|
HC DS ATT TIB MS SZ 6X5 R
|
Facility
|
IP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.00 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,909.76
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
|
|
HC DS ATT TIB MS SZ 6X6 L
|
Facility
|
IP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.00 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,909.76
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
|
|
HC DS ATT TIB MS SZ 6X6 L
|
Facility
|
OP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,772.96
|
| Rate for Payer: Aetna Medicare |
$2,188.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,120.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,928.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,275.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,517.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,407.68
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Centivo All Commercial |
$3,720.96
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Humana Medicare |
$2,188.80
|
| Rate for Payer: Lucent All Commercial |
$3,720.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,667.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,814.00
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
| Rate for Payer: United Healthcare Medicare |
$2,188.80
|
|
|
HC DS ATT TIB MS SZ 7 L
|
Facility
|
OP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,772.96
|
| Rate for Payer: Aetna Medicare |
$2,188.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,120.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,928.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,275.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,517.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,407.68
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Centivo All Commercial |
$3,720.96
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Humana Medicare |
$2,188.80
|
| Rate for Payer: Lucent All Commercial |
$3,720.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,667.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,814.00
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
| Rate for Payer: United Healthcare Medicare |
$2,188.80
|
|
|
HC DS ATT TIB MS SZ 7 L
|
Facility
|
IP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.00 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,909.76
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
|
|
HC DS ATT TIB MS SZ 8 L
|
Facility
|
IP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.00 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,909.76
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
|
|
HC DS ATT TIB MS SZ 8 L
|
Facility
|
OP
|
$6,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: Aetna Commercial |
$5,772.96
|
| Rate for Payer: Aetna Medicare |
$2,188.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,120.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,928.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,275.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,517.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,407.68
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Centivo All Commercial |
$3,720.96
|
| Rate for Payer: Cigna All Commercial |
$5,902.92
|
| Rate for Payer: CORVEL All Commercial |
$6,361.20
|
| Rate for Payer: Coventry All Commercial |
$6,019.20
|
| Rate for Payer: Encore All Commercial |
$6,296.22
|
| Rate for Payer: Frontpath All Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$5,907.71
|
| Rate for Payer: Humana Medicare |
$2,188.80
|
| Rate for Payer: Lucent All Commercial |
$3,720.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,156.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,130.00
|
| Rate for Payer: PHP All Commercial |
$5,187.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,667.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,280.48
|
| Rate for Payer: Signature Care EPO |
$5,677.20
|
| Rate for Payer: Signature Care PPO |
$6,019.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,814.00
|
| Rate for Payer: United Healthcare Commercial |
$5,389.92
|
| Rate for Payer: United Healthcare Medicare |
$2,188.80
|
|
|
HC DS AUGMENT 4MM KICKSTAND
|
Facility
|
OP
|
$9,528.12
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$8,861.15 |
| Rate for Payer: Aetna Commercial |
$8,041.73
|
| Rate for Payer: Aetna Medicare |
$3,049.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,953.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,472.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,956.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,506.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,353.90
|
| Rate for Payer: Cash Price |
$5,716.87
|
| Rate for Payer: Cash Price |
$5,716.87
|
| Rate for Payer: Centivo All Commercial |
$5,183.30
|
| Rate for Payer: Cigna All Commercial |
$8,222.77
|
| Rate for Payer: CORVEL All Commercial |
$8,861.15
|
| Rate for Payer: Coventry All Commercial |
$8,384.75
|
| Rate for Payer: Encore All Commercial |
$8,770.63
|
| Rate for Payer: Frontpath All Commercial |
$8,765.87
|
| Rate for Payer: Humana ChoiceCare |
$8,229.44
|
| Rate for Payer: Humana Medicare |
$3,049.00
|
| Rate for Payer: Lucent All Commercial |
$5,183.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,575.31
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,146.09
|
| Rate for Payer: PHP All Commercial |
$7,226.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,715.97
