|
HC AR ALLOGRAFT IMPLANT SYSTEM
|
Facility
|
OP
|
$11,732.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$10,911.13 |
| Rate for Payer: Aetna Commercial |
$9,902.15
|
| Rate for Payer: Aetna Medicare |
$3,754.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,637.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,737.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,333.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,317.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,129.80
|
| Rate for Payer: Cash Price |
$7,039.44
|
| Rate for Payer: Cash Price |
$7,039.44
|
| Rate for Payer: Centivo All Commercial |
$6,382.43
|
| Rate for Payer: Cigna All Commercial |
$10,125.06
|
| Rate for Payer: CORVEL All Commercial |
$10,911.13
|
| Rate for Payer: Coventry All Commercial |
$10,324.51
|
| Rate for Payer: Encore All Commercial |
$10,799.67
|
| Rate for Payer: Frontpath All Commercial |
$10,793.81
|
| Rate for Payer: Humana ChoiceCare |
$10,133.27
|
| Rate for Payer: Humana Medicare |
$3,754.37
|
| Rate for Payer: Lucent All Commercial |
$6,382.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,559.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,799.30
|
| Rate for Payer: PHP All Commercial |
$8,897.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,575.64
|
| Rate for Payer: Sagamore Health Network All Products |
$9,057.41
|
| Rate for Payer: Signature Care EPO |
$9,737.89
|
| Rate for Payer: Signature Care PPO |
$10,324.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,972.54
|
| Rate for Payer: United Healthcare Commercial |
$9,245.13
|
| Rate for Payer: United Healthcare Medicare |
$3,754.37
|
|
|
HC AR ANCHOR SWVLCK 4.75X19.1 BC
|
Facility
|
IP
|
$2,871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,153.25 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$2,480.54
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Cigna All Commercial |
$2,477.67
|
| Rate for Payer: CORVEL All Commercial |
$2,670.03
|
| Rate for Payer: Coventry All Commercial |
$2,526.48
|
| Rate for Payer: Encore All Commercial |
$2,642.76
|
| Rate for Payer: Frontpath All Commercial |
$2,641.32
|
| Rate for Payer: Humana ChoiceCare |
$2,479.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,583.90
|
| Rate for Payer: PHCS All Commercial |
$2,153.25
|
| Rate for Payer: PHP All Commercial |
$2,177.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,216.41
|
| Rate for Payer: Signature Care EPO |
$2,382.93
|
| Rate for Payer: Signature Care PPO |
$2,526.48
|
| Rate for Payer: United Healthcare Commercial |
$2,262.35
|
|
|
HC AR ANCHOR SWVLCK 4.75X19.1 BC
|
Facility
|
OP
|
$2,871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$2,423.12
|
| Rate for Payer: Aetna Medicare |
$918.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$890.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,648.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,794.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,056.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,010.59
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Centivo All Commercial |
$1,561.82
|
| Rate for Payer: Cigna All Commercial |
$2,477.67
|
| Rate for Payer: CORVEL All Commercial |
$2,670.03
|
| Rate for Payer: Coventry All Commercial |
$2,526.48
|
| Rate for Payer: Encore All Commercial |
$2,642.76
|
| Rate for Payer: Frontpath All Commercial |
$2,641.32
|
| Rate for Payer: Humana ChoiceCare |
$2,479.68
|
| Rate for Payer: Humana Medicare |
$918.72
|
| Rate for Payer: Lucent All Commercial |
$1,561.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,583.90
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,153.25
|
| Rate for Payer: PHP All Commercial |
$2,177.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,119.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,216.41
|
| Rate for Payer: Signature Care EPO |
$2,382.93
|
| Rate for Payer: Signature Care PPO |
$2,526.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,440.35
|
| Rate for Payer: United Healthcare Commercial |
$2,262.35
|
| Rate for Payer: United Healthcare Medicare |
$918.72
|
|
|
HC AR ARTHROFLEX 40X70X3.0
|
Facility
|
OP
|
$15,784.56
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,679.64 |
| Rate for Payer: Aetna Commercial |
$13,322.17
|
| Rate for Payer: Aetna Medicare |
$5,051.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,893.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,065.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,866.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,808.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,556.17
|
| Rate for Payer: Cash Price |
$9,470.74
|
| Rate for Payer: Cash Price |
$9,470.74
|
| Rate for Payer: Centivo All Commercial |
$8,586.80
|
