|
HC ACU 2 VDR PLT STD LONG L
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT STD LONG L
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PLT STD LONG R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PLT STD LONG R
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT STD R
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT STD R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PLT WIDE L
|
Facility
IP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.00 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,825.79
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
|
|
HC ACU 2 VDR PLT WIDE L
|
Facility
OP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,737.23
|
| Rate for Payer: Aetna Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,543.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,767.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,680.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,607.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Centivo All Commercial |
$2,258.28
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Humana Medicare |
$2,258.28
|
| Rate for Payer: Lucent All Commercial |
$2,258.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,726.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
| Rate for Payer: United Healthcare Medicare |
$1,461.24
|
|
|
HC ACU 2 VDR PLT WIDE R
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PLT WIDE R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PROX PLT NARR L
|
Facility
OP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,737.23
|
| Rate for Payer: Aetna Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,543.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,767.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,680.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,607.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Centivo All Commercial |
$2,258.28
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Humana Medicare |
$2,258.28
|
| Rate for Payer: Lucent All Commercial |
$2,258.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,726.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
| Rate for Payer: United Healthcare Medicare |
$1,461.24
|
|
|
HC ACU 2 VDR PROX PLT NARR L
|
Facility
IP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.00 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,825.79
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
|
|
HC ACU 2 VDR PROX PLT NARR R
|
Facility
OP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,737.23
|
| Rate for Payer: Aetna Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,543.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,767.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,680.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,607.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Centivo All Commercial |
$2,258.28
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Humana Medicare |
$2,258.28
|
| Rate for Payer: Lucent All Commercial |
$2,258.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,726.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
| Rate for Payer: United Healthcare Medicare |
$1,461.24
|
|
|
HC ACU 2 VDR PROX PLT NARR R
|
Facility
IP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.00 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,825.79
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
|
|
HC ACU 2 VDR PROX PLT STD L
|
Facility
OP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,737.23
|
| Rate for Payer: Aetna Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,543.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,767.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,680.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,607.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Centivo All Commercial |
$2,258.28
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Humana Medicare |
$2,258.28
|
| Rate for Payer: Lucent All Commercial |
$2,258.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,726.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
| Rate for Payer: United Healthcare Medicare |
$1,461.24
|
|
|
HC ACU 2 VDR PROX PLT STD L
|
Facility
IP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.00 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,825.79
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
|
|
HC ACU 2 VDR PROX PLT STD, R
|
Facility
OP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,737.23
|
| Rate for Payer: Aetna Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,461.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,543.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,767.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,680.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,607.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Centivo All Commercial |
$2,258.28
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Humana Medicare |
$2,258.28
|
| Rate for Payer: Lucent All Commercial |
$2,258.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,726.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
| Rate for Payer: United Healthcare Medicare |
$1,461.24
|
|
|
HC ACU 2 VDR PROX PLT STD, R
|
Facility
IP
|
$4,428.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.00 |
| Max. Negotiated Rate |
$4,118.04 |
| Rate for Payer: Aetna Commercial |
$3,825.79
|
| Rate for Payer: Cash Price |
$2,745.36
|
| Rate for Payer: Cigna All Commercial |
$3,821.36
|
| Rate for Payer: CORVEL All Commercial |
$4,118.04
|
| Rate for Payer: Coventry All Commercial |
$3,896.64
|
| Rate for Payer: Encore All Commercial |
$4,075.97
|
| Rate for Payer: Frontpath All Commercial |
$4,073.76
|
| Rate for Payer: Humana ChoiceCare |
$3,824.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,985.20
|
| Rate for Payer: PHCS All Commercial |
$3,321.00
|
| Rate for Payer: PHP All Commercial |
$3,358.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,418.42
|
| Rate for Payer: Signature Care EPO |
$3,675.24
|
| Rate for Payer: Signature Care PPO |
$3,896.64
|
| Rate for Payer: United Healthcare Commercial |
$3,489.26
|
|
|
HC ACU 2 VDR PROX PLT WIDE L
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PROX PLT WIDE L
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PROX PLT WIDE R
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PROX PLT WIDE R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PR PLT NARR LONG L
|
Facility
OP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,830.69
|
| Rate for Payer: Aetna Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,279.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,967.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,318.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,621.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,507.75
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Centivo All Commercial |
$3,523.28
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Humana Medicare |
$3,523.28
|
| Rate for Payer: Lucent All Commercial |
$3,523.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,694.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,872.14
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
| Rate for Payer: United Healthcare Medicare |
$2,279.77
|
|
|
HC ACU 2 VDR PR PLT NARR LONG L
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
|
HC ACU 2 VDR PR PLT NARR LONG R
|
Facility
IP
|
$6,908.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.30 |
| Max. Negotiated Rate |
$6,424.81 |
| Rate for Payer: Aetna Commercial |
$5,968.86
|
| Rate for Payer: Cash Price |
$4,283.21
|
| Rate for Payer: Cigna All Commercial |
$5,961.95
|
| Rate for Payer: CORVEL All Commercial |
$6,424.81
|
| Rate for Payer: Coventry All Commercial |
$6,079.39
|
| Rate for Payer: Encore All Commercial |
$6,359.18
|
| Rate for Payer: Frontpath All Commercial |
$6,355.73
|
| Rate for Payer: Humana ChoiceCare |
$5,966.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,217.56
|
| Rate for Payer: PHCS All Commercial |
$5,181.30
|
| Rate for Payer: PHP All Commercial |
$5,239.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,333.28
|
| Rate for Payer: Signature Care EPO |
$5,733.97
|
| Rate for Payer: Signature Care PPO |
$6,079.39
|
| Rate for Payer: United Healthcare Commercial |
$5,443.82
|
|
