|
HC AR FIBERTAK 2.6 DL
|
Facility
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,127.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,078.11
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Centivo All Commercial |
$1,514.70
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$1,514.70
|
| Rate for Payer: Lucent All Commercial |
$1,514.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$980.10
|
|
|
HC AR FIBERTAK 2.6 TL
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.25 |
| Max. Negotiated Rate |
$2,097.15 |
| Rate for Payer: Aetna Commercial |
$1,948.32
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Cigna All Commercial |
$1,946.06
|
| Rate for Payer: CORVEL All Commercial |
$2,097.15
|
| Rate for Payer: Coventry All Commercial |
$1,984.40
|
| Rate for Payer: Encore All Commercial |
$2,075.73
|
| Rate for Payer: Frontpath All Commercial |
$2,074.60
|
| Rate for Payer: Humana ChoiceCare |
$1,947.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,029.50
|
| Rate for Payer: PHCS All Commercial |
$1,691.25
|
| Rate for Payer: PHP All Commercial |
$1,710.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,740.86
|
| Rate for Payer: Signature Care EPO |
$1,871.65
|
| Rate for Payer: Signature Care PPO |
$1,984.40
|
| Rate for Payer: United Healthcare Commercial |
$1,776.94
|
|
|
HC AR FIBERTAK 2.6 TL
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,097.15 |
| Rate for Payer: Aetna Commercial |
$1,903.22
|
| Rate for Payer: Aetna Medicare |
$744.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$744.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,295.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,409.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$855.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$818.56
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Centivo All Commercial |
$1,150.05
|
| Rate for Payer: Cigna All Commercial |
$1,946.06
|
| Rate for Payer: CORVEL All Commercial |
$2,097.15
|
| Rate for Payer: Coventry All Commercial |
$1,984.40
|
| Rate for Payer: Encore All Commercial |
$2,075.73
|
| Rate for Payer: Frontpath All Commercial |
$2,074.60
|
| Rate for Payer: Humana ChoiceCare |
$1,947.64
|
| Rate for Payer: Humana Medicare |
$1,150.05
|
| Rate for Payer: Lucent All Commercial |
$1,150.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,029.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,691.25
|
| Rate for Payer: PHP All Commercial |
$1,710.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$879.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,740.86
|
| Rate for Payer: Signature Care EPO |
$1,871.65
|
| Rate for Payer: Signature Care PPO |
$1,984.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,916.75
|
| Rate for Payer: United Healthcare Commercial |
$1,776.94
|
| Rate for Payer: United Healthcare Medicare |
$744.15
|
|
|
HC AR FIBERTAK 2.6 W/BL
|
Facility
IP
|
$1,861.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.90 |
| Max. Negotiated Rate |
$1,730.92 |
| Rate for Payer: Aetna Commercial |
$1,608.08
|
| Rate for Payer: Cash Price |
$1,153.94
|
| Rate for Payer: Cigna All Commercial |
$1,606.22
|
| Rate for Payer: CORVEL All Commercial |
$1,730.92
|
| Rate for Payer: Coventry All Commercial |
$1,637.86
|
| Rate for Payer: Encore All Commercial |
$1,713.23
|
| Rate for Payer: Frontpath All Commercial |
$1,712.30
|
| Rate for Payer: Humana ChoiceCare |
$1,607.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,675.08
|
| Rate for Payer: PHCS All Commercial |
$1,395.90
|
| Rate for Payer: PHP All Commercial |
$1,411.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,436.85
|
| Rate for Payer: Signature Care EPO |
$1,544.80
|
| Rate for Payer: Signature Care PPO |
$1,637.86
|
| Rate for Payer: United Healthcare Commercial |
$1,466.63
|
|
|
HC AR FIBERTAK 2.6 W/BL
|
Facility
OP
|
$1,861.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,730.92 |
| Rate for Payer: Aetna Commercial |
$1,570.85
|
| Rate for Payer: Aetna Medicare |
$614.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$614.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,068.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,163.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$706.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$675.62
|
| Rate for Payer: Cash Price |
$1,153.94
|
| Rate for Payer: Cash Price |
$1,153.94
|
| Rate for Payer: Centivo All Commercial |
$949.21
|
| Rate for Payer: Cigna All Commercial |
$1,606.22
|
| Rate for Payer: CORVEL All Commercial |
$1,730.92
|
| Rate for Payer: Coventry All Commercial |
$1,637.86
|
| Rate for Payer: Encore All Commercial |
$1,713.23
|
| Rate for Payer: Frontpath All Commercial |
$1,712.30
|
| Rate for Payer: Humana ChoiceCare |
