|
HC W SCREW 2.4X14 LOCK TM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604899
|
|
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 2.4X14 LOCK TM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604899
|
|
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 2.5X10
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,223.80
|
| Rate for Payer: Aetna Medicare |
$464.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$449.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$832.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$533.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$510.40
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Centivo All Commercial |
$788.80
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.37
|
| Rate for Payer: Humana Medicare |
$464.00
|
| Rate for Payer: Lucent All Commercial |
$788.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
| Rate for Payer: United Healthcare Medicare |
$464.00
|
|
|
HC W SCREW 2.5X10
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,252.80
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
|
|
HC W SCREW 2.5X12
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,223.80
|
| Rate for Payer: Aetna Medicare |
$464.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$449.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$832.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$533.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$510.40
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Centivo All Commercial |
$788.80
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.37
|
| Rate for Payer: Humana Medicare |
$464.00
|
| Rate for Payer: Lucent All Commercial |
$788.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$565.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
| Rate for Payer: United Healthcare Medicare |
$464.00
|
|
|
HC W SCREW 2.5X12
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Aetna Commercial |
$1,252.80
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna All Commercial |
$1,251.35
|
| Rate for Payer: CORVEL All Commercial |
$1,348.50
|
| Rate for Payer: Coventry All Commercial |
$1,276.00
|
| Rate for Payer: Encore All Commercial |
$1,334.72
|
| Rate for Payer: Frontpath All Commercial |
$1,334.00
|
| Rate for Payer: Humana ChoiceCare |
$1,252.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,305.00
|
| Rate for Payer: PHCS All Commercial |
$1,087.50
|
| Rate for Payer: PHP All Commercial |
$1,099.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,119.40
|
| Rate for Payer: Signature Care EPO |
$1,203.50
|
| Rate for Payer: Signature Care PPO |
$1,276.00
|
| Rate for Payer: United Healthcare Commercial |
$1,142.60
|
|
|
HC W SCREW 2.5X16 HD
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$818.68
|
| Rate for Payer: Aetna Medicare |
$310.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$557.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$356.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$341.44
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Centivo All Commercial |
$527.68
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Humana Medicare |
$310.40
|
| Rate for Payer: Lucent All Commercial |
$527.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$378.30
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
| Rate for Payer: United Healthcare Medicare |
$310.40
|
|
|
HC W SCREW 2.5X16 HD
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Aetna Commercial |
$838.08
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna All Commercial |
$837.11
|
| Rate for Payer: CORVEL All Commercial |
$902.10
|
| Rate for Payer: Coventry All Commercial |
$853.60
|
| Rate for Payer: Encore All Commercial |
$892.88
|
| Rate for Payer: Frontpath All Commercial |
$892.40
|
| Rate for Payer: Humana ChoiceCare |
$837.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$873.00
|
| Rate for Payer: PHCS All Commercial |
$727.50
|
| Rate for Payer: PHP All Commercial |
$735.65
|
| Rate for Payer: Sagamore Health Network All Products |
$748.84
|
| Rate for Payer: Signature Care EPO |
$805.10
|
| Rate for Payer: Signature Care PPO |
$853.60
|
| Rate for Payer: United Healthcare Commercial |
$764.36
|
|
|
HC W SCREW 2.7X12 LOCK
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$375.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.92
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Centivo All Commercial |
$658.24
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$387.20
|
| Rate for Payer: Lucent All Commercial |
$658.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$387.20
|
|
|
HC W SCREW 2.7X12 LOCK
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC W SCREW 2.7X14 LOCK HD
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$375.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.92
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Centivo All Commercial |
$658.24
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$387.20
|
| Rate for Payer: Lucent All Commercial |
$658.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$387.20
|
|
|
HC W SCREW 2.7X14 LOCK HD
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC W SCREW 2.7X16 CORT LP
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.75 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$743.90
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
|
|
HC W SCREW 2.7X16 CORT LP
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$800.73 |
