|
HC DS GLENOSPHERE 36+4
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608410
|
|
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 GLENOSPHERE 36+4
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608410
|
|
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 GLEN PIN 3.5X230
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
41608398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$719.25 |
| Max. Negotiated Rate |
$891.87 |
| Rate for Payer: Aetna Commercial |
$828.58
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna All Commercial |
$827.62
|
| Rate for Payer: CORVEL All Commercial |
$891.87
|
| Rate for Payer: Coventry All Commercial |
$843.92
|
| Rate for Payer: Encore All Commercial |
$882.76
|
| Rate for Payer: Frontpath All Commercial |
$882.28
|
| Rate for Payer: Humana ChoiceCare |
$828.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$863.10
|
| Rate for Payer: PHCS All Commercial |
$719.25
|
| Rate for Payer: PHP All Commercial |
$727.31
|
| Rate for Payer: Sagamore Health Network All Products |
$740.35
|
| Rate for Payer: Signature Care EPO |
$795.97
|
| Rate for Payer: Signature Care PPO |
$843.92
|
| Rate for Payer: United Healthcare Commercial |
$755.69
|
|
|
HC DS GLEN PIN 3.5X230
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
41608398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$891.87 |
| Rate for Payer: Aetna Commercial |
$809.40
|
| Rate for Payer: Aetna Medicare |
$306.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$297.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$550.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$599.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.57
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Centivo All Commercial |
$521.70
|
| Rate for Payer: Cigna All Commercial |
$827.62
|
| Rate for Payer: CORVEL All Commercial |
$891.87
|
| Rate for Payer: Coventry All Commercial |
$843.92
|
| Rate for Payer: Encore All Commercial |
$882.76
|
| Rate for Payer: Frontpath All Commercial |
$882.28
|
| Rate for Payer: Humana ChoiceCare |
$828.29
|
| Rate for Payer: Humana Medicare |
$306.88
|
| Rate for Payer: Lucent All Commercial |
$521.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$863.10
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$719.25
|
| Rate for Payer: PHP All Commercial |
$727.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$374.01
|
| Rate for Payer: Sagamore Health Network All Products |
$740.35
|
| Rate for Payer: Signature Care EPO |
$795.97
|
| Rate for Payer: Signature Care PPO |
$843.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$815.15
|
| Rate for Payer: United Healthcare Commercial |
$755.69
|
| Rate for Payer: United Healthcare Medicare |
$306.88
|
|
|
HC DS GUIDE PIN 3.0X100
|
Facility
|
IP
|
$1,113.00
|
|
| Hospital Charge Code |
41608397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$834.75 |
| Max. Negotiated Rate |
$1,035.09 |
| Rate for Payer: Aetna Commercial |
$961.63
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Cigna All Commercial |
$960.52
|
| Rate for Payer: CORVEL All Commercial |
$1,035.09
|
| Rate for Payer: Coventry All Commercial |
$979.44
|
| Rate for Payer: Encore All Commercial |
$1,024.52
|
| Rate for Payer: Frontpath All Commercial |
$1,023.96
|
| Rate for Payer: Humana ChoiceCare |
$961.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,001.70
|
| Rate for Payer: PHCS All Commercial |
$834.75
|
| Rate for Payer: PHP All Commercial |
$844.10
|
| Rate for Payer: Sagamore Health Network All Products |
$859.24
|
| Rate for Payer: Signature Care EPO |
$923.79
|
| Rate for Payer: Signature Care PPO |
$979.44
|
| Rate for Payer: United Healthcare Commercial |
$877.04
|
|
|
HC DS GUIDE PIN 3.0X100
|
Facility
|
OP
|
$1,113.00
|
|
| Hospital Charge Code |
41608397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,035.09 |
| Rate for Payer: Aetna Commercial |
$939.37
|
| Rate for Payer: Aetna Medicare |