$1,607.52
|
| Rate for Payer: Humana Medicare |
$949.21
|
| Rate for Payer: Lucent All Commercial |
$949.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,675.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,395.90
|
| Rate for Payer: PHP All Commercial |
$1,411.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$725.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,436.85
|
| Rate for Payer: Signature Care EPO |
$1,544.80
|
| Rate for Payer: Signature Care PPO |
$1,637.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,582.02
|
| Rate for Payer: United Healthcare Commercial |
$1,466.63
|
| Rate for Payer: United Healthcare Medicare |
$614.20
|
|
|
HC AR FIBERTAK KIT
|
Facility
IP
|
$1,625.00
|
|
| Hospital Charge Code |
41607617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
|
HC AR FIBERTAK KIT
|
Facility
OP
|
$1,625.00
|
|
| Hospital Charge Code |
41607617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$616.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$589.88
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Centivo All Commercial |
$828.75
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Humana Medicare |
$828.75
|
| Rate for Payer: Lucent All Commercial |
$828.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
| Rate for Payer: United Healthcare Medicare |
$536.25
|
|
|
HC AR FIBERTAK W NEEDLE HYBRID
|
Facility
OP
|
$3,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,929.50 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Medicare |
$1,039.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,039.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,809.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,969.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,195.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: Centivo All Commercial |
$1,606.50
|
| Rate for Payer: Cigna All Commercial |
$2,718.45
|
| Rate for Payer: CORVEL All Commercial |
$2,929.50
|
| Rate for Payer: Coventry All Commercial |
$2,772.00
|
| Rate for Payer: Encore All Commercial |
$2,899.58
|
| Rate for Payer: Frontpath All Commercial |
$2,898.00
|
| Rate for Payer: Humana ChoiceCare |
$2,720.66
|
| Rate for Payer: Humana Medicare |
$1,606.50
|
| Rate for Payer: Lucent All Commercial |
$1,606.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,835.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,362.50
|
| Rate for Payer: PHP All Commercial |
$2,388.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,228.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,431.80
|
| Rate for Payer: Signature Care EPO |
$2,614.50
|
| Rate for Payer: Signature Care PPO |
$2,772.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,677.50
|
| Rate for Payer: United Healthcare Commercial |
$2,482.20
|
| Rate for Payer: United Healthcare Medicare |
$1,039.50
|
|
|
HC AR FIBERTAK W NEEDLE HYBRID
|
Facility
IP
|
$3,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.50 |
| Max. Negotiated Rate |
$2,929.50 |
| Rate for Payer: Aetna Commercial |
$2,721.60
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: Cigna All Commercial |
$2,718.45
|
| Rate for Payer: CORVEL All Commercial |
$2,929.50
|
| Rate for Payer: Coventry All Commercial |
$2,772.00
|
| Rate for Payer: Encore All Commercial |
$2,899.58
|
| Rate for Payer: Frontpath All Commercial |
$2,898.00
|
| Rate for Payer: Humana ChoiceCare |
$2,720.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,835.00
|
| Rate for Payer: PHCS All Commercial |
$2,362.50
|
| Rate for Payer: PHP All Commercial |
$2,388.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,431.80
|
| Rate for Payer: Signature Care EPO |
$2,614.50
|
| Rate for Payer: Signature Care PPO |
$2,772.00
|
| Rate for Payer: United Healthcare Commercial |
$2,482.20
|
|
|
HC AR FIBERTAPE 1.7
|
Facility
IP
|
$585.20
|
|
| Hospital Charge Code |
41607954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$544.24 |
| Rate for Payer: Aetna Commercial |
$505.61
|
| Rate for Payer: Cash Price |
$362.82
|
| Rate for Payer: Cigna All Commercial |
$505.03
|
| Rate for Payer: CORVEL All Commercial |
$544.24
|
| Rate for Payer: Coventry All Commercial |
$514.98
|
| Rate for Payer: Encore All Commercial |
$538.68
|
| Rate for Payer: Frontpath All Commercial |
$538.38
|
| Rate for Payer: Humana ChoiceCare |
$505.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.68
|
| Rate for Payer: PHCS All Commercial |
$438.90
|
| Rate for Payer: PHP All Commercial |
$443.82
|
| Rate for Payer: Sagamore Health Network All Products |
$451.77
|
| Rate for Payer: Signature Care EPO |
$485.72
|
| Rate for Payer: Signature Care PPO |
$514.98
|
| Rate for Payer: United Healthcare Commercial |
$461.14
|
|
|
HC AR FIBERTAPE 1.7
|
Facility
OP
|
$585.20
|
