|
HC AR COMP FT SCRW 4.0 STD 28MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COMP FT SCRW 4.0 STD 30MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR COMP FT SCRW 4.0 STD 30MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COMP FT SCRW 4.0 STD 32MM
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR COMP FT SCRW 4.0 STD 32MM
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR CPR MINI SCORPION SYS
|
Facility
OP
|
$4,888.80
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
41602575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,546.58 |
| Rate for Payer: Aetna Commercial |
$4,126.15
|
| Rate for Payer: Aetna Medicare |
$1,613.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,613.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,807.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,055.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,855.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,774.63
|
| Rate for Payer: Cash Price |
$3,031.06
|
| Rate for Payer: Cash Price |
$3,031.06
|
| Rate for Payer: Centivo All Commercial |
$2,493.29
|
| Rate for Payer: Cigna All Commercial |
$4,219.03
|
| Rate for Payer: CORVEL All Commercial |
$4,546.58
|
| Rate for Payer: Coventry All Commercial |
$4,302.14
|
| Rate for Payer: Encore All Commercial |
$4,500.14
|
| Rate for Payer: Frontpath All Commercial |
$4,497.70
|
| Rate for Payer: Humana ChoiceCare |
$4,222.46
|
| Rate for Payer: Humana Medicare |
$2,493.29
|
| Rate for Payer: Lucent All Commercial |
$2,493.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,399.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,666.60
|
| Rate for Payer: PHP All Commercial |
$3,707.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,906.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,774.15
|
| Rate for Payer: Signature Care EPO |
$4,057.70
|
| Rate for Payer: Signature Care PPO |
$4,302.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,155.48
|
| Rate for Payer: United Healthcare Commercial |
$3,852.37
|
| Rate for Payer: United Healthcare Medicare |
$1,613.30
|
|
|
HC AR CPR MINI SCORPION SYS
|
Facility
IP
|
$4,888.80
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
41602575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,666.60 |
| Max. Negotiated Rate |
$4,546.58 |
| Rate for Payer: Aetna Commercial |
$4,223.92
|
| Rate for Payer: Cash Price |
$3,031.06
|
| Rate for Payer: Cigna All Commercial |
$4,219.03
|
| Rate for Payer: CORVEL All Commercial |
$4,546.58
|
| Rate for Payer: Coventry All Commercial |
$4,302.14
|
| Rate for Payer: Encore All Commercial |
$4,500.14
|
| Rate for Payer: Frontpath All Commercial |
$4,497.70
|
| Rate for Payer: Humana ChoiceCare |
$4,222.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,399.92
|
| Rate for Payer: PHCS All Commercial |
$3,666.60
|
| Rate for Payer: PHP All Commercial |
$3,707.67
|
| Rate for Payer: Sagamore Health Network All Products |
$3,774.15
|
| Rate for Payer: Signature Care EPO |
$4,057.70
|
| Rate for Payer: Signature Care PPO |
$4,302.14
|
| Rate for Payer: United Healthcare Commercial |
$3,852.37
|
|
|
HC AR CRYSTAL CANNULA
|
Facility
IP
|
$192.50
|
|
| Hospital Charge Code |
41607616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$179.02 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cigna All Commercial |
$166.13
|
| Rate for Payer: CORVEL All Commercial |
$179.02
|
| Rate for Payer: Coventry All Commercial |
$169.40
|
| Rate for Payer: Encore All Commercial |
$177.20
|
| Rate for Payer: Frontpath All Commercial |
$177.10
|
| Rate for Payer: Humana ChoiceCare |
$166.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.25
|
| Rate for Payer: PHCS All Commercial |
$144.38
|
| Rate for Payer: PHP All Commercial |
$145.99
|
| Rate for Payer: Sagamore Health Network All Products |
$148.61
|
| Rate for Payer: Signature Care EPO |
$159.78
|
| Rate for Payer: Signature Care PPO |
$169.40
|
| Rate for Payer: United Healthcare Commercial |
$151.69
|
|
|
HC AR CRYSTAL CANNULA
|
Facility
OP
|
$192.50
|
|
| Hospital Charge Code |
41607616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$179.02 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Aetna Medicare |
$63.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.88
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Centivo All Commercial |
$98.18
|
| Rate for Payer: Cigna All Commercial |
$166.13
|
| Rate for Payer: CORVEL All Commercial |
$179.02
|
| Rate for Payer: Coventry All Commercial |
$169.40
|
| Rate for Payer: Encore All Commercial |
$177.20
|
| Rate for Payer: Frontpath All Commercial |
$177.10
|
| Rate for Payer: Humana ChoiceCare |
$166.26
|
| Rate for Payer: Humana Medicare |
$98.18
|
| Rate for Payer: Lucent All Commercial |
$98.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$144.38
|
| Rate for Payer: PHP All Commercial |
$145.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.08