$356.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$345.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$639.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$695.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$409.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$391.78
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Centivo All Commercial |
$605.47
|
| Rate for Payer: Cigna All Commercial |
$960.52
|
| Rate for Payer: CORVEL All Commercial |
$1,035.09
|
| Rate for Payer: Coventry All Commercial |
$979.44
|
| Rate for Payer: Encore All Commercial |
$1,024.52
|
| Rate for Payer: Frontpath All Commercial |
$1,023.96
|
| Rate for Payer: Humana ChoiceCare |
$961.30
|
| Rate for Payer: Humana Medicare |
$356.16
|
| Rate for Payer: Lucent All Commercial |
$605.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,001.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$834.75
|
| Rate for Payer: PHP All Commercial |
$844.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.07
|
| Rate for Payer: Sagamore Health Network All Products |
$859.24
|
| Rate for Payer: Signature Care EPO |
$923.79
|
| Rate for Payer: Signature Care PPO |
$979.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$946.05
|
| Rate for Payer: United Healthcare Commercial |
$877.04
|
| Rate for Payer: United Healthcare Medicare |
$356.16
|
|
|
HC DS HUM HEAD 46X16
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,400.00
|
| Rate for Payer: Cigna All Commercial |
$7,767.00
|
| Rate for Payer: CORVEL All Commercial |
$8,370.00
|
| Rate for Payer: Coventry All Commercial |
$7,920.00
|
| Rate for Payer: Encore All Commercial |
$8,284.50
|
| Rate for Payer: Frontpath All Commercial |
$8,280.00
|
| Rate for Payer: Humana ChoiceCare |
$7,773.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| Rate for Payer: Sagamore Health Network All Products |
$6,948.00
|
| Rate for Payer: Signature Care EPO |
$7,470.00
|
| Rate for Payer: Signature Care PPO |
$7,920.00
|
| Rate for Payer: United Healthcare Commercial |
$7,092.00
|
|
|
HC DS HUM HEAD 46X16
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Medicare |
$2,880.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,790.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,168.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,625.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,312.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,168.00
|
| Rate for Payer: Cash Price |
$5,400.00
|
| Rate for Payer: Cash Price |
$5,400.00
|
| Rate for Payer: Centivo All Commercial |
$4,896.00
|
| Rate for Payer: Cigna All Commercial |
$7,767.00
|
| Rate for Payer: CORVEL All Commercial |
$8,370.00
|
| Rate for Payer: Coventry All Commercial |
$7,920.00
|
| Rate for Payer: Encore All Commercial |
$8,284.50
|
| Rate for Payer: Frontpath All Commercial |
$8,280.00
|
| Rate for Payer: Humana ChoiceCare |
$7,773.30
|
| Rate for Payer: Humana Medicare |
$2,880.00
|
| Rate for Payer: Lucent All Commercial |
$4,896.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,510.00
|
| Rate for Payer: Sagamore Health Network All Products |
$6,948.00
|
| Rate for Payer: Signature Care EPO |
$7,470.00
|
| Rate for Payer: Signature Care PPO |
$7,920.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,650.00
|
| Rate for Payer: United Healthcare Commercial |
$7,092.00
|
| Rate for Payer: United Healthcare Medicare |
$2,880.00
|
|
|
HC DS HUM PIN 3.5X130
|
Facility
|
OP
|
$965.30
|
|
| Hospital Charge Code |
41608396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$897.73 |
| Rate for Payer: Aetna Commercial |
$814.71
|
| Rate for Payer: Aetna Medicare |
$308.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$554.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.79
|
| Rate for Payer: Cash Price |
$579.18
|
| Rate for Payer: Cash Price |
$579.18
|
| Rate for Payer: Centivo All Commercial |
$525.12
|
| Rate for Payer: Cigna All Commercial |
$833.05
|