|
| Hospital Charge Code |
41607954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$544.24 |
| Rate for Payer: Aetna Commercial |
$493.91
|
| Rate for Payer: Aetna Medicare |
$193.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$336.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$222.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$212.43
|
| Rate for Payer: Cash Price |
$362.82
|
| Rate for Payer: Cash Price |
$362.82
|
| Rate for Payer: Centivo All Commercial |
$298.45
|
| Rate for Payer: Cigna All Commercial |
$505.03
|
| Rate for Payer: CORVEL All Commercial |
$544.24
|
| Rate for Payer: Coventry All Commercial |
$514.98
|
| Rate for Payer: Encore All Commercial |
$538.68
|
| Rate for Payer: Frontpath All Commercial |
$538.38
|
| Rate for Payer: Humana ChoiceCare |
$505.44
|
| Rate for Payer: Humana Medicare |
$298.45
|
| Rate for Payer: Lucent All Commercial |
$298.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$438.90
|
| Rate for Payer: PHP All Commercial |
$443.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.23
|
| Rate for Payer: Sagamore Health Network All Products |
$451.77
|
| Rate for Payer: Signature Care EPO |
$485.72
|
| Rate for Payer: Signature Care PPO |
$514.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$497.42
|
| Rate for Payer: United Healthcare Commercial |
$461.14
|
| Rate for Payer: United Healthcare Medicare |
$193.12
|
|
|
HC AR FIBERTAPE 2MM
|
Facility
IP
|
$875.00
|
|
| Hospital Charge Code |
41608101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$756.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
|
|
HC AR FIBERTAPE 2MM
|
Facility
OP
|
$875.00
|
|
| Hospital Charge Code |
41608101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$738.50
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$546.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$332.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.62
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Centivo All Commercial |
$446.25
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Humana Medicare |
$446.25
|
| Rate for Payer: Lucent All Commercial |
$446.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.25
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$743.75
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
| Rate for Payer: United Healthcare Medicare |
$288.75
|
|
|
HC AR FIBERTAPE 2MM 17LN
|
Facility
IP
|
$1,625.00
|
|
| Hospital Charge Code |
41608159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
|
HC AR FIBERTAPE 2MM 17LN
|
Facility
OP
|
$1,625.00
|
|
| Hospital Charge Code |
41608159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$616.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$589.88
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Centivo All Commercial |
$828.75
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Humana Medicare |
$828.75
|
| Rate for Payer: Lucent All Commercial |
$828.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
| Rate for Payer: United Healthcare Medicare |
$536.25
|
|
|
HC AR FIBERTAPE CERCLAGE
|
Facility
OP
|
$731.50
|
|
| Hospital Charge Code |
41607462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$680.30 |
| Rate for Payer: Aetna Commercial |
$617.39
|
| Rate for Payer: Aetna Medicare |
$241.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$241.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$420.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.53
|
| Rate for Payer: Cash Price |
$453.53
|
| Rate for Payer: Cash Price |
$453.53
|
| Rate for Payer: Centivo All Commercial |
$373.06
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.30
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Humana Medicare |
$373.06
|
| Rate for Payer: Lucent All Commercial |
$373.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.28
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$621.78
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
| Rate for Payer: United Healthcare Medicare |
$241.40
|
|
|
HC AR FIBERTAPE CERCLAGE
|
Facility
IP
|
$731.50
|
|
| Hospital Charge Code |
41607462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$680.30 |
| Rate for Payer: Aetna Commercial |
$632.02
|
| Rate for Payer: Cash Price |
$453.53
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.30
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
|
|
HC AR FIBERTAPE TENDON BRIDGE KIT
|
Facility
OP
|
$2,376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,209.68 |
| Rate for Payer: Aetna Commercial |
$2,005.34
|
| Rate for Payer: Aetna Medicare |
$784.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$784.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,364.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,485.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$901.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$862.49
