|
HC WHOLE BODY TUMOR LOC
|
Facility
|
OP
|
$4,333.98
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
1638430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$4,030.60 |
| Rate for Payer: Aetna Commercial |
$3,657.88
|
| Rate for Payer: Aetna Medicare |
$1,386.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$363.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,343.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,489.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,709.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$363.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,594.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,525.56
|
| Rate for Payer: Cash Price |
$2,600.39
|
| Rate for Payer: Cash Price |
$2,600.39
|
| Rate for Payer: Centivo All Commercial |
$2,357.69
|
| Rate for Payer: Cigna All Commercial |
$3,740.22
|
| Rate for Payer: CORVEL All Commercial |
$4,030.60
|
| Rate for Payer: Coventry All Commercial |
$3,813.90
|
| Rate for Payer: Encore All Commercial |
$3,989.43
|
| Rate for Payer: Frontpath All Commercial |
$3,987.26
|
| Rate for Payer: Humana ChoiceCare |
$3,743.26
|
| Rate for Payer: Humana Medicare |
$1,386.87
|
| Rate for Payer: Lucent All Commercial |
$2,357.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,900.58
|
| Rate for Payer: Managed Health Services Medicaid |
$363.73
|
| Rate for Payer: MDWise Medicaid |
$363.73
|
| Rate for Payer: PHCS All Commercial |
$3,250.49
|
| Rate for Payer: PHP All Commercial |
$3,286.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,345.83
|
| Rate for Payer: Signature Care EPO |
$3,597.20
|
| Rate for Payer: Signature Care PPO |
$3,813.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,683.88
|
| Rate for Payer: United Healthcare Commercial |
$3,415.18
|
| Rate for Payer: United Healthcare Medicare |
$1,386.87
|
|
|
HC W K-WIRE 0.9X150 BLUNT TROC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
|
|
HC W K-WIRE 0.9X150 BLUNT TROC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$177.24
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.92
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Centivo All Commercial |
$114.24
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Humana Medicare |
$67.20
|
| Rate for Payer: Lucent All Commercial |
$114.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.90
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
| Rate for Payer: United Healthcare Medicare |
$67.20
|
|
|
HC W K-WIRE 1.1
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
|
|
HC W K-WIRE 1.1
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$177.24
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.92
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Centivo All Commercial |
$114.24
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Humana Medicare |
$67.20
|
| Rate for Payer: Lucent All Commercial |
$114.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.90
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
| Rate for Payer: United Healthcare Medicare |
$67.20
|
|
|
HC W K-WIRE 1.4X150 BLUNT TROC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
|
|
HC W K-WIRE 1.4X150 BLUNT TROC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$177.24
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.92
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Centivo All Commercial |
$114.24
|
| Rate for Payer: Cigna All Commercial |
$181.23
|
| Rate for Payer: CORVEL All Commercial |
$195.30
|
| Rate for Payer: Coventry All Commercial |
$184.80
|
| Rate for Payer: Encore All Commercial |
$193.31
|
| Rate for Payer: Frontpath All Commercial |
$193.20
|
| Rate for Payer: Humana ChoiceCare |
$181.38
|
| Rate for Payer: Humana Medicare |
$67.20
|
| Rate for Payer: Lucent All Commercial |
$114.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$157.50
|
| Rate for Payer: PHP All Commercial |
$159.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.90
|
| Rate for Payer: Sagamore Health Network All Products |
$162.12
|
| Rate for Payer: Signature Care EPO |
$174.30
|
| Rate for Payer: Signature Care PPO |
$184.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$165.48
|
| Rate for Payer: United Healthcare Medicare |