| Rate for Payer: CORVEL All Commercial |
$897.73
|
| Rate for Payer: Coventry All Commercial |
$849.46
|
| Rate for Payer: Encore All Commercial |
$888.56
|
| Rate for Payer: Frontpath All Commercial |
$888.08
|
| Rate for Payer: Humana ChoiceCare |
$833.73
|
| Rate for Payer: Humana Medicare |
$308.90
|
| Rate for Payer: Lucent All Commercial |
$525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.77
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$723.98
|
| Rate for Payer: PHP All Commercial |
$732.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.47
|
| Rate for Payer: Sagamore Health Network All Products |
$745.21
|
| Rate for Payer: Signature Care EPO |
$801.20
|
| Rate for Payer: Signature Care PPO |
$849.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.50
|
| Rate for Payer: United Healthcare Commercial |
$760.66
|
| Rate for Payer: United Healthcare Medicare |
$308.90
|
|
|
HC DS HUM PIN 3.5X130
|
Facility
|
IP
|
$965.30
|
|
| Hospital Charge Code |
41608396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.98 |
| Max. Negotiated Rate |
$897.73 |
| Rate for Payer: Aetna Commercial |
$834.02
|
| Rate for Payer: Cash Price |
$579.18
|
| Rate for Payer: Cigna All Commercial |
$833.05
|
| Rate for Payer: CORVEL All Commercial |
$897.73
|
| Rate for Payer: Coventry All Commercial |
$849.46
|
| Rate for Payer: Encore All Commercial |
$888.56
|
| Rate for Payer: Frontpath All Commercial |
$888.08
|
| Rate for Payer: Humana ChoiceCare |
$833.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.77
|
| Rate for Payer: PHCS All Commercial |
$723.98
|
| Rate for Payer: PHP All Commercial |
$732.08
|
| Rate for Payer: Sagamore Health Network All Products |
$745.21
|
| Rate for Payer: Signature Care EPO |
$801.20
|
| Rate for Payer: Signature Care PPO |
$849.46
|
| Rate for Payer: United Healthcare Commercial |
$760.66
|
|
|
HC DS K-WIRE 1.25 150
|
Facility
|
IP
|
$1,004.00
|
|
| Hospital Charge Code |
41608380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$933.72 |
| Rate for Payer: Aetna Commercial |
$867.46
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna All Commercial |
$866.45
|
| Rate for Payer: CORVEL All Commercial |
$933.72
|
| Rate for Payer: Coventry All Commercial |
$883.52
|
| Rate for Payer: Encore All Commercial |
$924.18
|
| Rate for Payer: Frontpath All Commercial |
$923.68
|
| Rate for Payer: Humana ChoiceCare |
$867.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$903.60
|
| Rate for Payer: PHCS All Commercial |
$753.00
|
| Rate for Payer: PHP All Commercial |
$761.43
|
| Rate for Payer: Sagamore Health Network All Products |
$775.09
|
| Rate for Payer: Signature Care EPO |
$833.32
|
| Rate for Payer: Signature Care PPO |
$883.52
|
| Rate for Payer: United Healthcare Commercial |
$791.15
|
|
|
HC DS K-WIRE 1.25 150
|
Facility
|
OP
|
$1,004.00
|
|
| Hospital Charge Code |
41608380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$933.72 |
| Rate for Payer: Aetna Commercial |
$847.38
|
| Rate for Payer: Aetna Medicare |
$321.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$576.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$627.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$369.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$353.41
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Centivo All Commercial |
$546.18
|
| Rate for Payer: Cigna All Commercial |
$866.45
|
| Rate for Payer: CORVEL All Commercial |
$933.72
|
| Rate for Payer: Coventry All Commercial |
$883.52
|
| Rate for Payer: Encore All Commercial |
$924.18
|
| Rate for Payer: Frontpath All Commercial |
$923.68
|
| Rate for Payer: Humana ChoiceCare |
$867.15
|
| Rate for Payer: Humana Medicare |
$321.28
|
| Rate for Payer: Lucent All Commercial |
$546.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$903.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$753.00
|
| Rate for Payer: PHP All Commercial |
$761.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$391.56
