|
HC SUT VICRYL+ 0 UR-5 27" VCP376H
|
Facility
|
OP
|
$11.52
|
|
| Hospital Charge Code |
41607986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.06
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Centivo All Commercial |
$6.27
|
| Rate for Payer: Cigna All Commercial |
$9.94
|
| Rate for Payer: CORVEL All Commercial |
$10.71
|
| Rate for Payer: Coventry All Commercial |
$10.14
|
| Rate for Payer: Encore All Commercial |
$10.60
|
| Rate for Payer: Frontpath All Commercial |
$10.60
|
| Rate for Payer: Humana ChoiceCare |
$9.95
|
| Rate for Payer: Humana Medicare |
$3.69
|
| Rate for Payer: Lucent All Commercial |
$6.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.64
|
| Rate for Payer: PHP All Commercial |
$8.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.49
|
| Rate for Payer: Sagamore Health Network All Products |
$8.89
|
| Rate for Payer: Signature Care EPO |
$9.56
|
| Rate for Payer: Signature Care PPO |
$10.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.79
|
| Rate for Payer: United Healthcare Commercial |
$9.08
|
| Rate for Payer: United Healthcare Medicare |
$3.69
|
|
|
HC SUT VICRYL+ 1 CT-1 36" VCP347H
|
Facility
|
OP
|
$6.29
|
|
| Hospital Charge Code |
41607987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.21
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Centivo All Commercial |
$3.42
|
| Rate for Payer: Cigna All Commercial |
$5.43
|
| Rate for Payer: CORVEL All Commercial |
$5.85
|
| Rate for Payer: Coventry All Commercial |
$5.54
|
| Rate for Payer: Encore All Commercial |
$5.79
|
| Rate for Payer: Frontpath All Commercial |
$5.79
|
| Rate for Payer: Humana ChoiceCare |
$5.43
|
| Rate for Payer: Humana Medicare |
$2.01
|
| Rate for Payer: Lucent All Commercial |
$3.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.66
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$4.72
|
| Rate for Payer: PHP All Commercial |
$4.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.45
|
| Rate for Payer: Sagamore Health Network All Products |
$4.86
|
| Rate for Payer: Signature Care EPO |
$5.22
|
| Rate for Payer: Signature Care PPO |
$5.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.35
|
| Rate for Payer: United Healthcare Commercial |
$4.96
|
| Rate for Payer: United Healthcare Medicare |
$2.01
|
|
|
HC SUT VICRYL+ 1 CT-1 36" VCP347H
|
Facility
|
IP
|
$6.29
|
|
| Hospital Charge Code |
41607987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cigna All Commercial |
$5.43
|
| Rate for Payer: CORVEL All Commercial |
$5.85
|
| Rate for Payer: Coventry All Commercial |
$5.54
|
| Rate for Payer: Encore All Commercial |
$5.79
|
| Rate for Payer: Frontpath All Commercial |
$5.79
|
| Rate for Payer: Humana ChoiceCare |
$5.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.66
|
| Rate for Payer: PHCS All Commercial |
$4.72
|
| Rate for Payer: PHP All Commercial |
$4.77
|
| Rate for Payer: Sagamore Health Network All Products |
$4.86
|
| Rate for Payer: Signature Care EPO |
$5.22
|
| Rate for Payer: Signature Care PPO |
$5.54
|
| Rate for Payer: United Healthcare Commercial |
$4.96
|
|
|
HC SUT VICRYL+ 2-0 CT-1 VCP259H
|
Facility
|
IP
|
$5.75
|
|
| Hospital Charge Code |
41607990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna Commercial |
$4.97
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cigna All Commercial |
$4.96
|
| Rate for Payer: CORVEL All Commercial |
$5.35
|
| Rate for Payer: Coventry All Commercial |
$5.06
|
| Rate for Payer: Encore All Commercial |
$5.29
|
| Rate for Payer: Frontpath All Commercial |
$5.29
|
| Rate for Payer: Humana ChoiceCare |
$4.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.17
|
| Rate for Payer: PHCS All Commercial |
$4.31
|
| Rate for Payer: PHP All Commercial |
$4.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4.44
|
| Rate for Payer: Signature Care EPO |
$4.77
|
| Rate for Payer: Signature Care PPO |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$4.53
|
|
|
HC SUT VICRYL+ 2-0 CT-1 VCP259H
|
Facility
|
OP
|
$5.75
|
|
| Hospital Charge Code |
41607990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$4.85
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.02
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Centivo All Commercial |
$3.13
