|
HC DS SCREW 90 TFNA FEN
|
Facility
|
IP
|
$2,968.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.64 |
| Max. Negotiated Rate |
$2,761.03 |
| Rate for Payer: Aetna Commercial |
$2,565.09
|
| Rate for Payer: Cash Price |
$1,781.31
|
| Rate for Payer: Cigna All Commercial |
$2,562.12
|
| Rate for Payer: CORVEL All Commercial |
$2,761.03
|
| Rate for Payer: Coventry All Commercial |
$2,612.59
|
| Rate for Payer: Encore All Commercial |
$2,732.83
|
| Rate for Payer: Frontpath All Commercial |
$2,731.34
|
| Rate for Payer: Humana ChoiceCare |
$2,564.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,671.97
|
| Rate for Payer: PHCS All Commercial |
$2,226.64
|
| Rate for Payer: PHP All Commercial |
$2,251.58
|
| Rate for Payer: Sagamore Health Network All Products |
$2,291.95
|
| Rate for Payer: Signature Care EPO |
$2,464.15
|
| Rate for Payer: Signature Care PPO |
$2,612.59
|
| Rate for Payer: United Healthcare Commercial |
$2,339.45
|
|
|
HC DS SCREW DRILL 3.2X250
|
Facility
|
IP
|
$822.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.88 |
| Max. Negotiated Rate |
$764.92 |
| Rate for Payer: Aetna Commercial |
$710.64
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna All Commercial |
$709.82
|
| Rate for Payer: CORVEL All Commercial |
$764.92
|
| Rate for Payer: Coventry All Commercial |
$723.80
|
| Rate for Payer: Encore All Commercial |
$757.11
|
| Rate for Payer: Frontpath All Commercial |
$756.70
|
| Rate for Payer: Humana ChoiceCare |
$710.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$740.25
|
| Rate for Payer: PHCS All Commercial |
$616.88
|
| Rate for Payer: PHP All Commercial |
$623.78
|
| Rate for Payer: Sagamore Health Network All Products |
$634.97
|
| Rate for Payer: Signature Care EPO |
$682.67
|
| Rate for Payer: Signature Care PPO |
$723.80
|
| Rate for Payer: United Healthcare Commercial |
$648.13
|
|
|
HC DS SCREW DRILL 3.2X250
|
Facility
|
OP
|
$822.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$764.92 |
| Rate for Payer: Aetna Commercial |
$694.19
|
| Rate for Payer: Aetna Medicare |
$263.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$254.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$472.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$514.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$302.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$289.52
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Centivo All Commercial |
$447.44
|
| Rate for Payer: Cigna All Commercial |
$709.82
|
| Rate for Payer: CORVEL All Commercial |
$764.92
|
| Rate for Payer: Coventry All Commercial |
$723.80
|
| Rate for Payer: Encore All Commercial |
$757.11
|
| Rate for Payer: Frontpath All Commercial |
$756.70
|
| Rate for Payer: Humana ChoiceCare |
$710.39
|
| Rate for Payer: Humana Medicare |
$263.20
|
| Rate for Payer: Lucent All Commercial |
$447.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$740.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$616.88
|
| Rate for Payer: PHP All Commercial |
$623.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$320.77
|
| Rate for Payer: Sagamore Health Network All Products |
$634.97
|
| Rate for Payer: Signature Care EPO |
$682.67
|
| Rate for Payer: Signature Care PPO |
$723.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$699.12
|
| Rate for Payer: United Healthcare Commercial |
$648.13
|
| Rate for Payer: United Healthcare Medicare |
$263.20
|
|
|
HC DS SCREW SD 20/25 MM LOCK
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Aetna Medicare |
$691.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$669.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,350.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$794.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$760.32
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Centivo All Commercial |
$1,175.04
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Humana Medicare |
$691.20
|
| Rate for Payer: Lucent All Commercial |
$1,175.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare Medicare |
$691.20
|
|
|
HC DS SCREW SD 20/25 MM LOCK
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,866.24
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
|
|
HC DS SIZER HANDLE
|
Facility
|
OP
|
$641.90
|
|
| Hospital Charge Code |
41608383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$596.97 |