|
| Rate for Payer: Sagamore Health Network All Products |
$7,355.71
|
| Rate for Payer: Signature Care EPO |
$7,908.34
|
| Rate for Payer: Signature Care PPO |
$8,384.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,098.90
|
| Rate for Payer: United Healthcare Commercial |
$7,508.16
|
| Rate for Payer: United Healthcare Medicare |
$3,049.00
|
|
|
HC DS AUGMENT 4MM KICKSTAND
|
Facility
|
IP
|
$9,528.12
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,146.09 |
| Max. Negotiated Rate |
$8,861.15 |
| Rate for Payer: Aetna Commercial |
$8,232.30
|
| Rate for Payer: Cash Price |
$5,716.87
|
| Rate for Payer: Cigna All Commercial |
$8,222.77
|
| Rate for Payer: CORVEL All Commercial |
$8,861.15
|
| Rate for Payer: Coventry All Commercial |
$8,384.75
|
| Rate for Payer: Encore All Commercial |
$8,770.63
|
| Rate for Payer: Frontpath All Commercial |
$8,765.87
|
| Rate for Payer: Humana ChoiceCare |
$8,229.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,575.31
|
| Rate for Payer: PHCS All Commercial |
$7,146.09
|
| Rate for Payer: PHP All Commercial |
$7,226.13
|
| Rate for Payer: Sagamore Health Network All Products |
$7,355.71
|
| Rate for Payer: Signature Care EPO |
$7,908.34
|
| Rate for Payer: Signature Care PPO |
$8,384.75
|
| Rate for Payer: United Healthcare Commercial |
$7,508.16
|
|
|
HC DS BASEPLATE 24 MOD CONV SM
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC DS BASEPLATE 24 MOD CONV SM
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,073.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Centivo All Commercial |
$3,525.12
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$2,073.60
|
| Rate for Payer: Lucent All Commercial |
$3,525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,073.60
|
|
|
HC DS BASEPLATE 24 MOD SM
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC DS BASEPLATE 24 MOD SM
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,073.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Centivo All Commercial |
$3,525.12
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$2,073.60
|
| Rate for Payer: Lucent All Commercial |
$3,525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,073.60
|
|
|
HC DS-DNA AB
|
Facility
|
IP
|
$92.53
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$86.05 |
| Rate for Payer: Aetna Commercial |
$79.95
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Cigna All Commercial |
$79.85
|
| Rate for Payer: CORVEL All Commercial |
$86.05
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$85.17
|
| Rate for Payer: Frontpath All Commercial |
$85.13
|
| Rate for Payer: Humana ChoiceCare |
$79.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.28
|
| Rate for Payer: PHCS All Commercial |
$69.40
|
| Rate for Payer: PHP All Commercial |
$70.17
|
| Rate for Payer: Sagamore Health Network All Products |
$71.43
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.43
|
| Rate for Payer: United Healthcare Commercial |
$72.91
|
|
|
HC DS-DNA AB
|
Facility
|
OP
|
$92.53
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
63001874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$86.05 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: Aetna Medicare |
$29.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.57
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Cash Price |
$55.52
|
| Rate for Payer: Centivo All Commercial |
$50.34
|
| Rate for Payer: Cigna All Commercial |
$79.85
|
| Rate for Payer: CORVEL All Commercial |
$86.05
|
| Rate for Payer: Coventry All Commercial |
$81.43
|
| Rate for Payer: Encore All Commercial |
$85.17
|
| Rate for Payer: Frontpath All Commercial |
$85.13
|
| Rate for Payer: Humana ChoiceCare |
$79.92
|
| Rate for Payer: Humana Medicare |
$29.61
|
| Rate for Payer: Lucent All Commercial |
$50.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.28
|
| Rate for Payer: Managed Health Services Medicaid |
$13.74
|
| Rate for Payer: MDWise Medicaid |
$13.74
|
| Rate for Payer: PHCS All Commercial |
$69.40
|
| Rate for Payer: PHP All Commercial |
$70.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.09
|
| Rate for Payer: Sagamore Health Network All Products |
$71.43
|
| Rate for Payer: Signature Care EPO |
$76.80
|
| Rate for Payer: Signature Care PPO |
$81.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.65
|
| Rate for Payer: United Healthcare Commercial |
$72.91
|
| Rate for Payer: United Healthcare Medicare |
$29.61
|
|
|
HC DS DRILL BIT 1.8
|
Facility
|
IP
|
$1,668.00
|
|
| Hospital Charge Code |
41608379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$1,551.24 |
| Rate for Payer: Aetna Commercial |
$1,441.15
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna All Commercial |
$1,439.48
|
| Rate for Payer: CORVEL All Commercial |
$1,551.24
|
| Rate for Payer: Coventry All Commercial |
$1,467.84
|
| Rate for Payer: Encore All Commercial |
$1,535.39
|
| Rate for Payer: Frontpath All Commercial |
$1,534.56
|
| Rate for Payer: Humana ChoiceCare |
$1,440.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,501.20
|
| Rate for Payer: PHCS All Commercial |
$1,251.00
|
| Rate for Payer: PHP All Commercial |
$1,265.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,287.70
|
| Rate for Payer: Signature Care EPO |
$1,384.44
|
| Rate for Payer: Signature Care PPO |
$1,467.84
|
| Rate for Payer: United Healthcare Commercial |
$1,314.38
|
|
|
HC DS DRILL BIT 1.8
|
Facility
|
OP
|
$1,668.00
|