|
| Rate for Payer: Cigna All Commercial |
$4.96
|
| Rate for Payer: CORVEL All Commercial |
$5.35
|
| Rate for Payer: Coventry All Commercial |
$5.06
|
| Rate for Payer: Encore All Commercial |
$5.29
|
| Rate for Payer: Frontpath All Commercial |
$5.29
|
| Rate for Payer: Humana ChoiceCare |
$4.97
|
| Rate for Payer: Humana Medicare |
$1.84
|
| Rate for Payer: Lucent All Commercial |
$3.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.17
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$4.31
|
| Rate for Payer: PHP All Commercial |
$4.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.24
|
| Rate for Payer: Sagamore Health Network All Products |
$4.44
|
| Rate for Payer: Signature Care EPO |
$4.77
|
| Rate for Payer: Signature Care PPO |
$5.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$4.53
|
| Rate for Payer: United Healthcare Medicare |
$1.84
|
|
|
HC SUT VICRYL+ 2-0 UR-4 VCP375H
|
Facility
|
OP
|
$11.52
|
|
| Hospital Charge Code |
41607992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.06
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Centivo All Commercial |
$6.27
|
| Rate for Payer: Cigna All Commercial |
$9.94
|
| Rate for Payer: CORVEL All Commercial |
$10.71
|
| Rate for Payer: Coventry All Commercial |
$10.14
|
| Rate for Payer: Encore All Commercial |
$10.60
|
| Rate for Payer: Frontpath All Commercial |
$10.60
|
| Rate for Payer: Humana ChoiceCare |
$9.95
|
| Rate for Payer: Humana Medicare |
$3.69
|
| Rate for Payer: Lucent All Commercial |
$6.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.64
|
| Rate for Payer: PHP All Commercial |
$8.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.49
|
| Rate for Payer: Sagamore Health Network All Products |
$8.89
|
| Rate for Payer: Signature Care EPO |
$9.56
|
| Rate for Payer: Signature Care PPO |
$10.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.79
|
| Rate for Payer: United Healthcare Commercial |
$9.08
|
| Rate for Payer: United Healthcare Medicare |
$3.69
|
|
|
HC SUT VICRYL+ 2-0 UR-4 VCP375H
|
Facility
|
IP
|
$11.52
|
|
| Hospital Charge Code |
41607992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cigna All Commercial |
$9.94
|
| Rate for Payer: CORVEL All Commercial |
$10.71
|
| Rate for Payer: Coventry All Commercial |
$10.14
|
| Rate for Payer: Encore All Commercial |
$10.60
|
| Rate for Payer: Frontpath All Commercial |
$10.60
|
| Rate for Payer: Humana ChoiceCare |
$9.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.37
|
| Rate for Payer: PHCS All Commercial |
$8.64
|
| Rate for Payer: PHP All Commercial |
$8.74
|
| Rate for Payer: Sagamore Health Network All Products |
$8.89
|
| Rate for Payer: Signature Care EPO |
$9.56
|
| Rate for Payer: Signature Care PPO |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$9.08
|
|
|
HC SUT VICRYL+ 3-0 54" VCP285G
|
Facility
|
IP
|
$12.86
|
|
| Hospital Charge Code |
41607994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$11.96 |
| Rate for Payer: Aetna Commercial |
$11.11
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cigna All Commercial |
$11.10
|
| Rate for Payer: CORVEL All Commercial |
$11.96
|
| Rate for Payer: Coventry All Commercial |
$11.32
|
| Rate for Payer: Encore All Commercial |
$11.84
|
| Rate for Payer: Frontpath All Commercial |
$11.83
|
| Rate for Payer: Humana ChoiceCare |
$11.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.57
|
| Rate for Payer: PHCS All Commercial |
$9.64
|
| Rate for Payer: PHP All Commercial |
$9.75
|
| Rate for Payer: Sagamore Health Network All Products |
$9.93
|
| Rate for Payer: Signature Care EPO |
$10.67
|
| Rate for Payer: Signature Care PPO |
$11.32
|
| Rate for Payer: United Healthcare Commercial |
$10.13
|
|
|
HC SUT VICRYL+ 3-0 54" VCP285G
|
Facility
|
OP
|
$12.86
|
|
| Hospital Charge Code |
41607994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Medicare |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.53
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Centivo All Commercial |
$7.00
|
| Rate for Payer: Cigna All Commercial |
$11.10
|
| Rate for Payer: CORVEL All Commercial |
$11.96
|
| Rate for Payer: Coventry All Commercial |
$11.32
|
| Rate for Payer: Encore All Commercial |
$11.84
|
| Rate for Payer: Frontpath All Commercial |