| Rate for Payer: Aetna Commercial |
$541.76
|
| Rate for Payer: Aetna Medicare |
$205.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$368.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$401.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.95
|
| Rate for Payer: Cash Price |
$385.14
|
| Rate for Payer: Cash Price |
$385.14
|
| Rate for Payer: Centivo All Commercial |
$349.19
|
| Rate for Payer: Cigna All Commercial |
$553.96
|
| Rate for Payer: CORVEL All Commercial |
$596.97
|
| Rate for Payer: Coventry All Commercial |
$564.87
|
| Rate for Payer: Encore All Commercial |
$590.87
|
| Rate for Payer: Frontpath All Commercial |
$590.55
|
| Rate for Payer: Humana ChoiceCare |
$554.41
|
| Rate for Payer: Humana Medicare |
$205.41
|
| Rate for Payer: Lucent All Commercial |
$349.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$577.71
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$481.43
|
| Rate for Payer: PHP All Commercial |
$486.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$250.34
|
| Rate for Payer: Sagamore Health Network All Products |
$495.55
|
| Rate for Payer: Signature Care EPO |
$532.78
|
| Rate for Payer: Signature Care PPO |
$564.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$545.62
|
| Rate for Payer: United Healthcare Commercial |
$505.82
|
| Rate for Payer: United Healthcare Medicare |
$205.41
|
|
|
HC DS SIZER HANDLE
|
Facility
|
IP
|
$641.90
|
|
| Hospital Charge Code |
41608383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$481.43 |
| Max. Negotiated Rate |
$596.97 |
| Rate for Payer: Aetna Commercial |
$554.60
|
| Rate for Payer: Cash Price |
$385.14
|
| Rate for Payer: Cigna All Commercial |
$553.96
|
| Rate for Payer: CORVEL All Commercial |
$596.97
|
| Rate for Payer: Coventry All Commercial |
$564.87
|
| Rate for Payer: Encore All Commercial |
$590.87
|
| Rate for Payer: Frontpath All Commercial |
$590.55
|
| Rate for Payer: Humana ChoiceCare |
$554.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$577.71
|
| Rate for Payer: PHCS All Commercial |
$481.43
|
| Rate for Payer: PHP All Commercial |
$486.82
|
| Rate for Payer: Sagamore Health Network All Products |
$495.55
|
| Rate for Payer: Signature Care EPO |
$532.78
|
| Rate for Payer: Signature Care PPO |
$564.87
|
| Rate for Payer: United Healthcare Commercial |
$505.82
|
|
|
HC DS SPEED BASEPLATE SM
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,365.60 |
| Rate for Payer: Aetna Commercial |
$6,684.48
|
| Rate for Payer: Aetna Medicare |
$2,534.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,455.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,548.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,950.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,914.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,787.84
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Centivo All Commercial |
$4,308.48
|
| Rate for Payer: Cigna All Commercial |
$6,834.96
|
| Rate for Payer: CORVEL All Commercial |
$7,365.60
|
| Rate for Payer: Coventry All Commercial |
$6,969.60
|
| Rate for Payer: Encore All Commercial |
$7,290.36
|
| Rate for Payer: Frontpath All Commercial |
$7,286.40
|
| Rate for Payer: Humana ChoiceCare |
$6,840.50
|
| Rate for Payer: Humana Medicare |
$2,534.40
|
| Rate for Payer: Lucent All Commercial |
$4,308.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,128.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,940.00
|
| Rate for Payer: PHP All Commercial |
$6,006.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,088.80
|
| Rate for Payer: Sagamore Health Network All Products |
$6,114.24
|
| Rate for Payer: Signature Care EPO |
$6,573.60
|
| Rate for Payer: Signature Care PPO |
$6,969.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare Commercial |
$6,240.96
|
| Rate for Payer: United Healthcare Medicare |
$2,534.40
|
|
|
HC DS SPEED BASEPLATE SM
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,940.00 |
| Max. Negotiated Rate |
$7,365.60 |
| Rate for Payer: Aetna Commercial |
$6,842.88
|
| Rate for Payer: Cash Price |
$4,752.00
|
| Rate for Payer: Cigna All Commercial |
$6,834.96
|
| Rate for Payer: CORVEL All Commercial |
$7,365.60
|
| Rate for Payer: Coventry All Commercial |
$6,969.60
|
| Rate for Payer: Encore All Commercial |
$7,290.36
|
