HC Z SM AUG BASEPLATE
|
Facility
IP
|
$8,694.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607139
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6,520.50 |
Max. Negotiated Rate |
$8,085.42 |
Rate for Payer: Aetna Commercial |
$7,511.62
|
Rate for Payer: Cash Price |
$5,390.28
|
Rate for Payer: Cigna All Commercial |
$7,502.92
|
Rate for Payer: CORVEL All Commercial |
$8,085.42
|
Rate for Payer: Coventry All Commercial |
$7,650.72
|
Rate for Payer: Encore All Commercial |
$8,002.83
|
Rate for Payer: Frontpath All Commercial |
$7,998.48
|
Rate for Payer: Humana ChoiceCare |
$7,509.01
|
Rate for Payer: Lutheran Preferred All Commercial |
$7,824.60
|
Rate for Payer: PHCS All Commercial |
$6,520.50
|
Rate for Payer: PHP All Commercial |
$6,593.53
|
Rate for Payer: Sagamore Health Network All Products |
$6,711.77
|
Rate for Payer: Signature Care EPO |
$7,216.02
|
Rate for Payer: Signature Care PPO |
$7,650.72
|
Rate for Payer: United Healthcare Commercial |
$6,850.87
|
|
HC Z STEM HUM 160 MICRO
|
Facility
IP
|
$16,560.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41608198
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12,420.00 |
Max. Negotiated Rate |
$15,400.80 |
Rate for Payer: Aetna Commercial |
$14,307.84
|
Rate for Payer: Cash Price |
$10,267.20
|
Rate for Payer: Cigna All Commercial |
$14,291.28
|
Rate for Payer: CORVEL All Commercial |
$15,400.80
|
Rate for Payer: Coventry All Commercial |
$14,572.80
|
Rate for Payer: Encore All Commercial |
$15,243.48
|
Rate for Payer: Frontpath All Commercial |
$15,235.20
|
Rate for Payer: Humana ChoiceCare |
$14,302.87
|
Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
Rate for Payer: PHCS All Commercial |
$12,420.00
|
Rate for Payer: PHP All Commercial |
$12,559.10
|
Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
Rate for Payer: Signature Care EPO |
$13,744.80
|
Rate for Payer: Signature Care PPO |
$14,572.80
|
Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
HC Z STEM HUM 160 MICRO
|
Facility
OP
|
$16,560.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41608198
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$15,400.80 |
Rate for Payer: Aetna Commercial |
$13,976.64
|
Rate for Payer: Aetna Medicare |
$5,464.80
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,464.80
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9,510.41
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,284.52
|
Rate for Payer: CareSource Indiana of IN Medicare |
$6,011.28
|
Rate for Payer: Cash Price |
$10,267.20
|
Rate for Payer: Cash Price |
$10,267.20
|
Rate for Payer: Centivo All Commercial |
$8,445.60
|
Rate for Payer: Cigna All Commercial |
$14,291.28
|
Rate for Payer: CORVEL All Commercial |
$15,400.80
|
Rate for Payer: Coventry All Commercial |
$14,572.80
|
Rate for Payer: Encore All Commercial |
$15,243.48
|
Rate for Payer: Frontpath All Commercial |
$15,235.20
|
Rate for Payer: Humana ChoiceCare |
$14,302.87
|
Rate for Payer: Humana Medicare |
$8,445.60
|
Rate for Payer: Lucent All Commercial |
$8,445.60
|
Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$12,420.00
|
Rate for Payer: PHP All Commercial |
$12,559.10
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
Rate for Payer: Signature Care EPO |
$13,744.80
|
Rate for Payer: Signature Care PPO |
$14,572.80
|
Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
Rate for Payer: United Healthcare Commercial |
$13,049.28
|
Rate for Payer: United Healthcare Medicare |
$5,464.80
|
|
HC Z STEM PRIMARY 10 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607065
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 10 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607065
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 11 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607503
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 11 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607503
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 12 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607137
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 12 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607137
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 13 EXT
|
Facility
IP
|
$9,273.60
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607429
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6,955.20 |
Max. Negotiated Rate |
$8,624.45 |
Rate for Payer: Aetna Commercial |
$8,012.39
|
Rate for Payer: Cash Price |
$5,749.63
|
Rate for Payer: Cigna All Commercial |
$8,003.12
|
Rate for Payer: CORVEL All Commercial |
$8,624.45
|
Rate for Payer: Coventry All Commercial |
$8,160.77
|
Rate for Payer: Encore All Commercial |
$8,536.35
|
Rate for Payer: Frontpath All Commercial |
$8,531.71
|