$11.83
|
| Rate for Payer: Humana ChoiceCare |
$11.11
|
| Rate for Payer: Humana Medicare |
$4.12
|
| Rate for Payer: Lucent All Commercial |
$7.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.64
|
| Rate for Payer: PHP All Commercial |
$9.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.02
|
| Rate for Payer: Sagamore Health Network All Products |
$9.93
|
| Rate for Payer: Signature Care EPO |
$10.67
|
| Rate for Payer: Signature Care PPO |
$11.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$10.13
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
|
|
HC SUT VICRYL+ 3-0 PS-2 VCP497H
|
Facility
|
IP
|
$24.03
|
|
| Hospital Charge Code |
41607995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cigna All Commercial |
$20.74
|
| Rate for Payer: CORVEL All Commercial |
$22.35
|
| Rate for Payer: Coventry All Commercial |
$21.15
|
| Rate for Payer: Encore All Commercial |
$22.12
|
| Rate for Payer: Frontpath All Commercial |
$22.11
|
| Rate for Payer: Humana ChoiceCare |
$20.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.63
|
| Rate for Payer: PHCS All Commercial |
$18.02
|
| Rate for Payer: PHP All Commercial |
$18.22
|
| Rate for Payer: Sagamore Health Network All Products |
$18.55
|
| Rate for Payer: Signature Care EPO |
$19.94
|
| Rate for Payer: Signature Care PPO |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$18.94
|
|
|
HC SUT VICRYL+ 3-0 PS-2 VCP497H
|
Facility
|
OP
|
$24.03
|
|
| Hospital Charge Code |
41607995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.28
|
| Rate for Payer: Aetna Medicare |
$7.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.46
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Centivo All Commercial |
$13.07
|
| Rate for Payer: Cigna All Commercial |
$20.74
|
| Rate for Payer: CORVEL All Commercial |
$22.35
|
| Rate for Payer: Coventry All Commercial |
$21.15
|
| Rate for Payer: Encore All Commercial |
$22.12
|
| Rate for Payer: Frontpath All Commercial |
$22.11
|
| Rate for Payer: Humana ChoiceCare |
$20.75
|
| Rate for Payer: Humana Medicare |
$7.69
|
| Rate for Payer: Lucent All Commercial |
$13.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.63
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$18.02
|
| Rate for Payer: PHP All Commercial |
$18.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.37
|
| Rate for Payer: Sagamore Health Network All Products |
$18.55
|
| Rate for Payer: Signature Care EPO |
$19.94
|
| Rate for Payer: Signature Care PPO |
$21.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.43
|
| Rate for Payer: United Healthcare Commercial |
$18.94
|
| Rate for Payer: United Healthcare Medicare |
$7.69
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP316H
|
Facility
|
IP
|
$9.17
|
|
| Hospital Charge Code |
41607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna All Commercial |
$7.91
|
| Rate for Payer: CORVEL All Commercial |
$8.53
|
| Rate for Payer: Coventry All Commercial |
$8.07
|
| Rate for Payer: Encore All Commercial |
$8.44
|
| Rate for Payer: Frontpath All Commercial |
$8.44
|
| Rate for Payer: Humana ChoiceCare |
$7.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.25
|
| Rate for Payer: PHCS All Commercial |
$6.88
|
| Rate for Payer: PHP All Commercial |
$6.95
|
| Rate for Payer: Sagamore Health Network All Products |
$7.08
|
| Rate for Payer: Signature Care EPO |
$7.61
|
| Rate for Payer: Signature Care PPO |
$8.07
|
| Rate for Payer: United Healthcare Commercial |
$7.23
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP316H
|
Facility
|
OP
|
$9.17
|
|
| Hospital Charge Code |
41607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.23
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Centivo All Commercial |
$4.99
|
| Rate for Payer: Cigna All Commercial |
$7.91
|
| Rate for Payer: CORVEL All Commercial |
$8.53
|
| Rate for Payer: Coventry All Commercial |
$8.07
|
| Rate for Payer: Encore All Commercial |
$8.44
|
| Rate for Payer: Frontpath All Commercial |
$8.44
|
| Rate for Payer: Humana ChoiceCare |
$7.92
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: Lucent All Commercial |
$4.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.88
|
| Rate for Payer: PHP All Commercial |