| Rate for Payer: Frontpath All Commercial |
$7,286.40
|
| Rate for Payer: Humana ChoiceCare |
$6,840.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,128.00
|
| Rate for Payer: PHCS All Commercial |
$5,940.00
|
| Rate for Payer: PHP All Commercial |
$6,006.53
|
| Rate for Payer: Sagamore Health Network All Products |
$6,114.24
|
| Rate for Payer: Signature Care EPO |
$6,573.60
|
| Rate for Payer: Signature Care PPO |
$6,969.60
|
| Rate for Payer: United Healthcare Commercial |
$6,240.96
|
|
|
HC DS STEM LONG MD 36X175
|
Facility
|
IP
|
$29,116.08
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,837.06 |
| Max. Negotiated Rate |
$27,077.95 |
| Rate for Payer: Aetna Commercial |
$25,156.29
|
| Rate for Payer: Cash Price |
$17,469.65
|
| Rate for Payer: Cigna All Commercial |
$25,127.18
|
| Rate for Payer: CORVEL All Commercial |
$27,077.95
|
| Rate for Payer: Coventry All Commercial |
$25,622.15
|
| Rate for Payer: Encore All Commercial |
$26,801.35
|
| Rate for Payer: Frontpath All Commercial |
$26,786.79
|
| Rate for Payer: Humana ChoiceCare |
$25,147.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26,204.47
|
| Rate for Payer: PHCS All Commercial |
$21,837.06
|
| Rate for Payer: PHP All Commercial |
$22,081.64
|
| Rate for Payer: Sagamore Health Network All Products |
$22,477.61
|
| Rate for Payer: Signature Care EPO |
$24,166.35
|
| Rate for Payer: Signature Care PPO |
$25,622.15
|
| Rate for Payer: United Healthcare Commercial |
$22,943.47
|
|
|
HC DS STEM LONG MD 36X175
|
Facility
|
OP
|
$29,116.08
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$27,077.95 |
| Rate for Payer: Aetna Commercial |
$24,573.97
|
| Rate for Payer: Aetna Medicare |
$9,317.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,025.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16,721.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18,200.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,714.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,248.86
|
| Rate for Payer: Cash Price |
$17,469.65
|
| Rate for Payer: Cash Price |
$17,469.65
|
| Rate for Payer: Centivo All Commercial |
$15,839.15
|
| Rate for Payer: Cigna All Commercial |
$25,127.18
|
| Rate for Payer: CORVEL All Commercial |
$27,077.95
|
| Rate for Payer: Coventry All Commercial |
$25,622.15
|
| Rate for Payer: Encore All Commercial |
$26,801.35
|
| Rate for Payer: Frontpath All Commercial |
$26,786.79
|
| Rate for Payer: Humana ChoiceCare |
$25,147.56
|
| Rate for Payer: Humana Medicare |
$9,317.15
|
| Rate for Payer: Lucent All Commercial |
$15,839.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26,204.47
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$21,837.06
|
| Rate for Payer: PHP All Commercial |
$22,081.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11,355.27
|
| Rate for Payer: Sagamore Health Network All Products |
$22,477.61
|
| Rate for Payer: Signature Care EPO |
$24,166.35
|
| Rate for Payer: Signature Care PPO |
$25,622.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,748.67
|
| Rate for Payer: United Healthcare Commercial |
$22,943.47
|
| Rate for Payer: United Healthcare Medicare |
$9,317.15
|
|
|
HC DS STEM SHORT 32X70 SM
|
Facility
|
OP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,153.60
|
| Rate for Payer: Aetna Medicare |
$4,608.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,269.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,001.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,299.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,068.80
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Centivo All Commercial |
$7,833.60
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Humana Medicare |
$4,608.00
|
| Rate for Payer: Lucent All Commercial |
$7,833.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,616.00
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,240.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
| Rate for Payer: United Healthcare Medicare |
$4,608.00
|
|
|
HC DS STEM SHORT 32X70 SM
|
Facility
|
IP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,800.00 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,441.60
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
|
|
HC DS STEM SHORT 40X78 LG
|
Facility
|
OP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,153.60
|
| Rate for Payer: Aetna Medicare |