|
| Rate for Payer: Cash Price |
$1,473.12
|
| Rate for Payer: Cash Price |
$1,473.12
|
| Rate for Payer: Centivo All Commercial |
$1,211.76
|
| Rate for Payer: Cigna All Commercial |
$2,050.49
|
| Rate for Payer: CORVEL All Commercial |
$2,209.68
|
| Rate for Payer: Coventry All Commercial |
$2,090.88
|
| Rate for Payer: Encore All Commercial |
$2,187.11
|
| Rate for Payer: Frontpath All Commercial |
$2,185.92
|
| Rate for Payer: Humana ChoiceCare |
$2,052.15
|
| Rate for Payer: Humana Medicare |
$1,211.76
|
| Rate for Payer: Lucent All Commercial |
$1,211.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,138.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,782.00
|
| Rate for Payer: PHP All Commercial |
$1,801.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$926.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,834.27
|
| Rate for Payer: Signature Care EPO |
$1,972.08
|
| Rate for Payer: Signature Care PPO |
$2,090.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,019.60
|
| Rate for Payer: United Healthcare Commercial |
$1,872.29
|
| Rate for Payer: United Healthcare Medicare |
$784.08
|
|
|
HC AR FIBERTAPE TENDON BRIDGE KIT
|
Facility
IP
|
$2,376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.00 |
| Max. Negotiated Rate |
$2,209.68 |
| Rate for Payer: Aetna Commercial |
$2,052.86
|
| Rate for Payer: Cash Price |
$1,473.12
|
| Rate for Payer: Cigna All Commercial |
$2,050.49
|
| Rate for Payer: CORVEL All Commercial |
$2,209.68
|
| Rate for Payer: Coventry All Commercial |
$2,090.88
|
| Rate for Payer: Encore All Commercial |
$2,187.11
|
| Rate for Payer: Frontpath All Commercial |
$2,185.92
|
| Rate for Payer: Humana ChoiceCare |
$2,052.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,138.40
|
| Rate for Payer: PHCS All Commercial |
$1,782.00
|
| Rate for Payer: PHP All Commercial |
$1,801.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,834.27
|
| Rate for Payer: Signature Care EPO |
$1,972.08
|
| Rate for Payer: Signature Care PPO |
$2,090.88
|
| Rate for Payer: United Healthcare Commercial |
$1,872.29
|
|
|
HC AR GEMINI SR8 CANNULA
|
Facility
OP
|
$374.50
|
|
| Hospital Charge Code |
41606554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$348.28 |
| Rate for Payer: Aetna Commercial |
$316.08
|
| Rate for Payer: Aetna Medicare |
$123.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$215.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$234.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.94
|
| Rate for Payer: Cash Price |
$232.19
|
| Rate for Payer: Cash Price |
$232.19
|
| Rate for Payer: Centivo All Commercial |
$191.00
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.28
|
| Rate for Payer: Coventry All Commercial |
$329.56
|
| Rate for Payer: Encore All Commercial |
$344.73
|
| Rate for Payer: Frontpath All Commercial |
$344.54
|
| Rate for Payer: Humana ChoiceCare |
$323.46
|
| Rate for Payer: Humana Medicare |
$191.00
|
| Rate for Payer: Lucent All Commercial |
$191.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$280.88
|
| Rate for Payer: PHP All Commercial |
$284.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$146.06
|
| Rate for Payer: Sagamore Health Network All Products |
$289.11
|
| Rate for Payer: Signature Care EPO |
$310.84
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$318.32
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
|
|
HC AR GEMINI SR8 CANNULA
|
Facility
IP
|
$374.50
|
|
| Hospital Charge Code |
41606554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.88 |
| Max. Negotiated Rate |
$348.28 |
| Rate for Payer: Aetna Commercial |
$323.57
|
| Rate for Payer: Cash Price |
$232.19
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.28
|
| Rate for Payer: Coventry All Commercial |
$329.56
|
| Rate for Payer: Encore All Commercial |
$344.73
|
| Rate for Payer: Frontpath All Commercial |
$344.54
|
| Rate for Payer: Humana ChoiceCare |
$323.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: PHCS All Commercial |
$280.88
|
| Rate for Payer: PHP All Commercial |
$284.02
|
| Rate for Payer: Sagamore Health Network All Products |
$289.11
|
| Rate for Payer: Signature Care EPO |
$310.84
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
|
|
HC ARGININE VASOPRESSIN HORMONE
|
Facility
IP
|
$180.67
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
63001714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.50 |
| Max. Negotiated Rate |
$168.03 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cigna All Commercial |
$155.92
|
| Rate for Payer: CORVEL All Commercial |
$168.03
|
| Rate for Payer: Coventry All Commercial |
$158.99
|
| Rate for Payer: Encore All Commercial |