|
| Rate for Payer: Sagamore Health Network All Products |
$775.09
|
| Rate for Payer: Signature Care EPO |
$833.32
|
| Rate for Payer: Signature Care PPO |
$883.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$853.40
|
| Rate for Payer: United Healthcare Commercial |
$791.15
|
| Rate for Payer: United Healthcare Medicare |
$321.28
|
|
|
HC DS K-WIRE 1.6 150 TROC TIP
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$654.10
|
| Rate for Payer: Aetna Medicare |
$248.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$240.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$445.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$285.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$272.80
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Centivo All Commercial |
$421.60
|
| Rate for Payer: Cigna All Commercial |
$668.83
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Humana Medicare |
$248.00
|
| Rate for Payer: Lucent All Commercial |
$421.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$302.25
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$658.75
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
| Rate for Payer: United Healthcare Medicare |
$248.00
|
|
|
HC DS K-WIRE 1.6 150 TROC TIP
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna All Commercial |
$668.83
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
|
|
HC DS MENISCAL REPAIR 12
|
Facility
|
IP
|
$3,074.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.80 |
| Max. Negotiated Rate |
$2,859.19 |
| Rate for Payer: Aetna Commercial |
$2,656.28
|
| Rate for Payer: Cash Price |
$1,844.64
|
| Rate for Payer: Cigna All Commercial |
$2,653.21
|
| Rate for Payer: CORVEL All Commercial |
$2,859.19
|
| Rate for Payer: Coventry All Commercial |
$2,705.47
|
| Rate for Payer: Encore All Commercial |
$2,829.99
|
| Rate for Payer: Frontpath All Commercial |
$2,828.45
|
| Rate for Payer: Humana ChoiceCare |
$2,655.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,766.96
|
| Rate for Payer: PHCS All Commercial |
$2,305.80
|
| Rate for Payer: PHP All Commercial |
$2,331.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,373.44
|
| Rate for Payer: Signature Care EPO |
$2,551.75
|
| Rate for Payer: Signature Care PPO |
$2,705.47
|
| Rate for Payer: United Healthcare Commercial |
$2,422.63
|
|
|
HC DS MENISCAL REPAIR 12
|
Facility
|
OP
|
$3,074.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,859.19 |
| Rate for Payer: Aetna Commercial |
$2,594.79
|
| Rate for Payer: Aetna Medicare |
$983.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$953.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,765.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,921.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,131.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,082.19
|
| Rate for Payer: Cash Price |
$1,844.64
|
| Rate for Payer: Cash Price |
$1,844.64
|
| Rate for Payer: Centivo All Commercial |
$1,672.47
|
| Rate for Payer: Cigna All Commercial |
$2,653.21
|
| Rate for Payer: CORVEL All Commercial |
$2,859.19
|
| Rate for Payer: Coventry All Commercial |
$2,705.47
|
| Rate for Payer: Encore All Commercial |
$2,829.99
|
| Rate for Payer: Frontpath All Commercial |
$2,828.45
|
| Rate for Payer: Humana ChoiceCare |
$2,655.36
|
| Rate for Payer: Humana Medicare |
$983.81
|
| Rate for Payer: Lucent All Commercial |
$1,672.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,766.96
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,305.80
|
| Rate for Payer: PHP All Commercial |
$2,331.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,199.02
|
| Rate for Payer: Sagamore Health Network All Products |
$2,373.44
|
| Rate for Payer: Signature Care EPO |
$2,551.75
|
| Rate for Payer: Signature Care PPO |
$2,705.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,613.24
|
| Rate for Payer: United Healthcare Commercial |
$2,422.63
|
| Rate for Payer: United Healthcare Medicare |