$6.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.58
|
| Rate for Payer: Sagamore Health Network All Products |
$7.08
|
| Rate for Payer: Signature Care EPO |
$7.61
|
| Rate for Payer: Signature Care PPO |
$8.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.79
|
| Rate for Payer: United Healthcare Commercial |
$7.23
|
| Rate for Payer: United Healthcare Medicare |
$2.93
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP416H
|
Facility
|
IP
|
$9.17
|
|
| Hospital Charge Code |
41607998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna All Commercial |
$7.91
|
| Rate for Payer: CORVEL All Commercial |
$8.53
|
| Rate for Payer: Coventry All Commercial |
$8.07
|
| Rate for Payer: Encore All Commercial |
$8.44
|
| Rate for Payer: Frontpath All Commercial |
$8.44
|
| Rate for Payer: Humana ChoiceCare |
$7.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.25
|
| Rate for Payer: PHCS All Commercial |
$6.88
|
| Rate for Payer: PHP All Commercial |
$6.95
|
| Rate for Payer: Sagamore Health Network All Products |
$7.08
|
| Rate for Payer: Signature Care EPO |
$7.61
|
| Rate for Payer: Signature Care PPO |
$8.07
|
| Rate for Payer: United Healthcare Commercial |
$7.23
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP416H
|
Facility
|
OP
|
$9.17
|
|
| Hospital Charge Code |
41607998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.23
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Centivo All Commercial |
$4.99
|
| Rate for Payer: Cigna All Commercial |
$7.91
|
| Rate for Payer: CORVEL All Commercial |
$8.53
|
| Rate for Payer: Coventry All Commercial |
$8.07
|
| Rate for Payer: Encore All Commercial |
$8.44
|
| Rate for Payer: Frontpath All Commercial |
$8.44
|
| Rate for Payer: Humana ChoiceCare |
$7.92
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: Lucent All Commercial |
$4.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.88
|
| Rate for Payer: PHP All Commercial |
$6.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.58
|
| Rate for Payer: Sagamore Health Network All Products |
$7.08
|
| Rate for Payer: Signature Care EPO |
$7.61
|
| Rate for Payer: Signature Care PPO |
$8.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.79
|
| Rate for Payer: United Healthcare Commercial |
$7.23
|
| Rate for Payer: United Healthcare Medicare |
$2.93
|
|
|
HC SUT VICRYL+ 4-0 FS-1 VCP441H
|
Facility
|
OP
|
$13.11
|
|
| Hospital Charge Code |
41607999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.06
|
| Rate for Payer: Aetna Medicare |
$4.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.61
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Centivo All Commercial |
$7.13
|
| Rate for Payer: Cigna All Commercial |
$11.31
|
| Rate for Payer: CORVEL All Commercial |
$12.19
|
| Rate for Payer: Coventry All Commercial |
$11.54
|
| Rate for Payer: Encore All Commercial |
$12.07
|
| Rate for Payer: Frontpath All Commercial |
$12.06
|
| Rate for Payer: Humana ChoiceCare |
$11.32
|
| Rate for Payer: Humana Medicare |
$4.20
|
| Rate for Payer: Lucent All Commercial |
$7.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.83
|
| Rate for Payer: PHP All Commercial |
$9.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.11
|
| Rate for Payer: Sagamore Health Network All Products |
$10.12
|
| Rate for Payer: Signature Care EPO |
$10.88
|
| Rate for Payer: Signature Care PPO |
$11.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.14
|
| Rate for Payer: United Healthcare Commercial |
$10.33
|
| Rate for Payer: United Healthcare Medicare |
$4.20
|
|
|
HC SUT VICRYL+ 4-0 FS-1 VCP441H
|
Facility
|
IP
|
$13.11
|
|
| Hospital Charge Code |
41607999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: Aetna Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Cigna All Commercial |
$11.31
|
| Rate for Payer: CORVEL All Commercial |
$12.19
|
| Rate for Payer: Coventry All Commercial |
$11.54
|
| Rate for Payer: Encore All Commercial |
$12.07
|
| Rate for Payer: Frontpath All Commercial |
$12.06
|
| Rate for Payer: Humana ChoiceCare |
$11.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.80
|
| Rate for Payer: PHCS All Commercial |
$9.83
|
| Rate for Payer: PHP All Commercial |
$9.94
|
| Rate for Payer: Sagamore Health Network All Products |
$10.12