Rate for Payer: Humana ChoiceCare |
$8,009.61
|
Rate for Payer: Lutheran Preferred All Commercial |
$8,346.24
|
Rate for Payer: PHCS All Commercial |
$6,955.20
|
Rate for Payer: PHP All Commercial |
$7,033.10
|
Rate for Payer: Sagamore Health Network All Products |
$7,159.22
|
Rate for Payer: Signature Care EPO |
$7,697.09
|
Rate for Payer: Signature Care PPO |
$8,160.77
|
Rate for Payer: United Healthcare Commercial |
$7,307.60
|
|
HC Z STEM PRIMARY 13 EXT
|
Facility
OP
|
$9,273.60
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607429
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$8,624.45 |
Rate for Payer: Aetna Commercial |
$7,826.92
|
Rate for Payer: Aetna Medicare |
$3,060.29
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,060.29
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,325.83
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,796.93
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,519.33
|
Rate for Payer: CareSource Indiana of IN Medicare |
$3,366.32
|
Rate for Payer: Cash Price |
$5,749.63
|
Rate for Payer: Cash Price |
$5,749.63
|
Rate for Payer: Centivo All Commercial |
$4,729.54
|
Rate for Payer: Cigna All Commercial |
$8,003.12
|
Rate for Payer: CORVEL All Commercial |
$8,624.45
|
Rate for Payer: Coventry All Commercial |
$8,160.77
|
Rate for Payer: Encore All Commercial |
$8,536.35
|
Rate for Payer: Frontpath All Commercial |
$8,531.71
|
Rate for Payer: Humana ChoiceCare |
$8,009.61
|
Rate for Payer: Humana Medicare |
$4,729.54
|
Rate for Payer: Lucent All Commercial |
$4,729.54
|
Rate for Payer: Lutheran Preferred All Commercial |
$8,346.24
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$6,955.20
|
Rate for Payer: PHP All Commercial |
$7,033.10
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$3,616.70
|
Rate for Payer: Sagamore Health Network All Products |
$7,159.22
|
Rate for Payer: Signature Care EPO |
$7,697.09
|
Rate for Payer: Signature Care PPO |
$8,160.77
|
Rate for Payer: Three Rivers Preferred All Commercial |
$7,882.56
|
Rate for Payer: United Healthcare Commercial |
$7,307.60
|
Rate for Payer: United Healthcare Medicare |
$3,060.29
|
|
HC Z STEM PRIMARY 13 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607505
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 13 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607505
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 14 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 14 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 15 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607033
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 15 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607033
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 16 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607138
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 16 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607138
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 17 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 17 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 18 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607073
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 18 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41607073
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
HC Z STEM PRIMARY 8 MICRO
|
Facility
OP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41608009
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$9,979.32
|
Rate for Payer: Aetna Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Centivo All Commercial |
$6,030.16
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Humana Medicare |
$6,030.16
|
Rate for Payer: Lucent All Commercial |
$6,030.16
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
HC Z STEM PRIMARY 8 MICRO
|
Facility
IP
|
$11,823.84
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41608009
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,867.88 |
Max. Negotiated Rate |
$10,996.17 |
Rate for Payer: Aetna Commercial |
$10,215.80
|
Rate for Payer: Cash Price |
$7,330.78
|
Rate for Payer: Cigna All Commercial |
$10,203.97
|
Rate for Payer: CORVEL All Commercial |
$10,996.17
|
Rate for Payer: Coventry All Commercial |
$10,404.98
|
Rate for Payer: Encore All Commercial |
$10,883.84
|
Rate for Payer: Frontpath All Commercial |
$10,877.93
|
Rate for Payer: Humana ChoiceCare |
$10,212.25
|
Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
Rate for Payer: PHCS All Commercial |
$8,867.88
|
Rate for Payer: PHP All Commercial |
$8,967.20
|
Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
Rate for Payer: Signature Care EPO |
$9,813.79
|
Rate for Payer: Signature Care PPO |
$10,404.98
|
Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|