| Rate for Payer: Cigna All Commercial |
$13,622.08
|
| Rate for Payer: CORVEL All Commercial |
$14,679.64
|
| Rate for Payer: Coventry All Commercial |
$13,890.41
|
| Rate for Payer: Encore All Commercial |
$14,529.69
|
| Rate for Payer: Frontpath All Commercial |
$14,521.80
|
| Rate for Payer: Humana ChoiceCare |
$13,633.12
|
| Rate for Payer: Humana Medicare |
$5,051.06
|
| Rate for Payer: Lucent All Commercial |
$8,586.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,206.10
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,838.42
|
| Rate for Payer: PHP All Commercial |
$11,971.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,155.98
|
| Rate for Payer: Sagamore Health Network All Products |
$12,185.68
|
| Rate for Payer: Signature Care EPO |
$13,101.18
|
| Rate for Payer: Signature Care PPO |
$13,890.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,416.88
|
| Rate for Payer: United Healthcare Commercial |
$12,438.23
|
| Rate for Payer: United Healthcare Medicare |
$5,051.06
|
|
|
HC AR ARTHROFLEX 40X70X3.0
|
Facility
|
IP
|
$15,784.56
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,838.42 |
| Max. Negotiated Rate |
$14,679.64 |
| Rate for Payer: Aetna Commercial |
$13,637.86
|
| Rate for Payer: Cash Price |
$9,470.74
|
| Rate for Payer: Cigna All Commercial |
$13,622.08
|
| Rate for Payer: CORVEL All Commercial |
$14,679.64
|
| Rate for Payer: Coventry All Commercial |
$13,890.41
|
| Rate for Payer: Encore All Commercial |
$14,529.69
|
| Rate for Payer: Frontpath All Commercial |
$14,521.80
|
| Rate for Payer: Humana ChoiceCare |
$13,633.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,206.10
|
| Rate for Payer: PHCS All Commercial |
$11,838.42
|
| Rate for Payer: PHP All Commercial |
$11,971.01
|
| Rate for Payer: Sagamore Health Network All Products |
$12,185.68
|
| Rate for Payer: Signature Care EPO |
$13,101.18
|
| Rate for Payer: Signature Care PPO |
$13,890.41
|
| Rate for Payer: United Healthcare Commercial |
$12,438.23
|
|
|
HC AR BUTTON EXT 5X20
|
Facility
|
OP
|
$1,237.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,044.45
|
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$383.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$710.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$773.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.60
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Centivo All Commercial |
$673.20
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Humana Medicare |
$396.00
|
| Rate for Payer: Lucent All Commercial |
$673.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$482.62
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,051.88
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
|
|
HC AR BUTTON EXT 5X20
|
Facility
|
IP
|
$1,237.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.12 |
| Max. Negotiated Rate |
$1,150.88 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna All Commercial |
$1,067.96
|
| Rate for Payer: CORVEL All Commercial |
$1,150.88
|
| Rate for Payer: Coventry All Commercial |
$1,089.00
|
| Rate for Payer: Encore All Commercial |
$1,139.12
|
| Rate for Payer: Frontpath All Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$1,068.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.75
|
| Rate for Payer: PHCS All Commercial |
$928.12
|
| Rate for Payer: PHP All Commercial |
$938.52
|
| Rate for Payer: Sagamore Health Network All Products |
$955.35
|
| Rate for Payer: Signature Care EPO |
$1,027.12
|
| Rate for Payer: Signature Care PPO |
$1,089.00
|
| Rate for Payer: United Healthcare Commercial |
$975.15
|
|
|
HC AR BUTTON TR ABS 17MM
|
Facility
|
IP
|
$2,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.25 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Aetna Commercial |
$1,982.88
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna All Commercial |
$1,980.59
|
| Rate for Payer: CORVEL All Commercial |
$2,134.35
|
| Rate for Payer: Coventry All Commercial |
$2,019.60
|
| Rate for Payer: Encore All Commercial |
$2,112.55
|
| Rate for Payer: Frontpath All Commercial |
$2,111.40
|
| Rate for Payer: Humana ChoiceCare |
$1,982.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,065.50
|
| Rate for Payer: PHCS All Commercial |
$1,721.25
|
| Rate for Payer: PHP All Commercial |
$1,740.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,771.74
|
| Rate for Payer: Signature Care EPO |
$1,904.85
|
| Rate for Payer: Signature Care PPO |
$2,019.60
|
| Rate for Payer: United Healthcare Commercial |
$1,808.46
|
|
|
HC AR BUTTON TR ABS 17MM
|
Facility
|
OP
|
$2,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Aetna Commercial |
$1,936.98
|
| Rate for Payer: Aetna Medicare |