|
| Rate for Payer: Signature Care EPO |
$10.88
|
| Rate for Payer: Signature Care PPO |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$10.33
|
|
|
HC SUT VICRYL+ 4-0 PS-2 VCP496H
|
Facility
|
IP
|
$24.20
|
|
| Hospital Charge Code |
41608000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$22.51 |
| Rate for Payer: Aetna Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cigna All Commercial |
$20.88
|
| Rate for Payer: CORVEL All Commercial |
$22.51
|
| Rate for Payer: Coventry All Commercial |
$21.30
|
| Rate for Payer: Encore All Commercial |
$22.28
|
| Rate for Payer: Frontpath All Commercial |
$22.26
|
| Rate for Payer: Humana ChoiceCare |
$20.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.78
|
| Rate for Payer: PHCS All Commercial |
$18.15
|
| Rate for Payer: PHP All Commercial |
$18.35
|
| Rate for Payer: Sagamore Health Network All Products |
$18.68
|
| Rate for Payer: Signature Care EPO |
$20.09
|
| Rate for Payer: Signature Care PPO |
$21.30
|
| Rate for Payer: United Healthcare Commercial |
$19.07
|
|
|
HC SUT VICRYL+ 4-0 PS-2 VCP496H
|
Facility
|
OP
|
$24.20
|
|
| Hospital Charge Code |
41608000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.42
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Centivo All Commercial |
$13.16
|
| Rate for Payer: Cigna All Commercial |
$20.88
|
| Rate for Payer: CORVEL All Commercial |
$22.51
|
| Rate for Payer: Coventry All Commercial |
$21.30
|
| Rate for Payer: Encore All Commercial |
$22.28
|
| Rate for Payer: Frontpath All Commercial |
$22.26
|
| Rate for Payer: Humana ChoiceCare |
$20.90
|
| Rate for Payer: Humana Medicare |
$7.74
|
| Rate for Payer: Lucent All Commercial |
$13.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.78
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$18.15
|
| Rate for Payer: PHP All Commercial |
$18.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.44
|
| Rate for Payer: Sagamore Health Network All Products |
$18.68
|
| Rate for Payer: Signature Care EPO |
$20.09
|
| Rate for Payer: Signature Care PPO |
$21.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.57
|
| Rate for Payer: United Healthcare Commercial |
$19.07
|
| Rate for Payer: United Healthcare Medicare |
$7.74
|
|
|
HC SUT VICRYL+ 4-0 SH-1 VCP218H
|
Facility
|
OP
|
$9.35
|
|
| Hospital Charge Code |
41608003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Aetna Medicare |
$2.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.29
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Centivo All Commercial |
$5.09
|
| Rate for Payer: Cigna All Commercial |
$8.07
|
| Rate for Payer: CORVEL All Commercial |
$8.70
|
| Rate for Payer: Coventry All Commercial |
$8.23
|
| Rate for Payer: Encore All Commercial |
$8.61
|
| Rate for Payer: Frontpath All Commercial |
$8.60
|
| Rate for Payer: Humana ChoiceCare |
$8.08
|
| Rate for Payer: Humana Medicare |
$2.99
|
| Rate for Payer: Lucent All Commercial |
$5.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.01
|
| Rate for Payer: PHP All Commercial |
$7.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.65
|
| Rate for Payer: Sagamore Health Network All Products |
$7.22
|
| Rate for Payer: Signature Care EPO |
$7.76
|
| Rate for Payer: Signature Care PPO |
$8.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.95
|
| Rate for Payer: United Healthcare Commercial |
$7.37
|
| Rate for Payer: United Healthcare Medicare |
$2.99
|
|
|
HC SUT VICRYL+ 4-0 SH-1 VCP218H
|
Facility
|
IP
|
$9.35
|
|
| Hospital Charge Code |
41608003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna All Commercial |
$8.07
|
| Rate for Payer: CORVEL All Commercial |
$8.70
|
| Rate for Payer: Coventry All Commercial |
$8.23
|
| Rate for Payer: Encore All Commercial |
$8.61
|
| Rate for Payer: Frontpath All Commercial |
$8.60
|
| Rate for Payer: Humana ChoiceCare |
$8.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.41
|
| Rate for Payer: PHCS All Commercial |
$7.01
|
| Rate for Payer: PHP All Commercial |
$7.09
|
| Rate for Payer: Sagamore Health Network All Products |
$7.22
|
| Rate for Payer: Signature Care EPO |
$7.76
|
| Rate for Payer: Signature Care PPO |
$8.23
|
| Rate for Payer: United Healthcare Commercial |
$7.37
|
|
|
HC SUT VICRYL+ 5-0 P-3 VCP493G