| Rate for Payer: Aetna Commercial |
$726.68
|
| Rate for Payer: Aetna Medicare |
$275.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$266.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$494.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$538.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$316.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$303.07
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Centivo All Commercial |
$468.38
|
| Rate for Payer: Cigna All Commercial |
$743.04
|
| Rate for Payer: CORVEL All Commercial |
$800.73
|
| Rate for Payer: Coventry All Commercial |
$757.68
|
| Rate for Payer: Encore All Commercial |
$792.55
|
| Rate for Payer: Frontpath All Commercial |
$792.12
|
| Rate for Payer: Humana ChoiceCare |
$743.65
|
| Rate for Payer: Humana Medicare |
$275.52
|
| Rate for Payer: Lucent All Commercial |
$468.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$774.90
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$645.75
|
| Rate for Payer: PHP All Commercial |
$652.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$335.79
|
| Rate for Payer: Sagamore Health Network All Products |
$664.69
|
| Rate for Payer: Signature Care EPO |
$714.63
|
| Rate for Payer: Signature Care PPO |
$757.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$678.47
|
| Rate for Payer: United Healthcare Medicare |
$275.52
|
|
|
HC W SCREW 2.7X16 LOCK
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$375.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.92
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Centivo All Commercial |
$658.24
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$387.20
|
| Rate for Payer: Lucent All Commercial |
$658.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$387.20
|
|
|
HC W SCREW 2.7X16 LOCK
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC W SCREW 2.7X18 LOCK
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC W SCREW 2.7X18 LOCK
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$375.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.92
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Centivo All Commercial |
$658.24
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$387.20
|
| Rate for Payer: Lucent All Commercial |
$658.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$387.20
|
|
|
HC XEROFORM 4X4
|
Facility
|
OP
|
$5.23
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
41605575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.84
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Centivo All Commercial |
$2.85
|
| Rate for Payer: Cigna All Commercial |
$4.51
|
| Rate for Payer: CORVEL All Commercial |
$4.86
|
| Rate for Payer: Coventry All Commercial |
$4.60
|
| Rate for Payer: Encore All Commercial |
$4.81
|
| Rate for Payer: Frontpath All Commercial |
$4.81
|
| Rate for Payer: Humana ChoiceCare |
$4.52
|
| Rate for Payer: Humana Medicare |
$1.67
|
| Rate for Payer: Lucent All Commercial |
$2.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.71
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3.92
|
| Rate for Payer: PHP All Commercial |
$3.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.04
|
| Rate for Payer: Sagamore Health Network All Products |
$4.04
|
| Rate for Payer: Signature Care EPO |
$4.34
|
| Rate for Payer: Signature Care PPO |
$4.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.45
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$1.67
|
|
|
HC XEROFORM 4X4
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
41605575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna All Commercial |
$4.51
|
| Rate for Payer: CORVEL All Commercial |
$4.86
|
| Rate for Payer: Coventry All Commercial |
$4.60
|
| Rate for Payer: Encore All Commercial |
$4.81
|
| Rate for Payer: Frontpath All Commercial |
$4.81
|
| Rate for Payer: Humana ChoiceCare |
$4.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.71
|
| Rate for Payer: PHCS All Commercial |
$3.92
|
| Rate for Payer: PHP All Commercial |
$3.97
|
| Rate for Payer: Sagamore Health Network All Products |
$4.04
|
| Rate for Payer: Signature Care EPO |
$4.34
|
| Rate for Payer: Signature Care PPO |
$4.60
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
|
|
HC X-RAY-ACROMIOCLAVICULAR JOINTS
|
Facility
|
OP
|
$539.08
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
1613050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$501.34 |
| Rate for Payer: Aetna Commercial |
$454.98
|
| Rate for Payer: Aetna Medicare |
$172.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$309.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.76
|
| Rate for Payer: Cash Price |
$323.45
|
| Rate for Payer: Cash Price |
$323.45
|
| Rate for Payer: Centivo All Commercial |
$293.26
|
| Rate for Payer: Cigna All Commercial |
$465.23
|
| Rate for Payer: CORVEL All Commercial |
$501.34
|
| Rate for Payer: Coventry All Commercial |
$474.39
|
| Rate for Payer: Encore All Commercial |
$496.22
|
| Rate for Payer: Frontpath All Commercial |
$495.95
|
| Rate for Payer: Humana ChoiceCare |
$465.60
|
| Rate for Payer: Humana Medicare |
$172.51
|
| Rate for Payer: Lucent All Commercial |
$293.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.17
|
| Rate for Payer: Managed Health Services Medicaid |
$20.23
|
| Rate for Payer: MDWise Medicaid |
$20.23
|
| Rate for Payer: PHCS All Commercial |
$404.31
|
| Rate for Payer: PHP All Commercial |