$67.20
|
|
|
HC WORK HARD/COND/INIT 2 HRS-OT
|
Facility
|
IP
|
$464.24
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
1738094
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$348.18 |
| Max. Negotiated Rate |
$431.74 |
| Rate for Payer: Aetna Commercial |
$401.10
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Cigna All Commercial |
$400.64
|
| Rate for Payer: CORVEL All Commercial |
$431.74
|
| Rate for Payer: Coventry All Commercial |
$408.53
|
| Rate for Payer: Encore All Commercial |
$427.33
|
| Rate for Payer: Frontpath All Commercial |
$427.10
|
| Rate for Payer: Humana ChoiceCare |
$400.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$417.82
|
| Rate for Payer: PHCS All Commercial |
$348.18
|
| Rate for Payer: PHP All Commercial |
$352.08
|
| Rate for Payer: Sagamore Health Network All Products |
$358.39
|
| Rate for Payer: Signature Care EPO |
$385.32
|
| Rate for Payer: Signature Care PPO |
$408.53
|
| Rate for Payer: United Healthcare Commercial |
$365.82
|
|
|
HC WORK HARD/COND/INIT 2 HRS-OT
|
Facility
|
OP
|
$464.24
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
1738094
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$431.74 |
| Rate for Payer: Aetna Commercial |
$391.82
|
| Rate for Payer: Aetna Medicare |
$148.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$266.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$290.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.41
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Centivo All Commercial |
$252.55
|
| Rate for Payer: Cigna All Commercial |
$400.64
|
| Rate for Payer: CORVEL All Commercial |
$431.74
|
| Rate for Payer: Coventry All Commercial |
$408.53
|
| Rate for Payer: Encore All Commercial |
$427.33
|
| Rate for Payer: Frontpath All Commercial |
$427.10
|
| Rate for Payer: Humana ChoiceCare |
$400.96
|
| Rate for Payer: Humana Medicare |
$148.56
|
| Rate for Payer: Lucent All Commercial |
$252.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$417.82
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$348.18
|
| Rate for Payer: PHP All Commercial |
$352.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.05
|
| Rate for Payer: Sagamore Health Network All Products |
$358.39
|
| Rate for Payer: Signature Care EPO |
$385.32
|
| Rate for Payer: Signature Care PPO |
$408.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$394.60
|
| Rate for Payer: United Healthcare Commercial |
$365.82
|
| Rate for Payer: United Healthcare Medicare |
$148.56
|
|
|
HC WOUND CARE NON SELECTIVE DBRDMT
|
Facility
|
IP
|
$205.80
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
1687602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$191.39 |
| Rate for Payer: Aetna Commercial |
$177.81
|
| Rate for Payer: Cash Price |
$123.48
|
| Rate for Payer: Cigna All Commercial |
$177.61
|
| Rate for Payer: CORVEL All Commercial |
$191.39
|
| Rate for Payer: Coventry All Commercial |
$181.10
|
| Rate for Payer: Encore All Commercial |
$189.44
|
| Rate for Payer: Frontpath All Commercial |
$189.34
|
| Rate for Payer: Humana ChoiceCare |
$177.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.22
|
| Rate for Payer: PHCS All Commercial |
$154.35
|
| Rate for Payer: PHP All Commercial |
$156.08
|
| Rate for Payer: Sagamore Health Network All Products |
$158.88
|
| Rate for Payer: Signature Care EPO |
$170.81
|
| Rate for Payer: Signature Care PPO |
$181.10
|
| Rate for Payer: United Healthcare Commercial |
$162.17
|
|
|
HC WOUND CARE NON SELECTIVE DBRDMT
|
Facility
|
OP
|
$205.80
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
1687602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$191.39 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Medicare |
$65.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.44
|
| Rate for Payer: Cash Price |
$123.48
|
| Rate for Payer: Cash Price |
$123.48
|
| Rate for Payer: Centivo All Commercial |
$111.96
|
| Rate for Payer: Cigna All Commercial |
$177.61
|
| Rate for Payer: CORVEL All Commercial |
$191.39
|
| Rate for Payer: Coventry All Commercial |
$181.10
|
| Rate for Payer: Encore All Commercial |
$189.44
|
| Rate for Payer: Frontpath All Commercial |
$189.34
|
