|
HC AR TIGHTROPE BUTTON 14 MM
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,145.76 |
| Rate for Payer: Aetna Commercial |
$1,039.81
|
| Rate for Payer: Aetna Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$381.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$707.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$770.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$453.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.66
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Centivo All Commercial |
$670.21
|
| Rate for Payer: Cigna All Commercial |
$1,063.22
|
| Rate for Payer: CORVEL All Commercial |
$1,145.76
|
| Rate for Payer: Coventry All Commercial |
$1,084.16
|
| Rate for Payer: Encore All Commercial |
$1,134.06
|
| Rate for Payer: Frontpath All Commercial |
$1,133.44
|
| Rate for Payer: Humana ChoiceCare |
$1,064.08
|
| Rate for Payer: Humana Medicare |
$394.24
|
| Rate for Payer: Lucent All Commercial |
$670.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$924.00
|
| Rate for Payer: PHP All Commercial |
$934.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$480.48
|
| Rate for Payer: Sagamore Health Network All Products |
$951.10
|
| Rate for Payer: Signature Care EPO |
$1,022.56
|
| Rate for Payer: Signature Care PPO |
$1,084.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,047.20
|
| Rate for Payer: United Healthcare Commercial |
$970.82
|
| Rate for Payer: United Healthcare Medicare |
$394.24
|
|
|
HC AR TIGHTROPE BUTTON 14 MM
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$1,145.76 |
| Rate for Payer: Aetna Commercial |
$1,064.45
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cigna All Commercial |
$1,063.22
|
| Rate for Payer: CORVEL All Commercial |
$1,145.76
|
| Rate for Payer: Coventry All Commercial |
$1,084.16
|
| Rate for Payer: Encore All Commercial |
$1,134.06
|
| Rate for Payer: Frontpath All Commercial |
$1,133.44
|
| Rate for Payer: Humana ChoiceCare |
$1,064.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.80
|
| Rate for Payer: PHCS All Commercial |
$924.00
|
| Rate for Payer: PHP All Commercial |
$934.35
|
| Rate for Payer: Sagamore Health Network All Products |
$951.10
|
| Rate for Payer: Signature Care EPO |
$1,022.56
|
| Rate for Payer: Signature Care PPO |
$1,084.16
|
| Rate for Payer: United Healthcare Commercial |
$970.82
|
|
|
HC AR TIGHTROPE BUTTON 14MM RND
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,506.54
|
| Rate for Payer: Aetna Medicare |
$571.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$553.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,025.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,115.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$656.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$628.32
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Centivo All Commercial |
$971.04
|
| Rate for Payer: Cigna All Commercial |
$1,540.45
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Humana Medicare |
$571.20
|
| Rate for Payer: Lucent All Commercial |
$971.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$696.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,517.25
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
| Rate for Payer: United Healthcare Medicare |
$571.20
|
|
|
HC AR TIGHTROPE BUTTON 14MM RND
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.75 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna All Commercial |
$1,540.45
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
|
|
HC AR TIGHTROPE II
|
Facility
|
OP
|
$3,571.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,321.22 |
| Rate for Payer: Aetna Commercial |
$3,014.09
|
| Rate for Payer: Aetna Medicare |
$1,142.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,107.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,050.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,232.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,314.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,257.06
|
| Rate for Payer: Cash Price |
$2,142.72
|
| Rate for Payer: Cash Price |
$2,142.72
|
| Rate for Payer: Centivo All Commercial |
$1,942.73
|
| Rate for Payer: Cigna All Commercial |
$3,081.95
|
| Rate for Payer: CORVEL All Commercial |
$3,321.22
|
| Rate for Payer: Coventry All Commercial |
$3,142.66
|
| Rate for Payer: Encore All Commercial |
$3,287.29
|
| Rate for Payer: Frontpath All Commercial |
$3,285.50
|
| Rate for Payer: Humana ChoiceCare |
$3,084.45
|
| Rate for Payer: Humana Medicare |
$1,142.78
|
| Rate for Payer: Lucent All Commercial |