$408.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.24
|
| Rate for Payer: Sagamore Health Network All Products |
$416.17
|
| Rate for Payer: Signature Care EPO |
$447.44
|
| Rate for Payer: Signature Care PPO |
$474.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$458.22
|
| Rate for Payer: United Healthcare Commercial |
$424.80
|
| Rate for Payer: United Healthcare Medicare |
$172.51
|
|
|
HC X-RAY-ACROMIOCLAVICULAR JOINTS
|
Facility
|
IP
|
$539.08
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
1613050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.31 |
| Max. Negotiated Rate |
$501.34 |
| Rate for Payer: Aetna Commercial |
$465.77
|
| Rate for Payer: Cash Price |
$323.45
|
| Rate for Payer: Cigna All Commercial |
$465.23
|
| Rate for Payer: CORVEL All Commercial |
$501.34
|
| Rate for Payer: Coventry All Commercial |
$474.39
|
| Rate for Payer: Encore All Commercial |
$496.22
|
| Rate for Payer: Frontpath All Commercial |
$495.95
|
| Rate for Payer: Humana ChoiceCare |
$465.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.17
|
| Rate for Payer: PHCS All Commercial |
$404.31
|
| Rate for Payer: PHP All Commercial |
$408.84
|
| Rate for Payer: Sagamore Health Network All Products |
$416.17
|
| Rate for Payer: Signature Care EPO |
$447.44
|
| Rate for Payer: Signature Care PPO |
$474.39
|
| Rate for Payer: United Healthcare Commercial |
$424.80
|
|
|
HC X-RAY-ACUTE ABDOMINAL
|
Facility
|
OP
|
$989.71
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
1614020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$920.43 |
| Rate for Payer: Aetna Commercial |
$835.32
|
| Rate for Payer: Aetna Medicare |
$316.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$306.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$568.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$364.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$348.38
|
| Rate for Payer: Cash Price |
$593.83
|
| Rate for Payer: Cash Price |
$593.83
|
| Rate for Payer: Centivo All Commercial |
$538.40
|
| Rate for Payer: Cigna All Commercial |
$854.12
|
| Rate for Payer: CORVEL All Commercial |
$920.43
|
| Rate for Payer: Coventry All Commercial |
$870.94
|
| Rate for Payer: Encore All Commercial |
$911.03
|
| Rate for Payer: Frontpath All Commercial |
$910.53
|
| Rate for Payer: Humana ChoiceCare |
$854.81
|
| Rate for Payer: Humana Medicare |
$316.71
|
| Rate for Payer: Lucent All Commercial |
$538.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$890.74
|
| Rate for Payer: Managed Health Services Medicaid |
$23.45
|
| Rate for Payer: MDWise Medicaid |
$23.45
|
| Rate for Payer: PHCS All Commercial |
$742.28
|
| Rate for Payer: PHP All Commercial |
$750.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$385.99
|
| Rate for Payer: Sagamore Health Network All Products |
$764.06
|
| Rate for Payer: Signature Care EPO |
$821.46
|
| Rate for Payer: Signature Care PPO |
$870.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.25
|
| Rate for Payer: United Healthcare Commercial |
$779.89
|
| Rate for Payer: United Healthcare Medicare |
$316.71
|
|
|
HC X-RAY-ACUTE ABDOMINAL
|
Facility
|
IP
|
$989.71
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
1614020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$742.28 |
| Max. Negotiated Rate |
$920.43 |
| Rate for Payer: Aetna Commercial |
$855.11
|
| Rate for Payer: Cash Price |
$593.83
|
| Rate for Payer: Cigna All Commercial |
$854.12
|
| Rate for Payer: CORVEL All Commercial |
$920.43
|
| Rate for Payer: Coventry All Commercial |
$870.94
|
| Rate for Payer: Encore All Commercial |
$911.03
|
| Rate for Payer: Frontpath All Commercial |
$910.53
|
| Rate for Payer: Humana ChoiceCare |
$854.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$890.74
|
| Rate for Payer: PHCS All Commercial |
$742.28
|
| Rate for Payer: PHP All Commercial |
$750.60
|
| Rate for Payer: Sagamore Health Network All Products |
$764.06
|
| Rate for Payer: Signature Care EPO |
$821.46
|
| Rate for Payer: Signature Care PPO |
$870.94
|
| Rate for Payer: United Healthcare Commercial |
$779.89
|
|
|
HC X-RAY-ANKLE 1 VIEW BI
|
Facility
|
OP
|
$468.37
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$435.58 |
| Rate for Payer: Aetna Commercial |
$395.30
|
| Rate for Payer: Aetna Medicare |
$149.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$268.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.87
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Centivo All Commercial |
$254.79
|
| Rate for Payer: Cigna All Commercial |
$404.20
|
| Rate for Payer: CORVEL All Commercial |
$435.58
|
| Rate for Payer: Coventry All Commercial |
$412.17
|
| Rate for Payer: Encore All Commercial |
$431.13
|
| Rate for Payer: Frontpath All Commercial |
$430.90
|
| Rate for Payer: Humana ChoiceCare |
$404.53
|
| Rate for Payer: Humana Medicare |
$149.88
|
| Rate for Payer: Lucent All Commercial |
$254.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.53
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$351.28
|
| Rate for Payer: PHP All Commercial |
$355.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.66
|
| Rate for Payer: Sagamore Health Network All Products |
$361.58
|
| Rate for Payer: Signature Care EPO |
$388.75
|
| Rate for Payer: Signature Care PPO |
$412.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.11
|
| Rate for Payer: United Healthcare Commercial |
$369.08
|
| Rate for Payer: United Healthcare Medicare |
$149.88
|
|