| Rate for Payer: Humana ChoiceCare |
$177.75
|
| Rate for Payer: Humana Medicare |
$65.86
|
| Rate for Payer: Lucent All Commercial |
$111.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.22
|
| Rate for Payer: Managed Health Services Medicaid |
$97.73
|
| Rate for Payer: MDWise Medicaid |
$97.73
|
| Rate for Payer: PHCS All Commercial |
$154.35
|
| Rate for Payer: PHP All Commercial |
$156.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.26
|
| Rate for Payer: Sagamore Health Network All Products |
$158.88
|
| Rate for Payer: Signature Care EPO |
$170.81
|
| Rate for Payer: Signature Care PPO |
$181.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.93
|
| Rate for Payer: United Healthcare Commercial |
$162.17
|
| Rate for Payer: United Healthcare Medicare |
$65.86
|
|
|
HC WOUND CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$69.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.82
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Centivo All Commercial |
$118.72
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$69.84
|
| Rate for Payer: Lucent All Commercial |
$118.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$69.84
|
|
|
HC WOUND CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC W PHALINX HAMMERTOE MED
|
Facility
|
OP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,291.08 |
| Rate for Payer: Aetna Commercial |
$2,986.75
|
| Rate for Payer: Aetna Medicare |
$1,132.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,097.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,032.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,212.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,302.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,245.66
|
| Rate for Payer: Cash Price |
$2,123.28
|
| Rate for Payer: Cash Price |
$2,123.28
|
| Rate for Payer: Centivo All Commercial |
$1,925.11
|
| Rate for Payer: Cigna All Commercial |
$3,053.98
|
| Rate for Payer: CORVEL All Commercial |
$3,291.08
|
| Rate for Payer: Coventry All Commercial |
$3,114.14
|
| Rate for Payer: Encore All Commercial |
$3,257.47
|
| Rate for Payer: Frontpath All Commercial |
$3,255.70
|
| Rate for Payer: Humana ChoiceCare |
$3,056.46
|
| Rate for Payer: Humana Medicare |
$1,132.42
|
| Rate for Payer: Lucent All Commercial |
$1,925.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,184.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,654.10
|
| Rate for Payer: PHP All Commercial |
$2,683.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,380.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,731.95
|
| Rate for Payer: Signature Care EPO |
$2,937.20
|
| Rate for Payer: Signature Care PPO |
$3,114.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,007.98
|
| Rate for Payer: United Healthcare Commercial |
$2,788.57
|
| Rate for Payer: United Healthcare Medicare |
$1,132.42
|
|
|
HC W PHALINX HAMMERTOE MED
|
Facility
|
IP
|
$3,538.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.10 |
| Max. Negotiated Rate |
$3,291.08 |
| Rate for Payer: Aetna Commercial |
$3,057.52
|
| Rate for Payer: Cash Price |
$2,123.28
|
| Rate for Payer: Cigna All Commercial |
$3,053.98
|
| Rate for Payer: CORVEL All Commercial |
$3,291.08
|
| Rate for Payer: Coventry All Commercial |
$3,114.14
|
| Rate for Payer: Encore All Commercial |
$3,257.47
|
| Rate for Payer: Frontpath All Commercial |
$3,255.70
|
| Rate for Payer: Humana ChoiceCare |
$3,056.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,184.92
|
| Rate for Payer: PHCS All Commercial |
$2,654.10
|
| Rate for Payer: PHP All Commercial |
$2,683.83
|
| Rate for Payer: Sagamore Health Network All Products |
$2,731.95
|
| Rate for Payer: Signature Care EPO |
$2,937.20
|
| Rate for Payer: Signature Care PPO |
$3,114.14
|
| Rate for Payer: United Healthcare Commercial |
$2,788.57
|
|
|
HC W PLATE 10DG MTP SM R
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$2,937.60
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
|
HC W PLATE 10DG MTP SM R
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,566.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,517.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,801.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,723.39