$4,608.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,269.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,001.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,299.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,068.80
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Centivo All Commercial |
$7,833.60
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Humana Medicare |
$4,608.00
|
| Rate for Payer: Lucent All Commercial |
$7,833.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,616.00
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,240.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
| Rate for Payer: United Healthcare Medicare |
$4,608.00
|
|
|
HC DS STEM SHORT 40X78 LG
|
Facility
|
IP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,800.00 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,441.60
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
|
|
HC DS STEM SHORT MD 36X74
|
Facility
|
OP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,153.60
|
| Rate for Payer: Aetna Medicare |
$4,608.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,269.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,001.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,299.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,068.80
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Centivo All Commercial |
$7,833.60
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Humana Medicare |
$4,608.00
|
| Rate for Payer: Lucent All Commercial |
$7,833.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,616.00
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,240.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
| Rate for Payer: United Healthcare Medicare |
$4,608.00
|
|
|
HC DS STEM SHORT MD 36X74
|
Facility
|
IP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,800.00 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,441.60
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
|
|
HC DS STEM STD 32X109 MM SM
|
Facility
|
OP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,153.60
|
| Rate for Payer: Aetna Medicare |
$4,608.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,269.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,001.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,299.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,068.80
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Centivo All Commercial |
$7,833.60
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Humana Medicare |
$4,608.00
|
| Rate for Payer: Lucent All Commercial |
$7,833.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,616.00
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,240.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
| Rate for Payer: United Healthcare Medicare |
$4,608.00
|
|
|
HC DS STEM STD 32X109 MM SM
|
Facility
|
IP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,800.00 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,441.60
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
|
|
HC DS STEM STD 36X115 MD
|
Facility
|
OP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,153.60
|
| Rate for Payer: Aetna Medicare |
$4,608.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,269.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,001.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,299.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,068.80
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Centivo All Commercial |
$7,833.60
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Humana Medicare |
$4,608.00
|
| Rate for Payer: Lucent All Commercial |
$7,833.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,616.00
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,240.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
| Rate for Payer: United Healthcare Medicare |
$4,608.00
|
|
|
HC DS STEM STD 36X115 MD
|
Facility
|
IP
|
$14,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,800.00 |
| Max. Negotiated Rate |
$13,392.00 |
| Rate for Payer: Aetna Commercial |
$12,441.60
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna All Commercial |
$12,427.20
|
| Rate for Payer: CORVEL All Commercial |
$13,392.00
|
| Rate for Payer: Coventry All Commercial |
$12,672.00
|
| Rate for Payer: Encore All Commercial |
$13,255.20
|