$734.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$711.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,318.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,434.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$844.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$807.84
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Centivo All Commercial |
$1,248.48
|
| Rate for Payer: Cigna All Commercial |
$1,980.59
|
| Rate for Payer: CORVEL All Commercial |
$2,134.35
|
| Rate for Payer: Coventry All Commercial |
$2,019.60
|
| Rate for Payer: Encore All Commercial |
$2,112.55
|
| Rate for Payer: Frontpath All Commercial |
$2,111.40
|
| Rate for Payer: Humana ChoiceCare |
$1,982.19
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Lucent All Commercial |
$1,248.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,065.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,721.25
|
| Rate for Payer: PHP All Commercial |
$1,740.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$895.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,771.74
|
| Rate for Payer: Signature Care EPO |
$1,904.85
|
| Rate for Payer: Signature Care PPO |
$2,019.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,950.75
|
| Rate for Payer: United Healthcare Commercial |
$1,808.46
|
| Rate for Payer: United Healthcare Medicare |
$734.40
|
|
|
HC AR CARTIFORM 10MM
|
Facility
|
IP
|
$13,860.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,395.00 |
| Max. Negotiated Rate |
$12,889.80 |
| Rate for Payer: Aetna Commercial |
$11,975.04
|
| Rate for Payer: Cash Price |
$8,316.00
|
| Rate for Payer: Cigna All Commercial |
$11,961.18
|
| Rate for Payer: CORVEL All Commercial |
$12,889.80
|
| Rate for Payer: Coventry All Commercial |
$12,196.80
|
| Rate for Payer: Encore All Commercial |
$12,758.13
|
| Rate for Payer: Frontpath All Commercial |
$12,751.20
|
| Rate for Payer: Humana ChoiceCare |
$11,970.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,474.00
|
| Rate for Payer: PHCS All Commercial |
$10,395.00
|
| Rate for Payer: PHP All Commercial |
$10,511.42
|
| Rate for Payer: Sagamore Health Network All Products |
$10,699.92
|
| Rate for Payer: Signature Care EPO |
$11,503.80
|
| Rate for Payer: Signature Care PPO |
$12,196.80
|
| Rate for Payer: United Healthcare Commercial |
$10,921.68
|
|
|
HC AR CARTIFORM 10MM
|
Facility
|
OP
|
$13,860.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41608161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$12,889.80 |
| Rate for Payer: Aetna Commercial |
$11,697.84
|
| Rate for Payer: Aetna Medicare |
$4,435.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,296.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,959.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,663.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,100.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,878.72
|
| Rate for Payer: Cash Price |
$8,316.00
|
| Rate for Payer: Cash Price |
$8,316.00
|
| Rate for Payer: Centivo All Commercial |
$7,539.84
|
| Rate for Payer: Cigna All Commercial |
$11,961.18
|
| Rate for Payer: CORVEL All Commercial |
$12,889.80
|
| Rate for Payer: Coventry All Commercial |
$12,196.80
|
| Rate for Payer: Encore All Commercial |
$12,758.13
|
| Rate for Payer: Frontpath All Commercial |
$12,751.20
|
| Rate for Payer: Humana ChoiceCare |
$11,970.88
|
| Rate for Payer: Humana Medicare |
$4,435.20
|
| Rate for Payer: Lucent All Commercial |
$7,539.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,474.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,395.00
|
| Rate for Payer: PHP All Commercial |
$10,511.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,405.40
|
| Rate for Payer: Sagamore Health Network All Products |
$10,699.92
|
| Rate for Payer: Signature Care EPO |
$11,503.80
|
| Rate for Payer: Signature Care PPO |
$12,196.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,781.00
|
| Rate for Payer: United Healthcare Commercial |
$10,921.68
|
| Rate for Payer: United Healthcare Medicare |
$4,435.20
|
|
|
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 |
$2,933.28
|
| 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 CPR MINI SCORPION SYS
|
Facility
|
OP
|
$4,888.80
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
41602575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,546.58 |
| Rate for Payer: Aetna Commercial |
$4,126.15
|
| Rate for Payer: Aetna Medicare |
$1,564.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,515.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,807.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,055.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,799.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,720.86
|
| Rate for Payer: Cash Price |
$2,933.28
|
| Rate for Payer: Cash Price |
$2,933.28
|
| Rate for Payer: Centivo All Commercial |
$2,659.51
|