|
| Rate for Payer: Cash Price |
$2,937.60
|
| Rate for Payer: Cash Price |
$2,937.60
|
| Rate for Payer: Centivo All Commercial |
$2,663.42
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$1,566.72
|
| Rate for Payer: Lucent All Commercial |
$2,663.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,566.72
|
|
|
HC W PLATE 4-0 ST
|
Facility
|
IP
|
$2,206.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.10 |
| Max. Negotiated Rate |
$2,052.32 |
| Rate for Payer: Aetna Commercial |
$1,906.68
|
| Rate for Payer: Cash Price |
$1,324.08
|
| Rate for Payer: Cigna All Commercial |
$1,904.47
|
| Rate for Payer: CORVEL All Commercial |
$2,052.32
|
| Rate for Payer: Coventry All Commercial |
$1,941.98
|
| Rate for Payer: Encore All Commercial |
$2,031.36
|
| Rate for Payer: Frontpath All Commercial |
$2,030.26
|
| Rate for Payer: Humana ChoiceCare |
$1,906.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,986.12
|
| Rate for Payer: PHCS All Commercial |
$1,655.10
|
| Rate for Payer: PHP All Commercial |
$1,673.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,703.65
|
| Rate for Payer: Signature Care EPO |
$1,831.64
|
| Rate for Payer: Signature Care PPO |
$1,941.98
|
| Rate for Payer: United Healthcare Commercial |
$1,738.96
|
|
|
HC W PLATE 4-0 ST
|
Facility
|
OP
|
$2,206.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,052.32 |
| Rate for Payer: Aetna Commercial |
$1,862.54
|
| Rate for Payer: Aetna Medicare |
$706.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$684.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,379.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$812.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$776.79
|
| Rate for Payer: Cash Price |
$1,324.08
|
| Rate for Payer: Cash Price |
$1,324.08
|
| Rate for Payer: Centivo All Commercial |
$1,200.50
|
| Rate for Payer: Cigna All Commercial |
$1,904.47
|
| Rate for Payer: CORVEL All Commercial |
$2,052.32
|
| Rate for Payer: Coventry All Commercial |
$1,941.98
|
| Rate for Payer: Encore All Commercial |
$2,031.36
|
| Rate for Payer: Frontpath All Commercial |
$2,030.26
|
| Rate for Payer: Humana ChoiceCare |
$1,906.01
|
| Rate for Payer: Humana Medicare |
$706.18
|
| Rate for Payer: Lucent All Commercial |
$1,200.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,986.12
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,655.10
|
| Rate for Payer: PHP All Commercial |
$1,673.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$860.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,703.65
|
| Rate for Payer: Signature Care EPO |
$1,831.64
|
| Rate for Payer: Signature Care PPO |
$1,941.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,875.78
|
| Rate for Payer: United Healthcare Commercial |
$1,738.96
|
| Rate for Payer: United Healthcare Medicare |
$706.18
|
|
|
HC WRENCH TORQUE-BI ORANGE
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
41607300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$295.40
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.20
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Centivo All Commercial |
$190.40
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Humana Medicare |
$112.00
|
| Rate for Payer: Lucent All Commercial |
$190.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.50
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.50
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
| Rate for Payer: United Healthcare Medicare |
$112.00
|
|
|
HC WRENCH TORQUE-BI ORANGE
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
41607300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
|
|
HC W SCREW 2.4X12 LOCK TM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,204.35 |
| Rate for Payer: Aetna Commercial |
$1,118.88
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna All Commercial |
$1,117.59
|
| Rate for Payer: CORVEL All Commercial |
$1,204.35
|
| Rate for Payer: Coventry All Commercial |
$1,139.60
|
| Rate for Payer: Encore All Commercial |
$1,192.05
|
| Rate for Payer: Frontpath All Commercial |
$1,191.40
|
| Rate for Payer: Humana ChoiceCare |
$1,118.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,165.50
|
| Rate for Payer: PHCS All Commercial |