$1,942.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,214.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,678.40
|
| Rate for Payer: PHP All Commercial |
$2,708.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,392.77
|
| Rate for Payer: Sagamore Health Network All Products |
$2,756.97
|
| Rate for Payer: Signature Care EPO |
$2,964.10
|
| Rate for Payer: Signature Care PPO |
$3,142.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,035.52
|
| Rate for Payer: United Healthcare Commercial |
$2,814.11
|
| Rate for Payer: United Healthcare Medicare |
$1,142.78
|
|
|
HC AR TIGHTROPE II
|
Facility
|
IP
|
$3,571.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,678.40 |
| Max. Negotiated Rate |
$3,321.22 |
| Rate for Payer: Aetna Commercial |
$3,085.52
|
| Rate for Payer: Cash Price |
$2,142.72
|
| Rate for Payer: Cigna All Commercial |
$3,081.95
|
| Rate for Payer: CORVEL All Commercial |
$3,321.22
|
| Rate for Payer: Coventry All Commercial |
$3,142.66
|
| Rate for Payer: Encore All Commercial |
$3,287.29
|
| Rate for Payer: Frontpath All Commercial |
$3,285.50
|
| Rate for Payer: Humana ChoiceCare |
$3,084.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,214.08
|
| Rate for Payer: PHCS All Commercial |
$2,678.40
|
| Rate for Payer: PHP All Commercial |
$2,708.40
|
| Rate for Payer: Sagamore Health Network All Products |
$2,756.97
|
| Rate for Payer: Signature Care EPO |
$2,964.10
|
| Rate for Payer: Signature Care PPO |
$3,142.66
|
| Rate for Payer: United Healthcare Commercial |
$2,814.11
|
|
|
HC AR TIGHTROPE PLATE IMPLANT 1.5
|
Facility
|
OP
|
$15,820.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$14,712.79 |
| Rate for Payer: Aetna Commercial |
$13,352.25
|
| Rate for Payer: Aetna Medicare |
$5,062.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,904.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,085.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,889.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,821.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,568.71
|
| Rate for Payer: Cash Price |
$9,492.12
|
| Rate for Payer: Cash Price |
$9,492.12
|
| Rate for Payer: Centivo All Commercial |
$8,606.19
|
| Rate for Payer: Cigna All Commercial |
$13,652.83
|
| Rate for Payer: CORVEL All Commercial |
$14,712.79
|
| Rate for Payer: Coventry All Commercial |
$13,921.78
|
| Rate for Payer: Encore All Commercial |
$14,562.49
|
| Rate for Payer: Frontpath All Commercial |
$14,554.58
|
| Rate for Payer: Humana ChoiceCare |
$13,663.91
|
| Rate for Payer: Humana Medicare |
$5,062.46
|
| Rate for Payer: Lucent All Commercial |
$8,606.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,238.18
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$11,865.15
|
| Rate for Payer: PHP All Commercial |
$11,998.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,169.88
|
| Rate for Payer: Sagamore Health Network All Products |
$12,213.19
|
| Rate for Payer: Signature Care EPO |
$13,130.77
|
| Rate for Payer: Signature Care PPO |
$13,921.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,447.17
|
| Rate for Payer: United Healthcare Commercial |
$12,466.32
|
| Rate for Payer: United Healthcare Medicare |
$5,062.46
|
|
|
HC AR TIGHTROPE PLATE IMPLANT 1.5
|
Facility
|
IP
|
$15,820.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,865.15 |
| Max. Negotiated Rate |
$14,712.79 |
| Rate for Payer: Aetna Commercial |
$13,668.65
|
| Rate for Payer: Cash Price |
$9,492.12
|
| Rate for Payer: Cigna All Commercial |
$13,652.83
|
| Rate for Payer: CORVEL All Commercial |
$14,712.79
|
| Rate for Payer: Coventry All Commercial |
$13,921.78
|
| Rate for Payer: Encore All Commercial |
$14,562.49
|
| Rate for Payer: Frontpath All Commercial |
$14,554.58
|
| Rate for Payer: Humana ChoiceCare |
$13,663.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,238.18
|
| Rate for Payer: PHCS All Commercial |
$11,865.15
|
| Rate for Payer: PHP All Commercial |
$11,998.04
|
| Rate for Payer: Sagamore Health Network All Products |
$12,213.19
|
| Rate for Payer: Signature Care EPO |
$13,130.77
|
| Rate for Payer: Signature Care PPO |
$13,921.78
|
| Rate for Payer: United Healthcare Commercial |
$12,466.32
|
|
|
HC AR TIGHTROPE SUTURE ACL 2
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,594.70 |
| Rate for Payer: Aetna Commercial |
$2,354.76
|
| Rate for Payer: Aetna Medicare |
$892.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$864.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,602.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,744.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,026.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$982.08