$983.81
|
|
|
HC DS NAIL 10/130 X170 CANN TFNA
|
Facility
|
OP
|
$11,595.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$10,783.91 |
| Rate for Payer: Aetna Commercial |
$9,786.69
|
| Rate for Payer: Aetna Medicare |
$3,710.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,594.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,659.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,248.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,267.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,081.65
|
| Rate for Payer: Cash Price |
$6,957.36
|
| Rate for Payer: Cash Price |
$6,957.36
|
| Rate for Payer: Centivo All Commercial |
$6,308.01
|
| Rate for Payer: Cigna All Commercial |
$10,007.00
|
| Rate for Payer: CORVEL All Commercial |
$10,783.91
|
| Rate for Payer: Coventry All Commercial |
$10,204.13
|
| Rate for Payer: Encore All Commercial |
$10,673.75
|
| Rate for Payer: Frontpath All Commercial |
$10,667.95
|
| Rate for Payer: Humana ChoiceCare |
$10,015.12
|
| Rate for Payer: Humana Medicare |
$3,710.59
|
| Rate for Payer: Lucent All Commercial |
$6,308.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,436.04
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$8,696.70
|
| Rate for Payer: PHP All Commercial |
$8,794.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,522.28
|
| Rate for Payer: Sagamore Health Network All Products |
$8,951.80
|
| Rate for Payer: Signature Care EPO |
$9,624.35
|
| Rate for Payer: Signature Care PPO |
$10,204.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,856.26
|
| Rate for Payer: United Healthcare Commercial |
$9,137.33
|
| Rate for Payer: United Healthcare Medicare |
$3,710.59
|
|
|
HC DS NAIL 10/130 X170 CANN TFNA
|
Facility
|
IP
|
$11,595.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,696.70 |
| Max. Negotiated Rate |
$10,783.91 |
| Rate for Payer: Aetna Commercial |
$10,018.60
|
| Rate for Payer: Cash Price |
$6,957.36
|
| Rate for Payer: Cigna All Commercial |
$10,007.00
|
| Rate for Payer: CORVEL All Commercial |
$10,783.91
|
| Rate for Payer: Coventry All Commercial |
$10,204.13
|
| Rate for Payer: Encore All Commercial |
$10,673.75
|
| Rate for Payer: Frontpath All Commercial |
$10,667.95
|
| Rate for Payer: Humana ChoiceCare |
$10,015.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,436.04
|
| Rate for Payer: PHCS All Commercial |
$8,696.70
|
| Rate for Payer: PHP All Commercial |
$8,794.10
|
| Rate for Payer: Sagamore Health Network All Products |
$8,951.80
|
| Rate for Payer: Signature Care EPO |
$9,624.35
|
| Rate for Payer: Signature Care PPO |
$10,204.13
|
| Rate for Payer: United Healthcare Commercial |
$9,137.33
|
|
|
HC DS PLATE 2.4 VA 6H/3H L
|
Facility
|
IP
|
$3,289.97
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.48 |
| Max. Negotiated Rate |
$3,059.67 |
| Rate for Payer: Aetna Commercial |
$2,842.53
|
| Rate for Payer: Cash Price |
$1,973.98
|
| Rate for Payer: Cigna All Commercial |
$2,839.24
|
| Rate for Payer: CORVEL All Commercial |
$3,059.67
|
| Rate for Payer: Coventry All Commercial |
$2,895.17
|
| Rate for Payer: Encore All Commercial |
$3,028.42
|
| Rate for Payer: Frontpath All Commercial |
$3,026.77
|
| Rate for Payer: Humana ChoiceCare |
$2,841.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,960.97
|
| Rate for Payer: PHCS All Commercial |
$2,467.48
|
| Rate for Payer: PHP All Commercial |
$2,495.11
|
| Rate for Payer: Sagamore Health Network All Products |
$2,539.86
|
| Rate for Payer: Signature Care EPO |
$2,730.68
|
| Rate for Payer: Signature Care PPO |
$2,895.17
|
| Rate for Payer: United Healthcare Commercial |
$2,592.50
|
|
|
HC DS PLATE 2.4 VA 6H/3H L
|
Facility
|
OP
|
$3,289.97
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,059.67 |
| Rate for Payer: Aetna Commercial |
$2,776.73
|
| Rate for Payer: Aetna Medicare |
$1,052.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,019.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,889.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,210.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,158.07