$971.25
|
| Rate for Payer: PHP All Commercial |
$982.13
|
| Rate for Payer: Sagamore Health Network All Products |
$999.74
|
| Rate for Payer: Signature Care EPO |
$1,074.85
|
| Rate for Payer: Signature Care PPO |
$1,139.60
|
| Rate for Payer: United Healthcare Commercial |
$1,020.46
|
|
|
HC W SCREW 2.4X12 LOCK TM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,204.35 |
| Rate for Payer: Aetna Commercial |
$1,092.98
|
| Rate for Payer: Aetna Medicare |
$414.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$401.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$743.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$809.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.84
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Centivo All Commercial |
$704.48
|
| Rate for Payer: Cigna All Commercial |
$1,117.59
|
| Rate for Payer: CORVEL All Commercial |
$1,204.35
|
| Rate for Payer: Coventry All Commercial |
$1,139.60
|
| Rate for Payer: Encore All Commercial |
$1,192.05
|
| Rate for Payer: Frontpath All Commercial |
$1,191.40
|
| Rate for Payer: Humana ChoiceCare |
$1,118.49
|
| Rate for Payer: Humana Medicare |
$414.40
|
| Rate for Payer: Lucent All Commercial |
$704.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,165.50
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$971.25
|
| Rate for Payer: PHP All Commercial |
$982.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$505.05
|
| Rate for Payer: Sagamore Health Network All Products |
$999.74
|
| Rate for Payer: Signature Care EPO |
$1,074.85
|
| Rate for Payer: Signature Care PPO |
$1,139.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,100.75
|
| Rate for Payer: United Healthcare Commercial |
$1,020.46
|
| Rate for Payer: United Healthcare Medicare |
$414.40
|
|
|
HC W SCREW 2.4X12 NON LOCK TM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.25 |
| Max. Negotiated Rate |
$709.59 |
| Rate for Payer: Aetna Commercial |
$659.23
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna All Commercial |
$658.47
|
| Rate for Payer: CORVEL All Commercial |
$709.59
|
| Rate for Payer: Coventry All Commercial |
$671.44
|
| Rate for Payer: Encore All Commercial |
$702.34
|
| Rate for Payer: Frontpath All Commercial |
$701.96
|
| Rate for Payer: Humana ChoiceCare |
$659.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$686.70
|
| Rate for Payer: PHCS All Commercial |
$572.25
|
| Rate for Payer: PHP All Commercial |
$578.66
|
| Rate for Payer: Sagamore Health Network All Products |
$589.04
|
| Rate for Payer: Signature Care EPO |
$633.29
|
| Rate for Payer: Signature Care PPO |
$671.44
|
| Rate for Payer: United Healthcare Commercial |
$601.24
|
|
|
HC W SCREW 2.4X12 NON LOCK TM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$709.59 |
| Rate for Payer: Aetna Commercial |
$643.97
|
| Rate for Payer: Aetna Medicare |
$244.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$236.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$438.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$476.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$280.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$268.58
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Centivo All Commercial |
$415.07
|
| Rate for Payer: Cigna All Commercial |
$658.47
|
| Rate for Payer: CORVEL All Commercial |
$709.59
|
| Rate for Payer: Coventry All Commercial |
$671.44
|
| Rate for Payer: Encore All Commercial |
$702.34
|
| Rate for Payer: Frontpath All Commercial |
$701.96
|
| Rate for Payer: Humana ChoiceCare |
$659.00
|
| Rate for Payer: Humana Medicare |
$244.16
|
| Rate for Payer: Lucent All Commercial |
$415.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$686.70
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$572.25
|
| Rate for Payer: PHP All Commercial |
$578.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$297.57
|
| Rate for Payer: Sagamore Health Network All Products |
$589.04
|
| Rate for Payer: Signature Care EPO |
$633.29
|
| Rate for Payer: Signature Care PPO |
$671.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$648.55
|
| Rate for Payer: United Healthcare Commercial |
$601.24
|
| Rate for Payer: United Healthcare Medicare |
$244.16
|
|