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Centivo All Commercial |
$1,517.76
|
| Rate for Payer: Cigna All Commercial |
$2,407.77
|
| Rate for Payer: CORVEL All Commercial |
$2,594.70
|
| Rate for Payer: Coventry All Commercial |
$2,455.20
|
| Rate for Payer: Encore All Commercial |
$2,568.20
|
| Rate for Payer: Frontpath All Commercial |
$2,566.80
|
| Rate for Payer: Humana ChoiceCare |
$2,409.72
|
| Rate for Payer: Humana Medicare |
$892.80
|
| Rate for Payer: Lucent All Commercial |
$1,517.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,511.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,092.50
|
| Rate for Payer: PHP All Commercial |
$2,115.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,088.10
|
| Rate for Payer: Sagamore Health Network All Products |
$2,153.88
|
| Rate for Payer: Signature Care EPO |
$2,315.70
|
| Rate for Payer: Signature Care PPO |
$2,455.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,371.50
|
| Rate for Payer: United Healthcare Commercial |
$2,198.52
|
| Rate for Payer: United Healthcare Medicare |
$892.80
|
|
|
HC AR TIGHTROPE SUTURE ACL 2
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.50 |
| Max. Negotiated Rate |
$2,594.70 |
| Rate for Payer: Aetna Commercial |
$2,410.56
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna All Commercial |
$2,407.77
|
| Rate for Payer: CORVEL All Commercial |
$2,594.70
|
| Rate for Payer: Coventry All Commercial |
$2,455.20
|
| Rate for Payer: Encore All Commercial |
$2,568.20
|
| Rate for Payer: Frontpath All Commercial |
$2,566.80
|
| Rate for Payer: Humana ChoiceCare |
$2,409.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,511.00
|
| Rate for Payer: PHCS All Commercial |
$2,092.50
|
| Rate for Payer: PHP All Commercial |
$2,115.94
|
| Rate for Payer: Sagamore Health Network All Products |
$2,153.88
|
| Rate for Payer: Signature Care EPO |
$2,315.70
|
| Rate for Payer: Signature Care PPO |
$2,455.20
|
| Rate for Payer: United Healthcare Commercial |
$2,198.52
|
|
|
HC AR TIGHTROPE SYN IMPLANT
|
Facility
|
IP
|
$8,971.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,728.40 |
| Max. Negotiated Rate |
$8,343.22 |
| Rate for Payer: Aetna Commercial |
$7,751.12
|
| Rate for Payer: Cash Price |
$5,382.72
|
| Rate for Payer: Cigna All Commercial |
$7,742.15
|
| Rate for Payer: CORVEL All Commercial |
$8,343.22
|
| Rate for Payer: Coventry All Commercial |
$7,894.66
|
| Rate for Payer: Encore All Commercial |
$8,257.99
|
| Rate for Payer: Frontpath All Commercial |
$8,253.50
|
| Rate for Payer: Humana ChoiceCare |
$7,748.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,074.08
|
| Rate for Payer: PHCS All Commercial |
$6,728.40
|
| Rate for Payer: PHP All Commercial |
$6,803.76
|
| Rate for Payer: Sagamore Health Network All Products |
$6,925.77
|
| Rate for Payer: Signature Care EPO |
$7,446.10
|
| Rate for Payer: Signature Care PPO |
$7,894.66
|
| Rate for Payer: United Healthcare Commercial |
$7,069.31
|
|
|
HC AR TIGHTROPE SYN IMPLANT
|
Facility
|
OP
|
$8,971.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$8,343.22 |
| Rate for Payer: Aetna Commercial |
$7,571.69
|
| Rate for Payer: Aetna Medicare |
$2,870.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,781.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,152.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,607.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,301.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,157.86
|
| Rate for Payer: Cash Price |
$5,382.72
|
| Rate for Payer: Cash Price |
$5,382.72
|
| Rate for Payer: Centivo All Commercial |
$4,880.33
|
| Rate for Payer: Cigna All Commercial |
$7,742.15
|
| Rate for Payer: CORVEL All Commercial |
$8,343.22
|
| Rate for Payer: Coventry All Commercial |
$7,894.66
|
| Rate for Payer: Encore All Commercial |
$8,257.99
|
| Rate for Payer: Frontpath All Commercial |
$8,253.50
|
| Rate for Payer: Humana ChoiceCare |
$7,748.43
|
| Rate for Payer: Humana Medicare |
$2,870.78
|
| Rate for Payer: Lucent All Commercial |
$4,880.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,074.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,728.40
|
| Rate for Payer: PHP All Commercial |
$6,803.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,498.77
|
| Rate for Payer: Sagamore Health Network All Products |
$6,925.77
|
| Rate for Payer: Signature Care EPO |
$7,446.10
|
| Rate for Payer: Signature Care PPO |
$7,894.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,625.52
|
| Rate for Payer: United Healthcare Commercial |