| 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 |
$1,564.42
|
| Rate for Payer: Lucent All Commercial |
$2,659.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,399.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| 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 |
$1,564.42
|
|
|
HC AR CRYSTAL CANNULA
|
Facility
|
OP
|
$192.50
|
|
| Hospital Charge Code |
41607616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$179.03 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Aetna Medicare |
$61.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.76
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Centivo All Commercial |
$104.72
|
| Rate for Payer: Cigna All Commercial |
$166.13
|
| Rate for Payer: CORVEL All Commercial |
$179.03
|
| 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 |
$61.60
|
| Rate for Payer: Lucent All Commercial |
$104.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$61.60
|
|
|
HC AR CRYSTAL CANNULA
|
Facility
|
IP
|
$192.50
|
|
| Hospital Charge Code |
41607616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$179.03 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna All Commercial |
$166.13
|
| Rate for Payer: CORVEL All Commercial |
$179.03
|
| 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 DBL COMP DRILL BIT 2.5 CAL
|
Facility
|
OP
|
$654.50
|
|
| Hospital Charge Code |
41603295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$240.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.38
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Centivo All Commercial |
$356.05
|
| 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 |
$209.44
|
| Rate for Payer: Lucent All Commercial |
$356.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$255.25
|
| 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 |
$556.33
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$209.44
|
|
|
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 |
$392.70
|
| 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 DISP MINI KIT
|
Facility
|
OP
|
$1,460.00
|
|
| Hospital Charge Code |
41608160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,232.24
|
| Rate for Payer: Aetna Medicare |
$467.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$452.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$838.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$537.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.92
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Centivo All Commercial |
$794.24
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Humana Medicare |
$467.20
|
| Rate for Payer: Lucent All Commercial |
$794.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$569.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,241.00
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
| Rate for Payer: United Healthcare Medicare |
$467.20
|
|
|
HC AR DISP MINI KIT
|
Facility
|
IP
|
$1,460.00
|
|
| Hospital Charge Code |
41608160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,357.80 |
| Rate for Payer: Aetna Commercial |
$1,261.44
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna All Commercial |
$1,259.98
|
| Rate for Payer: CORVEL All Commercial |
$1,357.80
|
| Rate for Payer: Coventry All Commercial |
$1,284.80
|
| Rate for Payer: Encore All Commercial |
$1,343.93
|
| Rate for Payer: Frontpath All Commercial |
$1,343.20
|
| Rate for Payer: Humana ChoiceCare |
$1,261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,314.00
|
| Rate for Payer: PHCS All Commercial |
$1,095.00
|
| Rate for Payer: PHP All Commercial |
$1,107.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,127.12
|
| Rate for Payer: Signature Care EPO |
$1,211.80
|
| Rate for Payer: Signature Care PPO |
$1,284.80
|
| Rate for Payer: United Healthcare Commercial |
$1,150.48
|
|
|
HC AR DISTAL BICEP
|
Facility
|
OP
|
$6,602.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,140.23 |
| Rate for Payer: Aetna Commercial |
$5,572.43
|
| Rate for Payer: Aetna Medicare |
$2,112.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,046.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,791.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,127.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,429.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,324.04
|
| Rate for Payer: Cash Price |
$3,961.44
|
| Rate for Payer: Cash Price |
$3,961.44
|
| Rate for Payer: Centivo All Commercial |
$3,591.71
|
| Rate for Payer: Cigna All Commercial |
$5,697.87
|
| Rate for Payer: CORVEL All Commercial |
$6,140.23
|
| Rate for Payer: Coventry All Commercial |
$5,810.11
|
| Rate for Payer: Encore All Commercial |
$6,077.51
|
| Rate for Payer: Frontpath All Commercial |
$6,074.21
|
| Rate for Payer: Humana ChoiceCare |
$5,702.49
|
| Rate for Payer: Humana Medicare |
$2,112.77
|