|
| Hospital Charge Code |
41608379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,551.24 |
| Rate for Payer: Aetna Commercial |
$1,407.79
|
| Rate for Payer: Aetna Medicare |
$533.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$517.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$957.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,042.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$613.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$587.14
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Centivo All Commercial |
$907.39
|
| Rate for Payer: Cigna All Commercial |
$1,439.48
|
| Rate for Payer: CORVEL All Commercial |
$1,551.24
|
| Rate for Payer: Coventry All Commercial |
$1,467.84
|
| Rate for Payer: Encore All Commercial |
$1,535.39
|
| Rate for Payer: Frontpath All Commercial |
$1,534.56
|
| Rate for Payer: Humana ChoiceCare |
$1,440.65
|
| Rate for Payer: Humana Medicare |
$533.76
|
| Rate for Payer: Lucent All Commercial |
$907.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,501.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,251.00
|
| Rate for Payer: PHP All Commercial |
$1,265.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$650.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,287.70
|
| Rate for Payer: Signature Care EPO |
$1,384.44
|
| Rate for Payer: Signature Care PPO |
$1,467.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,417.80
|
| Rate for Payer: United Healthcare Commercial |
$1,314.38
|
| Rate for Payer: United Healthcare Medicare |
$533.76
|
|
|
HC DS DRILL BIT 4.2 QC330-100
|
Facility
|
OP
|
$1,768.00
|
|
| Hospital Charge Code |
41606219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,644.24 |
| Rate for Payer: Aetna Commercial |
$1,492.19
|
| Rate for Payer: Aetna Medicare |
$565.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$548.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,015.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,105.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$650.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$622.34
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Centivo All Commercial |
$961.79
|
| Rate for Payer: Cigna All Commercial |
$1,525.78
|
| Rate for Payer: CORVEL All Commercial |
$1,644.24
|
| Rate for Payer: Coventry All Commercial |
$1,555.84
|
| Rate for Payer: Encore All Commercial |
$1,627.44
|
| Rate for Payer: Frontpath All Commercial |
$1,626.56
|
| Rate for Payer: Humana ChoiceCare |
$1,527.02
|
| Rate for Payer: Humana Medicare |
$565.76
|
| Rate for Payer: Lucent All Commercial |
$961.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,326.00
|
| Rate for Payer: PHP All Commercial |
$1,340.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$689.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,364.90
|
| Rate for Payer: Signature Care EPO |
$1,467.44
|
| Rate for Payer: Signature Care PPO |
$1,555.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,502.80
|
| Rate for Payer: United Healthcare Commercial |
$1,393.18
|
| Rate for Payer: United Healthcare Medicare |
$565.76
|
|
|
HC DS DRILL BIT 4.2 QC330-100
|
Facility
|
IP
|
$1,768.00
|
|
| Hospital Charge Code |
41606219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,326.00 |
| Max. Negotiated Rate |
$1,644.24 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna All Commercial |
$1,525.78
|
| Rate for Payer: CORVEL All Commercial |
$1,644.24
|
| Rate for Payer: Coventry All Commercial |
$1,555.84
|
| Rate for Payer: Encore All Commercial |
$1,627.44
|
| Rate for Payer: Frontpath All Commercial |
$1,626.56
|
| Rate for Payer: Humana ChoiceCare |
$1,527.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.20
|
| Rate for Payer: PHCS All Commercial |
$1,326.00
|
| Rate for Payer: PHP All Commercial |
$1,340.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,364.90
|
| Rate for Payer: Signature Care EPO |
$1,467.44
|
| Rate for Payer: Signature Care PPO |
$1,555.84
|
| Rate for Payer: United Healthcare Commercial |
$1,393.18
|
|
|
HC DS GELNOSPHERE 36+8
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,073.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Centivo All Commercial |
$3,525.12
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$2,073.60
|
| Rate for Payer: Lucent All Commercial |
$3,525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,073.60
|
|
|
HC DS GELNOSPHERE 36+8
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC DS GLENOID 23.5 MD
|
Facility
|
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,566.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,047.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,914.56
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Centivo All Commercial |
$4,504.32
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$2,649.60
|
| Rate for Payer: Lucent All Commercial |
$4,504.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,649.60
|
|
|
HC DS GLENOID 23.5 MD
|
Facility
|
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC DS GLENOPHERE 32+4MM
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC DS GLENOPHERE 32+4MM
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,073.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Centivo All Commercial |
$3,525.12
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$2,073.60
|
| Rate for Payer: Lucent All Commercial |
$3,525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,073.60
|
|