$7,069.31
|
| Rate for Payer: United Healthcare Medicare |
$2,870.78
|
|
|
HC AR TIGHTROPE W INTBRCE
|
Facility
|
IP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.30 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,760.47
|
| Rate for Payer: Cash Price |
$2,611.44
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
|
|
HC AR TIGHTROPE W INTBRCE
|
Facility
|
OP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,673.43
|
| Rate for Payer: Aetna Medicare |
$1,392.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,349.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,499.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,720.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,601.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,532.04
|
| Rate for Payer: Cash Price |
$2,611.44
|
| Rate for Payer: Cash Price |
$2,611.44
|
| Rate for Payer: Centivo All Commercial |
$2,367.71
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Humana Medicare |
$1,392.77
|
| Rate for Payer: Lucent All Commercial |
$2,367.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,697.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,699.54
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
| Rate for Payer: United Healthcare Medicare |
$1,392.77
|
|
|
HC AR TRIPLEDAM CANNULA
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
|
HC AR TRIPLEDAM CANNULA
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR TRIPLEDAM CANNULA 7X7
|
Facility
|
OP
|
$246.40
|
|
| Hospital Charge Code |
41606208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$78.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.73
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centivo All Commercial |
$134.04
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$78.85
|
| Rate for Payer: Lucent All Commercial |
$134.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$78.85
|
|
|
HC AR TRIPLEDAM CANNULA 7X7
|
Facility
|
IP
|
$246.40
|
|
| Hospital Charge Code |
41606208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR WASHER 7.0
|
Facility
|
IP
|
$374.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.88 |
| Max. Negotiated Rate |
$348.29 |
| Rate for Payer: Aetna Commercial |
$323.57
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.29
|
| 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 |
$310.83
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
|
|
HC AR WASHER 7.0
|
Facility
|
OP
|
$374.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$348.29 |
| Rate for Payer: Aetna Commercial |
$316.08
|
| Rate for Payer: Aetna Medicare |
$119.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$116.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$215.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$234.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.82
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Centivo All Commercial |
$203.73
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.29
|
| 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 |
$119.84
|
| Rate for Payer: Lucent All Commercial |
$203.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| 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 |
$310.83
|
| 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 |
$119.84
|
|
|
HC AR WASHER 7.0 TI
|
Facility
|
OP
|
$409.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$380.83 |
| Rate for Payer: Aetna Commercial |
$345.62
|
| Rate for Payer: Aetna Medicare |
$131.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$235.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.14
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Centivo All Commercial |
$222.77
|
| Rate for Payer: Cigna All Commercial |
$353.40
|
| Rate for Payer: CORVEL All Commercial |
$380.83
|
| Rate for Payer: Coventry All Commercial |
$360.36
|
| Rate for Payer: Encore All Commercial |
$376.94
|
| Rate for Payer: Frontpath All Commercial |
$376.74
|
| Rate for Payer: Humana ChoiceCare |
$353.69
|
| Rate for Payer: Humana Medicare |
$131.04
|
| Rate for Payer: Lucent All Commercial |
$222.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.55
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$307.12
|
| Rate for Payer: PHP All Commercial |
$310.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.71
|
| Rate for Payer: Sagamore Health Network All Products |
$316.13
|
| Rate for Payer: Signature Care EPO |
$339.88
|
| Rate for Payer: Signature Care PPO |
$360.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$348.07
|
| Rate for Payer: United Healthcare Commercial |