| Rate for Payer: Lucent All Commercial |
$3,591.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,942.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,951.80
|
| Rate for Payer: PHP All Commercial |
$5,007.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,574.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,097.05
|
| Rate for Payer: Signature Care EPO |
$5,479.99
|
| Rate for Payer: Signature Care PPO |
$5,810.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,612.04
|
| Rate for Payer: United Healthcare Commercial |
$5,202.69
|
| Rate for Payer: United Healthcare Medicare |
$2,112.77
|
|
|
HC AR DISTAL BICEP
|
Facility
|
IP
|
$6,602.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.80 |
| Max. Negotiated Rate |
$6,140.23 |
| Rate for Payer: Aetna Commercial |
$5,704.47
|
| Rate for Payer: Cash Price |
$3,961.44
|
| Rate for Payer: Cigna All Commercial |
$5,697.87
|
| Rate for Payer: CORVEL All Commercial |
$6,140.23
|
| Rate for Payer: Coventry All Commercial |
$5,810.11
|
| Rate for Payer: Encore All Commercial |
$6,077.51
|
| Rate for Payer: Frontpath All Commercial |
$6,074.21
|
| Rate for Payer: Humana ChoiceCare |
$5,702.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,942.16
|
| Rate for Payer: PHCS All Commercial |
$4,951.80
|
| Rate for Payer: PHP All Commercial |
$5,007.26
|
| Rate for Payer: Sagamore Health Network All Products |
$5,097.05
|
| Rate for Payer: Signature Care EPO |
$5,479.99
|
| Rate for Payer: Signature Care PPO |
$5,810.11
|
| Rate for Payer: United Healthcare Commercial |
$5,202.69
|
|
|
HC AR DOG BONE BUTTON
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607786
|
|
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 |
$1,155.00
|
| 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 DOG BONE BUTTON
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$596.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$708.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$677.60
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Centivo All Commercial |
$1,047.20
|
| 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 |
$616.00
|
| Rate for Payer: Lucent All Commercial |
$1,047.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| 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 |
$616.00
|
|
|
HC AR DRILL BIT 2.0 CALI
|
Facility
|
IP
|
$795.00
|
|
| Hospital Charge Code |
41608059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.25 |
| Max. Negotiated Rate |
$739.35 |
| Rate for Payer: Aetna Commercial |
$686.88
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna All Commercial |
$686.09
|
| Rate for Payer: CORVEL All Commercial |
$739.35
|
| Rate for Payer: Coventry All Commercial |
$699.60
|
| Rate for Payer: Encore All Commercial |
$731.80
|
| Rate for Payer: Frontpath All Commercial |
$731.40
|
| Rate for Payer: Humana ChoiceCare |
$686.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$715.50
|
| Rate for Payer: PHCS All Commercial |
$596.25
|
| Rate for Payer: PHP All Commercial |
$602.93
|
| Rate for Payer: Sagamore Health Network All Products |
$613.74
|
| Rate for Payer: Signature Care EPO |
$659.85
|
| Rate for Payer: Signature Care PPO |
$699.60
|
| Rate for Payer: United Healthcare Commercial |
$626.46
|
|
|
HC AR DRILL BIT 2.0 CALI
|
Facility
|
OP
|
$795.00
|
|
| Hospital Charge Code |
41608059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$739.35 |
| Rate for Payer: Aetna Commercial |
$670.98
|
| Rate for Payer: Aetna Medicare |
$254.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$246.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$456.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$496.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.84
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Centivo All Commercial |
$432.48
|
| Rate for Payer: Cigna All Commercial |
$686.09
|
| Rate for Payer: CORVEL All Commercial |
$739.35
|
| Rate for Payer: Coventry All Commercial |
$699.60
|
| Rate for Payer: Encore All Commercial |
$731.80
|
| Rate for Payer: Frontpath All Commercial |
$731.40
|
| Rate for Payer: Humana ChoiceCare |
$686.64
|
| Rate for Payer: Humana Medicare |
$254.40
|
| Rate for Payer: Lucent All Commercial |
$432.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$715.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$596.25
|
| Rate for Payer: PHP All Commercial |
$602.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$310.05
|
| Rate for Payer: Sagamore Health Network All Products |
$613.74
|
| Rate for Payer: Signature Care EPO |
$659.85
|
| Rate for Payer: Signature Care PPO |
$699.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$675.75
|
| Rate for Payer: United Healthcare Commercial |
$626.46
|
| Rate for Payer: United Healthcare Medicare |
$254.40
|
|