|
| Rate for Payer: Sagamore Health Network All Products |
$148.61
|
| Rate for Payer: Signature Care EPO |
$159.78
|
| Rate for Payer: Signature Care PPO |
$169.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.62
|
| Rate for Payer: United Healthcare Commercial |
$151.69
|
| Rate for Payer: United Healthcare Medicare |
$63.52
|
|
|
HC AR DBL COMP DRILL BIT 2.5 CAL
|
Facility
IP
|
$654.50
|
|
| Hospital Charge Code |
41603295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
|
|
HC AR DBL COMP DRILL BIT 2.5 CAL
|
Facility
OP
|
$654.50
|
|
| Hospital Charge Code |
41603295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$215.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.58
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Cash Price |
$405.79
|
| Rate for Payer: Centivo All Commercial |
$333.80
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Humana Medicare |
$333.80
|
| Rate for Payer: Lucent All Commercial |
$333.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.26
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.32
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$215.98
|
|
|
HC AR DBL COMP PLATE 2H 20MM
|
Facility
IP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC AR DBL COMP PLATE 2H 20MM
|
Facility
OP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC AR DBL COMP PLATE 2H 25MM
|
Facility
IP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC AR DBL COMP PLATE 2H 25MM
|
Facility
OP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC AR DBL COMP PLATE 2H 30MM
|
Facility
IP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.15 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$3,062.19
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
|
|
HC AR DBL COMP PLATE 2H 30MM
|
Facility
OP
|
$3,544.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,296.11 |
| Rate for Payer: Aetna Commercial |
$2,991.30
|
| Rate for Payer: Aetna Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,035.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,215.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,345.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,286.54
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Cash Price |
$2,197.40
|
| Rate for Payer: Centivo All Commercial |
$1,807.54
|
| Rate for Payer: Cigna All Commercial |
$3,058.64
|
| Rate for Payer: CORVEL All Commercial |
$3,296.11
|
| Rate for Payer: Coventry All Commercial |
$3,118.90
|
| Rate for Payer: Encore All Commercial |
$3,262.44
|
| Rate for Payer: Frontpath All Commercial |
$3,260.66
|
| Rate for Payer: Humana ChoiceCare |
$3,061.13
|
| Rate for Payer: Humana Medicare |
$1,807.54
|
| Rate for Payer: Lucent All Commercial |
$1,807.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,189.78
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,658.15
|
| Rate for Payer: PHP All Commercial |
$2,687.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,382.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,736.12
|
| Rate for Payer: Signature Care EPO |
$2,941.69
|
| Rate for Payer: Signature Care PPO |
$3,118.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,012.57
|
| Rate for Payer: United Healthcare Commercial |
$2,792.83
|
| Rate for Payer: United Healthcare Medicare |
$1,169.59
|
|
|
HC AR DBL COMP PLATE 3H 20MM
|
Facility
IP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,955.15 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,404.33
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
|
|
HC AR DBL COMP PLATE 3H 20MM
|
Facility
OP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,325.53
|
| Rate for Payer: Aetna Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,262.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,463.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,495.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,430.29
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Centivo All Commercial |
$2,009.50
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Humana Medicare |
$2,009.50
|
| Rate for Payer: Lucent All Commercial |
$2,009.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,536.68
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,349.17
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
| Rate for Payer: United Healthcare Medicare |
$1,300.27
|
|
|
HC AR DBL COMP PLATE 3H 25MM
|
Facility
IP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,955.15 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,404.33
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
|
|
HC AR DBL COMP PLATE 3H 25MM
|
Facility
OP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,325.53
|
| Rate for Payer: Aetna Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,262.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,463.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,495.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,430.29
