|
HC Z PSN TIB SPK SZ H 0 DEG R
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608195
|
|
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 R
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608195
|
|
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 SZ C 0 DEG R
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608098
|
|
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 SZ C 0 DEG R
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608098
|
|
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 SZ C L 0 DEG
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607958
|
|
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 SZ C L 0 DEG
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607958
|
|
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 SZ D L 0 DEG
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608041
|
|
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 SZ D L 0 DEG
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608041
|
|
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 SZ D R 0 DEG
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607946
|
|
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 SZ D R 0 DEG
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607946
|
|
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 SZ E R 2 PEG
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607824
|
|
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 SZ E R 2 PEG
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607824
|
|
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 SZ F L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607607
|
|
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 SZ F L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607607
|
|
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 SZ F L 2 PEG
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607613
|
|
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 SZ F L 2 PEG
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607613
|
|
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 SZ F R
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607054
|
|
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 SZ F R
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607054
|
|
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 SZ F R 0 DEG
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607956
|
|
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 SZ F R 0 DEG
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607956
|
|
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 SZ G R
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607134
|
|
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 SZ G R
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607134
|
|
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 SZ H 2 PEG L
|
Facility
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608054
|
|
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 SZ H 2 PEG L
|
Facility
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608054
|
|
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 PULSAVAC PLUS FAN KIT
|
Facility
OP
|
$2,047.50
|
|
| Hospital Charge Code |
41603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,904.18 |
| Rate for Payer: Aetna Commercial |
$1,728.09
|
| Rate for Payer: Aetna Medicare |
$675.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$675.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,175.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,279.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$777.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$743.24
|
| Rate for Payer: Cash Price |
$1,269.45
|
| Rate for Payer: Cash Price |
$1,269.45
|
| Rate for Payer: Centivo All Commercial |
$1,044.22
|
| Rate for Payer: Cigna All Commercial |
$1,766.99
|
| Rate for Payer: CORVEL All Commercial |
$1,904.18
|
| Rate for Payer: Coventry All Commercial |
$1,801.80
|
| Rate for Payer: Encore All Commercial |
$1,884.72
|
| Rate for Payer: Frontpath All Commercial |
$1,883.70
|
| Rate for Payer: Humana ChoiceCare |
$1,768.43
|
| Rate for Payer: Humana Medicare |
$1,044.22
|
| Rate for Payer: Lucent All Commercial |
$1,044.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,842.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,535.62
|
| Rate for Payer: PHP All Commercial |
$1,552.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$798.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,580.67
|
| Rate for Payer: Signature Care EPO |
$1,699.42
|
| Rate for Payer: Signature Care PPO |
$1,801.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,740.38
|
| Rate for Payer: United Healthcare Commercial |
$1,613.43
|
| Rate for Payer: United Healthcare Medicare |
$675.68
|
|