$322.69
|
| Rate for Payer: United Healthcare Medicare |
$131.04
|
|
|
HC AR WASHER 7.0 TI
|
Facility
|
IP
|
$409.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$380.83 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cigna All Commercial |
$353.40
|
| Rate for Payer: CORVEL All Commercial |
$380.83
|
| Rate for Payer: Coventry All Commercial |
$360.36
|
| Rate for Payer: Encore All Commercial |
$376.94
|
| Rate for Payer: Frontpath All Commercial |
$376.74
|
| Rate for Payer: Humana ChoiceCare |
$353.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.55
|
| Rate for Payer: PHCS All Commercial |
$307.12
|
| Rate for Payer: PHP All Commercial |
$310.56
|
| Rate for Payer: Sagamore Health Network All Products |
$316.13
|
| Rate for Payer: Signature Care EPO |
$339.88
|
| Rate for Payer: Signature Care PPO |
$360.36
|
| Rate for Payer: United Healthcare Commercial |
$322.69
|
|
|
HC ASO TITER
|
Facility
|
OP
|
$122.67
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
63001027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$103.53
|
| Rate for Payer: Aetna Medicare |
$39.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.18
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Centivo All Commercial |
$66.73
|
| Rate for Payer: Cigna All Commercial |
$105.86
|
| Rate for Payer: CORVEL All Commercial |
$114.08
|
| Rate for Payer: Coventry All Commercial |
$107.95
|
| Rate for Payer: Encore All Commercial |
$112.92
|
| Rate for Payer: Frontpath All Commercial |
$112.86
|
| Rate for Payer: Humana ChoiceCare |
$105.95
|
| Rate for Payer: Humana Medicare |
$39.25
|
| Rate for Payer: Lucent All Commercial |
$66.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.40
|
| Rate for Payer: Managed Health Services Medicaid |
$7.30
|
| Rate for Payer: MDWise Medicaid |
$7.30
|
| Rate for Payer: PHCS All Commercial |
$92.00
|
| Rate for Payer: PHP All Commercial |
$93.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.84
|
| Rate for Payer: Sagamore Health Network All Products |
$94.70
|
| Rate for Payer: Signature Care EPO |
$101.82
|
| Rate for Payer: Signature Care PPO |
$107.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.27
|
| Rate for Payer: United Healthcare Commercial |
$96.66
|
| Rate for Payer: United Healthcare Medicare |
$39.25
|
|
|
HC ASO TITER
|
Facility
|
IP
|
$122.67
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
63001027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$105.99
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cigna All Commercial |
$105.86
|
| Rate for Payer: CORVEL All Commercial |
$114.08
|
| Rate for Payer: Coventry All Commercial |
$107.95
|
| Rate for Payer: Encore All Commercial |
$112.92
|
| Rate for Payer: Frontpath All Commercial |
$112.86
|
| Rate for Payer: Humana ChoiceCare |
$105.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.40
|
| Rate for Payer: PHCS All Commercial |
$92.00
|
| Rate for Payer: PHP All Commercial |
$93.03
|
| Rate for Payer: Sagamore Health Network All Products |
$94.70
|
| Rate for Payer: Signature Care EPO |
$101.82
|
| Rate for Payer: Signature Care PPO |
$107.95
|
| Rate for Payer: United Healthcare Commercial |
$96.66
|
|
|
HC ASPERGILLUS AB - CF
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$95.81 |
| Rate for Payer: Aetna Commercial |
$86.95
|
| Rate for Payer: Aetna Medicare |
$32.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.26
|
| Rate for Payer: Cash Price |
$61.81
|
| Rate for Payer: Cash Price |
$61.81
|
| Rate for Payer: Centivo All Commercial |
$56.04
|
| Rate for Payer: Cigna All Commercial |
$88.91
|
| Rate for Payer: CORVEL All Commercial |
$95.81
|
| Rate for Payer: Coventry All Commercial |
$90.66
|
| Rate for Payer: Encore All Commercial |
$94.83
|
| Rate for Payer: Frontpath All Commercial |
$94.78
|
| Rate for Payer: Humana ChoiceCare |
$88.98
|
| Rate for Payer: Humana Medicare |
$32.97
|
| Rate for Payer: Lucent All Commercial |
$56.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.72
|
| Rate for Payer: Managed Health Services Medicaid |
$15.05
|
| Rate for Payer: MDWise Medicaid |
$15.05
|
| Rate for Payer: PHCS All Commercial |
$77.27
|
| Rate for Payer: PHP All Commercial |
$78.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.18
|
| Rate for Payer: Sagamore Health Network All Products |
$79.53
|
| Rate for Payer: Signature Care EPO |
$85.51
|
| Rate for Payer: Signature Care PPO |
$90.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.57
|
| Rate for Payer: United Healthcare Commercial |
$81.18
|
| Rate for Payer: United Healthcare Medicare |
$32.97
|
|