$166.31
|
| Rate for Payer: Frontpath All Commercial |
$166.22
|
| Rate for Payer: Humana ChoiceCare |
$156.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.61
|
| Rate for Payer: PHCS All Commercial |
$135.50
|
| Rate for Payer: PHP All Commercial |
$137.02
|
| Rate for Payer: Sagamore Health Network All Products |
$139.48
|
| Rate for Payer: Signature Care EPO |
$149.96
|
| Rate for Payer: Signature Care PPO |
$158.99
|
| Rate for Payer: United Healthcare Commercial |
$142.37
|
|
|
HC ARGININE VASOPRESSIN HORMONE
|
Facility
OP
|
$180.67
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
63001714
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$168.03 |
| Rate for Payer: Aetna Commercial |
$152.49
|
| Rate for Payer: Aetna Medicare |
$59.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$103.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$33.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.58
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Centivo All Commercial |
$92.14
|
| Rate for Payer: Cigna All Commercial |
$155.92
|
| Rate for Payer: CORVEL All Commercial |
$168.03
|
| Rate for Payer: Coventry All Commercial |
$158.99
|
| Rate for Payer: Encore All Commercial |
$166.31
|
| Rate for Payer: Frontpath All Commercial |
$166.22
|
| Rate for Payer: Humana ChoiceCare |
$156.05
|
| Rate for Payer: Humana Medicare |
$92.14
|
| Rate for Payer: Lucent All Commercial |
$92.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.61
|
| Rate for Payer: Managed Health Services Medicaid |
$33.94
|
| Rate for Payer: MDWise Medicaid |
$33.94
|
| Rate for Payer: PHCS All Commercial |
$135.50
|
| Rate for Payer: PHP All Commercial |
$137.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.46
|
| Rate for Payer: Sagamore Health Network All Products |
$139.48
|
| Rate for Payer: Signature Care EPO |
$149.96
|
| Rate for Payer: Signature Care PPO |
$158.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.57
|
| Rate for Payer: United Healthcare Commercial |
$142.37
|
| Rate for Payer: United Healthcare Medicare |
$59.62
|
|
|
HC AR GRAFT CARTIFORM 20 MM
|
Facility
IP
|
$33,660.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,245.00 |
| Max. Negotiated Rate |
$31,303.80 |
| Rate for Payer: Aetna Commercial |
$29,082.24
|
| Rate for Payer: Cash Price |
$20,869.20
|
| Rate for Payer: Cigna All Commercial |
$29,048.58
|
| Rate for Payer: CORVEL All Commercial |
$31,303.80
|
| Rate for Payer: Coventry All Commercial |
$29,620.80
|
| Rate for Payer: Encore All Commercial |
$30,984.03
|
| Rate for Payer: Frontpath All Commercial |
$30,967.20
|
| Rate for Payer: Humana ChoiceCare |
$29,072.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30,294.00
|
| Rate for Payer: PHCS All Commercial |
$25,245.00
|
| Rate for Payer: PHP All Commercial |
$25,527.74
|
| Rate for Payer: Sagamore Health Network All Products |
$25,985.52
|
| Rate for Payer: Signature Care EPO |
$27,937.80
|
| Rate for Payer: Signature Care PPO |
$29,620.80
|
| Rate for Payer: United Healthcare Commercial |
$26,524.08
|
|
|
HC AR GRAFT CARTIFORM 20 MM
|
Facility
OP
|
$33,660.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$31,303.80 |
| Rate for Payer: Aetna Commercial |
$28,409.04
|
| Rate for Payer: Aetna Medicare |
$11,107.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11,107.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19,330.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21,040.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12,773.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12,218.58
|
| Rate for Payer: Cash Price |
$20,869.20
|
| Rate for Payer: Cash Price |
$20,869.20
|
| Rate for Payer: Centivo All Commercial |
$17,166.60
|
| Rate for Payer: Cigna All Commercial |
$29,048.58
|
| Rate for Payer: CORVEL All Commercial |
$31,303.80
|
| Rate for Payer: Coventry All Commercial |
$29,620.80
|
| Rate for Payer: Encore All Commercial |
$30,984.03
|
| Rate for Payer: Frontpath All Commercial |
$30,967.20
|
| Rate for Payer: Humana ChoiceCare |
$29,072.14
|
| Rate for Payer: Humana Medicare |
$17,166.60
|
| Rate for Payer: Lucent All Commercial |
$17,166.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30,294.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$25,245.00
|
| Rate for Payer: PHP All Commercial |
$25,527.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13,127.40
|
| Rate for Payer: Sagamore Health Network All Products |
$25,985.52
|
| Rate for Payer: Signature Care EPO |
$27,937.80
|
| Rate for Payer: Signature Care PPO |
$29,620.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,611.00
|
| Rate for Payer: United Healthcare Commercial |
$26,524.08
|
| Rate for Payer: United Healthcare Medicare |
$11,107.80
|
|