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Centivo All Commercial |
$2,009.50
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Humana Medicare |
$2,009.50
|
| Rate for Payer: Lucent All Commercial |
$2,009.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,536.68
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,349.17
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
| Rate for Payer: United Healthcare Medicare |
$1,300.27
|
|
|
HC AR DBL COMP PLATE 3H 30MM
|
Facility
IP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,955.15 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,404.33
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
|
|
HC AR DBL COMP PLATE 3H 30MM
|
Facility
OP
|
$3,940.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,664.39 |
| Rate for Payer: Aetna Commercial |
$3,325.53
|
| Rate for Payer: Aetna Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,300.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,262.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,463.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,495.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,430.29
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Cash Price |
$2,442.92
|
| Rate for Payer: Centivo All Commercial |
$2,009.50
|
| Rate for Payer: Cigna All Commercial |
$3,400.39
|
| Rate for Payer: CORVEL All Commercial |
$3,664.39
|
| Rate for Payer: Coventry All Commercial |
$3,467.38
|
| Rate for Payer: Encore All Commercial |
$3,626.95
|
| Rate for Payer: Frontpath All Commercial |
$3,624.98
|
| Rate for Payer: Humana ChoiceCare |
$3,403.15
|
| Rate for Payer: Humana Medicare |
$2,009.50
|
| Rate for Payer: Lucent All Commercial |
$2,009.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,546.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,955.15
|
| Rate for Payer: PHP All Commercial |
$2,988.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,536.68
|
| Rate for Payer: Sagamore Health Network All Products |
$3,041.83
|
| Rate for Payer: Signature Care EPO |
$3,270.37
|
| Rate for Payer: Signature Care PPO |
$3,467.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,349.17
|
| Rate for Payer: United Healthcare Commercial |
$3,104.88
|
| Rate for Payer: United Healthcare Medicare |
$1,300.27
|
|
|
HC AR DBL COMP PLATE SQR 4H 20MM
|
Facility
IP
|
$4,732.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.15 |
| Max. Negotiated Rate |
$4,400.95 |
| Rate for Payer: Aetna Commercial |
$4,088.62
|
| Rate for Payer: Cash Price |
$2,933.96
|
| Rate for Payer: Cigna All Commercial |
$4,083.89
|
| Rate for Payer: CORVEL All Commercial |
$4,400.95
|
| Rate for Payer: Coventry All Commercial |
$4,164.34
|
| Rate for Payer: Encore All Commercial |
$4,355.99
|
| Rate for Payer: Frontpath All Commercial |
$4,353.62
|
| Rate for Payer: Humana ChoiceCare |
$4,087.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,258.98
|
| Rate for Payer: PHCS All Commercial |
$3,549.15
|
| Rate for Payer: PHP All Commercial |
$3,588.90
|
| Rate for Payer: Sagamore Health Network All Products |
$3,653.26
|
| Rate for Payer: Signature Care EPO |
$3,927.73
|
| Rate for Payer: Signature Care PPO |
$4,164.34
|
| Rate for Payer: United Healthcare Commercial |
$3,728.97
|
|
|
HC AR DBL COMP PLATE SQR 4H 20MM
|
Facility
OP
|
$4,732.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,400.95 |
| Rate for Payer: Aetna Commercial |
$3,993.98
|
| Rate for Payer: Aetna Medicare |
$1,561.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,561.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,717.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,958.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,795.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,717.79
|
| Rate for Payer: Cash Price |
$2,933.96
|
| Rate for Payer: Cash Price |
$2,933.96
|
| Rate for Payer: Centivo All Commercial |
$2,413.42
|
| Rate for Payer: Cigna All Commercial |
$4,083.89
|
| Rate for Payer: CORVEL All Commercial |
$4,400.95
|
| Rate for Payer: Coventry All Commercial |
$4,164.34
|
| Rate for Payer: Encore All Commercial |
$4,355.99
|
| Rate for Payer: Frontpath All Commercial |
$4,353.62
|
| Rate for Payer: Humana ChoiceCare |
$4,087.20
|
| Rate for Payer: Humana Medicare |
$2,413.42
|
| Rate for Payer: Lucent All Commercial |
$2,413.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,258.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,549.15
|
| Rate for Payer: PHP All Commercial |
$3,588.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,845.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3,653.26
|
| Rate for Payer: Signature Care EPO |
$3,927.73
|
| Rate for Payer: Signature Care PPO |
$4,164.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,022.37
|
| Rate for Payer: United Healthcare Commercial |
$3,728.97
|
| Rate for Payer: United Healthcare Medicare |
$1,561.63
|
|