| Rate for Payer: Frontpath All Commercial |
$13,248.00
|
| Rate for Payer: Humana ChoiceCare |
$12,437.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,960.00
|
| Rate for Payer: PHCS All Commercial |
$10,800.00
|
| Rate for Payer: PHP All Commercial |
$10,920.96
|
| Rate for Payer: Sagamore Health Network All Products |
$11,116.80
|
| Rate for Payer: Signature Care EPO |
$11,952.00
|
| Rate for Payer: Signature Care PPO |
$12,672.00
|
| Rate for Payer: United Healthcare Commercial |
$11,347.20
|
|
|
HC DU (WEAK D)
|
Facility
|
IP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.21
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.60
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.75
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.73
|
| Rate for Payer: Signature Care PPO |
$61.21
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
|
|
HC DU (WEAK D)
|
Facility
|
OP
|
$69.56
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
63001984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Aetna Commercial |
$58.71
|
| Rate for Payer: Aetna Medicare |
$22.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.49
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Centivo All Commercial |
$37.84
|
| Rate for Payer: Cigna All Commercial |
$60.03
|
| Rate for Payer: CORVEL All Commercial |
$64.69
|
| Rate for Payer: Coventry All Commercial |
$61.21
|
| Rate for Payer: Encore All Commercial |
$64.03
|
| Rate for Payer: Frontpath All Commercial |
$64.00
|
| Rate for Payer: Humana ChoiceCare |
$60.08
|
| Rate for Payer: Humana Medicare |
$22.26
|
| Rate for Payer: Lucent All Commercial |
$37.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.60
|
| Rate for Payer: Managed Health Services Medicaid |
$2.99
|
| Rate for Payer: MDWise Medicaid |
$2.99
|
| Rate for Payer: PHCS All Commercial |
$52.17
|
| Rate for Payer: PHP All Commercial |
$52.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.13
|
| Rate for Payer: Sagamore Health Network All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$57.73
|
| Rate for Payer: Signature Care PPO |
$61.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.13
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$22.26
|
|
|
HC DVT GARMENT 17 IN
|
Facility
|
IP
|
$114.45
|
|
| Hospital Charge Code |
41601059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$106.44 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Cigna All Commercial |
$98.77
|
| Rate for Payer: CORVEL All Commercial |
$106.44
|
| Rate for Payer: Coventry All Commercial |
$100.72
|
| Rate for Payer: Encore All Commercial |
$105.35
|
| Rate for Payer: Frontpath All Commercial |
$105.29
|
| Rate for Payer: Humana ChoiceCare |
$98.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: PHCS All Commercial |
$85.84
|
| Rate for Payer: PHP All Commercial |
$86.80
|
| Rate for Payer: Sagamore Health Network All Products |
$88.36
|
| Rate for Payer: Signature Care EPO |
$94.99
|
| Rate for Payer: Signature Care PPO |
$100.72
|
| Rate for Payer: United Healthcare Commercial |
$90.19
|
|
|
HC DVT GARMENT 17 IN
|
Facility
|
OP
|
$114.45
|
|
| Hospital Charge Code |
41601059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$106.44 |
| Rate for Payer: Aetna Commercial |
$96.60
|
| Rate for Payer: Aetna Medicare |
$36.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.29
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Centivo All Commercial |
$62.26
|
| Rate for Payer: Cigna All Commercial |
$98.77
|
| Rate for Payer: CORVEL All Commercial |
$106.44
|
| Rate for Payer: Coventry All Commercial |
$100.72
|
| Rate for Payer: Encore All Commercial |
$105.35
|
| Rate for Payer: Frontpath All Commercial |
$105.29
|
| Rate for Payer: Humana ChoiceCare |
$98.85
|
| Rate for Payer: Humana Medicare |
$36.62
|
| Rate for Payer: Lucent All Commercial |
$62.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$85.84
|
| Rate for Payer: PHP All Commercial |
$86.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.64
|
| Rate for Payer: Sagamore Health Network All Products |
$88.36
|
| Rate for Payer: Signature Care EPO |
$94.99
|
| Rate for Payer: Signature Care PPO |
$100.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.28
|
| Rate for Payer: United Healthcare Commercial |
$90.19
|
| Rate for Payer: United Healthcare Medicare |
$36.62
|
|