|
Facility
|
IP
|
$26.83
|
|
| Hospital Charge Code |
41608004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cigna All Commercial |
$23.15
|
| Rate for Payer: CORVEL All Commercial |
$24.95
|
| Rate for Payer: Coventry All Commercial |
$23.61
|
| Rate for Payer: Encore All Commercial |
$24.70
|
| Rate for Payer: Frontpath All Commercial |
$24.68
|
| Rate for Payer: Humana ChoiceCare |
$23.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.15
|
| Rate for Payer: PHCS All Commercial |
$20.12
|
| Rate for Payer: PHP All Commercial |
$20.35
|
| Rate for Payer: Sagamore Health Network All Products |
$20.71
|
| Rate for Payer: Signature Care EPO |
$22.27
|
| Rate for Payer: Signature Care PPO |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$21.14
|
|
|
HC SUT VICRYL+ 5-0 P-3 VCP493G
|
Facility
|
OP
|
$26.83
|
|
| Hospital Charge Code |
41608004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$22.64
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Centivo All Commercial |
$14.60
|
| Rate for Payer: Cigna All Commercial |
$23.15
|
| Rate for Payer: CORVEL All Commercial |
$24.95
|
| Rate for Payer: Coventry All Commercial |
$23.61
|
| Rate for Payer: Encore All Commercial |
$24.70
|
| Rate for Payer: Frontpath All Commercial |
$24.68
|
| Rate for Payer: Humana ChoiceCare |
$23.17
|
| Rate for Payer: Humana Medicare |
$8.59
|
| Rate for Payer: Lucent All Commercial |
$14.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.15
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$20.12
|
| Rate for Payer: PHP All Commercial |
$20.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.46
|
| Rate for Payer: Sagamore Health Network All Products |
$20.71
|
| Rate for Payer: Signature Care EPO |
$22.27
|
| Rate for Payer: Signature Care PPO |
$23.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.81
|
| Rate for Payer: United Healthcare Commercial |
$21.14
|
| Rate for Payer: United Healthcare Medicare |
$8.59
|
|
|
HC SYSTEM FIXATION PERMANENT CAPSURE
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
41602188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial |
$1,181.60
|
| Rate for Payer: Aetna Medicare |
$448.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$434.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$804.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$875.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$515.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$492.80
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Centivo All Commercial |
$761.60
|
| Rate for Payer: Cigna All Commercial |
$1,208.20
|
| Rate for Payer: CORVEL All Commercial |
$1,302.00
|
| Rate for Payer: Coventry All Commercial |
$1,232.00
|
| Rate for Payer: Encore All Commercial |
$1,288.70
|
| Rate for Payer: Frontpath All Commercial |
$1,288.00
|
| Rate for Payer: Humana ChoiceCare |
$1,209.18
|
| Rate for Payer: Humana Medicare |
$448.00
|
| Rate for Payer: Lucent All Commercial |
$761.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$1,050.00
|
| Rate for Payer: PHP All Commercial |
$1,061.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,080.80
|
| Rate for Payer: Signature Care EPO |
$1,162.00
|
| Rate for Payer: Signature Care PPO |
$1,232.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,190.00
|
| Rate for Payer: United Healthcare Commercial |
$1,103.20
|
| Rate for Payer: United Healthcare Medicare |
$448.00
|
|
|
HC SYSTEM FIXATION PERMANENT CAPSURE
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
41602188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna All Commercial |
$1,208.20
|
| Rate for Payer: CORVEL All Commercial |
$1,302.00
|
| Rate for Payer: Coventry All Commercial |
$1,232.00
|
| Rate for Payer: Encore All Commercial |
$1,288.70
|
| Rate for Payer: Frontpath All Commercial |
$1,288.00
|
| Rate for Payer: Humana ChoiceCare |
$1,209.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: PHCS All Commercial |
$1,050.00
|
| Rate for Payer: PHP All Commercial |
$1,061.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,080.80
|
| Rate for Payer: Signature Care EPO |
$1,162.00
|
| Rate for Payer: Signature Care PPO |
$1,232.00
|
| Rate for Payer: United Healthcare Commercial |
$1,103.20
|
|
