
|
| Rate for Payer: United Healthcare Medicare |
$3,065.75
|
|
|
HC Z PSN TIB FIXED E L
|
Facility
IP
|
$9,290.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,967.62 |
| Max. Negotiated Rate |
$8,639.85 |
| Rate for Payer: Aetna Commercial |
$8,026.70
|
| Rate for Payer: Cash Price |
$5,759.90
|
| Rate for Payer: Cigna All Commercial |
$8,017.41
|
| Rate for Payer: CORVEL All Commercial |
$8,639.85
|
| Rate for Payer: Coventry All Commercial |
$8,175.34
|
| Rate for Payer: Encore All Commercial |
$8,551.59
|
| Rate for Payer: Frontpath All Commercial |
$8,546.95
|
| Rate for Payer: Humana ChoiceCare |
$8,023.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,361.14
|
| Rate for Payer: PHCS All Commercial |
$6,967.62
|
| Rate for Payer: PHP All Commercial |
$7,045.66
|
| Rate for Payer: Sagamore Health Network All Products |
$7,172.00
|
| Rate for Payer: Signature Care EPO |
$7,710.83
|
| Rate for Payer: Signature Care PPO |
$8,175.34
|
| Rate for Payer: United Healthcare Commercial |
$7,320.65
|
|
|
HC Z PSN TIB KEL SZ E 0 DEG R
|
Facility
OP
|
$5,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,407.02 |
| Rate for Payer: Aetna Commercial |
$4,907.02
|
| Rate for Payer: Aetna Medicare |
$1,918.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,918.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,338.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,634.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,206.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,110.48
|
| Rate for Payer: Cash Price |
$3,604.68
|
| Rate for Payer: Cash Price |
$3,604.68
|
| Rate for Payer: Centivo All Commercial |
$2,965.14
|
| Rate for Payer: Cigna All Commercial |
$5,017.48
|
| Rate for Payer: CORVEL All Commercial |
$5,407.02
|
| Rate for Payer: Coventry All Commercial |
$5,116.32
|
| Rate for Payer: Encore All Commercial |
$5,351.79
|
| Rate for Payer: Frontpath All Commercial |
$5,348.88
|
| Rate for Payer: Humana ChoiceCare |
$5,021.55
|
| Rate for Payer: Humana Medicare |
$2,965.14
|
| Rate for Payer: Lucent All Commercial |
$2,965.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,232.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,360.50
|
| Rate for Payer: PHP All Commercial |
$4,409.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,267.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4,488.41
|
| Rate for Payer: Signature Care EPO |
$4,825.62
|
| Rate for Payer: Signature Care PPO |
$5,116.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,941.90
|
| Rate for Payer: United Healthcare Commercial |
$4,581.43
|
| Rate for Payer: United Healthcare Medicare |
$1,918.62
|
|
|
HC Z PSN TIB KEL SZ E 0 DEG R
|
Facility
IP
|
$5,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,360.50 |
| Max. Negotiated Rate |
$5,407.02 |
| Rate for Payer: Aetna Commercial |
$5,023.30
|
| Rate for Payer: Cash Price |
$3,604.68
|
| Rate for Payer: Cigna All Commercial |
$5,017.48
|
| Rate for Payer: CORVEL All Commercial |
$5,407.02
|
| Rate for Payer: Coventry All Commercial |
$5,116.32
|
| Rate for Payer: Encore All Commercial |
$5,351.79
|
| Rate for Payer: Frontpath All Commercial |
$5,348.88
|
| Rate for Payer: Humana ChoiceCare |
$5,021.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,232.60
|
| Rate for Payer: PHCS All Commercial |
$4,360.50
|
| Rate for Payer: PHP All Commercial |
$4,409.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4,488.41
|
| Rate for Payer: Signature Care EPO |
$4,825.62
|
| Rate for Payer: Signature Care PPO |
$5,116.32
|
| Rate for Payer: United Healthcare Commercial |
$4,581.43
|
|
|
HC Z PSN TIB KEL SZ G 0 DEG R
|
Facility
OP
|
$5,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,407.02 |
| Rate for Payer: Aetna Commercial |
$4,907.02
|
| Rate for Payer: Aetna Medicare |
$1,918.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,918.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,338.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,634.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,206.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,110.48
|
| Rate for Payer: Cash Price |
$3,604.68
|
| Rate for Payer: Cash Price |
$3,604.68
|
| Rate for Payer: Centivo All Commercial |
$2,965.14
|
| Rate for Payer: Cigna All Commercial |
$5,017.48
|
| Rate for Payer: CORVEL All Commercial |
$5,407.02
|
| Rate for Payer: Coventry All Commercial |
$5,116.32
|
| Rate for Payer: Encore All Commercial |
$5,351.79
|
| Rate for Payer: Frontpath All Commercial |
$5,348.88
|
| Rate for Payer: Humana ChoiceCare |
$5,021.55
|
| Rate for Payer: Humana Medicare |
$2,965.14
|
| Rate for Payer: Lucent All Commercial |
$2,965.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,232.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,360.50
|
| Rate for Payer: PHP All Commercial |
$4,409.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,267.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4,488.41
|
| Rate for Payer: Signature Care EPO |
$4,825.62
|
| Rate for Payer: Signature Care PPO |
$5,116.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,941.90
|
| Rate for Payer: United Healthcare Commercial |
$4,581.43
|
| Rate for Payer: United Healthcare Medicare |
$1,918.62
|
|
|
HC Z PSN TIB KEL SZ G 0 DEG R
|
Facility
IP
|
$5,814.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,360.50 |
| Max. Negotiated Rate |
$5,407.02 |
| Rate for Payer: Aetna Commercial |
$5,023.30
|
| Rate for Payer: Cash Price |
$3,604.68
|
| Rate for Payer: Cigna All Commercial |
$5,017.48
|
| Rate for Payer: CORVEL All Commercial |
$5,407.02
|
| Rate for Payer: Coventry All Commercial |
$5,116.32
|
| Rate for Payer: Encore All Commercial |
$5,351.79
|
| Rate for Payer: Frontpath All Commercial |
$5,348.88
|
| Rate for Payer: Humana ChoiceCare |
$5,021.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,232.60
|
| Rate for Payer: PHCS All Commercial |
$4,360.50
|
| Rate for Payer: PHP All Commercial |
$4,409.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4,488.41
|
| Rate for Payer: Signature Care EPO |
$4,825.62
|
| Rate for Payer: Signature Care PPO |
$5,116.32
|
| Rate for Payer: United Healthcare Commercial |
$4,581.43
|
|
|
HC Z PSN TIB SPK SZ E 0 DEG L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607951
|
|
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 TIB SPK SZ E 0 DEG L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607951
|
|
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 TIB SPK SZ E 0 DEG R
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608044
|
|
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 TIB SPK SZ E 0 DEG R
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608044
|
|
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 TIB SPK SZ F 0 DEG L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608045
|
|
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 TIB SPK SZ F 0 DEG L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608045
|
|
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 TIB SPK SZ G 0 DEG L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608068
|
|
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 TIB SPK SZ G 0 DEG L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608078
|
|
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 TIB SPK SZ G 0 DEG L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608078
|
|
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 TIB SPK SZ G 0 DEG L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608068
|
|
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 TIB SPK SZ G 0 DEG R
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608051
|
|
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 TIB SPK SZ G 0 DEG R
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608051
|
|
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 TIB SPK SZ H 0 DEG L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608340
|
|
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 TIB SPK SZ H 0 DEG L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608340
|
|
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
|
|