|
| Rate for Payer: Cash Price |
$1,973.98
|
| Rate for Payer: Cash Price |
$1,973.98
|
| Rate for Payer: Centivo All Commercial |
$1,789.74
|
| Rate for Payer: Cigna All Commercial |
$2,839.24
|
| Rate for Payer: CORVEL All Commercial |
$3,059.67
|
| Rate for Payer: Coventry All Commercial |
$2,895.17
|
| Rate for Payer: Encore All Commercial |
$3,028.42
|
| Rate for Payer: Frontpath All Commercial |
$3,026.77
|
| Rate for Payer: Humana ChoiceCare |
$2,841.55
|
| Rate for Payer: Humana Medicare |
$1,052.79
|
| Rate for Payer: Lucent All Commercial |
$1,789.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,960.97
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,467.48
|
| Rate for Payer: PHP All Commercial |
$2,495.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.09
|
| Rate for Payer: Sagamore Health Network All Products |
$2,539.86
|
| Rate for Payer: Signature Care EPO |
$2,730.68
|
| Rate for Payer: Signature Care PPO |
$2,895.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.47
|
| Rate for Payer: United Healthcare Commercial |
$2,592.50
|
| Rate for Payer: United Healthcare Medicare |
$1,052.79
|
|
|
HC DS PLATE 2.4 VA 6H/3H R
|
Facility
|
IP
|
$3,289.97
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,467.48 |
| Max. Negotiated Rate |
$3,059.67 |
| Rate for Payer: Aetna Commercial |
$2,842.53
|
| Rate for Payer: Cash Price |
$1,973.98
|
| Rate for Payer: Cigna All Commercial |
$2,839.24
|
| Rate for Payer: CORVEL All Commercial |
$3,059.67
|
| Rate for Payer: Coventry All Commercial |
$2,895.17
|
| Rate for Payer: Encore All Commercial |
$3,028.42
|
| Rate for Payer: Frontpath All Commercial |
$3,026.77
|
| Rate for Payer: Humana ChoiceCare |
$2,841.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,960.97
|
| Rate for Payer: PHCS All Commercial |
$2,467.48
|
| Rate for Payer: PHP All Commercial |
$2,495.11
|
| Rate for Payer: Sagamore Health Network All Products |
$2,539.86
|
| Rate for Payer: Signature Care EPO |
$2,730.68
|
| Rate for Payer: Signature Care PPO |
$2,895.17
|
| Rate for Payer: United Healthcare Commercial |
$2,592.50
|
|
|
HC DS PLATE 2.4 VA 6H/3H R
|
Facility
|
OP
|
$3,289.97
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,059.67 |
| Rate for Payer: Aetna Commercial |
$2,776.73
|
| Rate for Payer: Aetna Medicare |
$1,052.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,019.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,889.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,056.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,210.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,158.07
|
| Rate for Payer: Cash Price |
$1,973.98
|
| Rate for Payer: Cash Price |
$1,973.98
|
| Rate for Payer: Centivo All Commercial |
$1,789.74
|
| Rate for Payer: Cigna All Commercial |
$2,839.24
|
| Rate for Payer: CORVEL All Commercial |
$3,059.67
|
| Rate for Payer: Coventry All Commercial |
$2,895.17
|
| Rate for Payer: Encore All Commercial |
$3,028.42
|
| Rate for Payer: Frontpath All Commercial |
$3,026.77
|
| Rate for Payer: Humana ChoiceCare |
$2,841.55
|
| Rate for Payer: Humana Medicare |
$1,052.79
|
| Rate for Payer: Lucent All Commercial |
$1,789.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,960.97
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,467.48
|
| Rate for Payer: PHP All Commercial |
$2,495.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,283.09
|
| Rate for Payer: Sagamore Health Network All Products |
$2,539.86
|
| Rate for Payer: Signature Care EPO |
$2,730.68
|
| Rate for Payer: Signature Care PPO |
$2,895.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,796.47
|
| Rate for Payer: United Healthcare Commercial |
$2,592.50
|
| Rate for Payer: United Healthcare Medicare |
$1,052.79
|
|
|
HC DS PLATE 2.4 VA 7H/5H L
|
Facility
|
IP
|
$703.92
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.94 |
| Max. Negotiated Rate |
$654.65 |
| Rate for Payer: Aetna Commercial |
$608.19
|
| Rate for Payer: Cash Price |
$422.35
|
| Rate for Payer: Cigna All Commercial |
$607.48
|
| Rate for Payer: CORVEL All Commercial |
$654.65
|
| Rate for Payer: Coventry All Commercial |
$619.45
|
| Rate for Payer: Encore All Commercial |
$647.96
|
| Rate for Payer: Frontpath All Commercial |
$647.61
|
| Rate for Payer: Humana ChoiceCare |
$607.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.53
|
| Rate for Payer: PHCS All Commercial |
$527.94
|
| Rate for Payer: PHP All Commercial |
$533.85
|
| Rate for Payer: Sagamore Health Network All Products |
$543.43
|
| Rate for Payer: Signature Care EPO |
$584.25
|
| Rate for Payer: Signature Care PPO |
$619.45
|
| Rate for Payer: United Healthcare Commercial |
$554.69
|
|
|
HC DS PLATE 2.4 VA 7H/5H L
|
Facility
|
OP
|
$703.92
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$654.65 |
| Rate for Payer: Aetna Commercial |
$594.11
|
| Rate for Payer: Aetna Medicare |
$225.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$218.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$404.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$247.78
|
| Rate for Payer: Cash Price |
$422.35
|
| Rate for Payer: Cash Price |
$422.35
|
| Rate for Payer: Centivo All Commercial |
$382.93
|
| Rate for Payer: Cigna All Commercial |
$607.48
|
| Rate for Payer: CORVEL All Commercial |
$654.65
|
| Rate for Payer: Coventry All Commercial |
$619.45
|
| Rate for Payer: Encore All Commercial |
$647.96
|
| Rate for Payer: Frontpath All Commercial |
$647.61
|
| Rate for Payer: Humana ChoiceCare |
$607.98
|
| Rate for Payer: Humana Medicare |
$225.25
|
| Rate for Payer: Lucent All Commercial |
$382.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.53
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$527.94
|
| Rate for Payer: PHP All Commercial |
$533.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.53
|
| Rate for Payer: Sagamore Health Network All Products |
$543.43
|
| Rate for Payer: Signature Care EPO |
$584.25
|
| Rate for Payer: Signature Care PPO |
$619.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$598.33
|
| Rate for Payer: United Healthcare Commercial |
$554.69
|
| Rate for Payer: United Healthcare Medicare |
$225.25
|
|
|
HC DS PLATE DR 2.4 VA 7H/3H L
|
Facility
|
OP
|
$6,485.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,031.76 |
| Rate for Payer: Aetna Commercial |
$5,473.98
|
| Rate for Payer: Aetna Medicare |
$2,075.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,010.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,724.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,054.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,386.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,282.99
|
| Rate for Payer: Cash Price |
$3,891.46
|
| Rate for Payer: Cash Price |
$3,891.46
|
| Rate for Payer: Centivo All Commercial |
$3,528.25
|
| Rate for Payer: Cigna All Commercial |
$5,597.21
|
| Rate for Payer: CORVEL All Commercial |
$6,031.76
|
| Rate for Payer: Coventry All Commercial |
$5,707.47
|
| Rate for Payer: Encore All Commercial |
$5,970.14
|
| Rate for Payer: Frontpath All Commercial |
$5,966.90
|
| Rate for Payer: Humana ChoiceCare |
$5,601.75
|
| Rate for Payer: Humana Medicare |
$2,075.44
|
| Rate for Payer: Lucent All Commercial |
$3,528.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,837.18
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,864.32
|
| Rate for Payer: PHP All Commercial |
$4,918.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,529.45
|
| Rate for Payer: Sagamore Health Network All Products |
$5,007.01
|
| Rate for Payer: Signature Care EPO |
$5,383.18
|
| Rate for Payer: Signature Care PPO |
$5,707.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,512.90
|
| Rate for Payer: United Healthcare Commercial |
$5,110.78
|
| Rate for Payer: United Healthcare Medicare |
$2,075.44
|
|
