|
HC Z COCR 12/14 28 FEM HD +7
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$713.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$846.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$809.60
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Centivo All Commercial |
$1,251.20
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$736.00
|
| Rate for Payer: Lucent All Commercial |
$1,251.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$736.00
|
|
|
HC Z COCR 12/14 28 FEM HD +7
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC Z COCR 40 FEM HD +10.5
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC Z COCR 40 FEM HD +10.5
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$713.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$846.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$809.60
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Centivo All Commercial |
$1,251.20
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$736.00
|
| Rate for Payer: Lucent All Commercial |
$1,251.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$736.00
|
|
|
HC Z COMP AUG ROT BUIDE/BONE LT
|
Facility
|
OP
|
$4,104.00
|
|
| Hospital Charge Code |
41608317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$3,816.72 |
| Rate for Payer: Aetna Commercial |
$3,463.78
|
| Rate for Payer: Aetna Medicare |
$1,313.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,272.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,356.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,565.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,510.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,444.61
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Centivo All Commercial |
$2,232.58
|
| Rate for Payer: Cigna All Commercial |
$3,541.75
|
| Rate for Payer: CORVEL All Commercial |
$3,816.72
|
| Rate for Payer: Coventry All Commercial |
$3,611.52
|
| Rate for Payer: Encore All Commercial |
$3,777.73
|
| Rate for Payer: Frontpath All Commercial |
$3,775.68
|
| Rate for Payer: Humana ChoiceCare |
$3,544.62
|
| Rate for Payer: Humana Medicare |
$1,313.28
|
| Rate for Payer: Lucent All Commercial |
$2,232.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,693.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,078.00
|
| Rate for Payer: PHP All Commercial |
$3,112.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,600.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3,168.29
|
| Rate for Payer: Signature Care EPO |
$3,406.32
|
| Rate for Payer: Signature Care PPO |
$3,611.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,488.40
|
| Rate for Payer: United Healthcare Commercial |
$3,233.95
|
| Rate for Payer: United Healthcare Medicare |
$1,313.28
|
|
|
HC Z COMP AUG ROT BUIDE/BONE LT
|
Facility
|
IP
|
$4,104.00
|
|
| Hospital Charge Code |
41608317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,078.00 |
| Max. Negotiated Rate |
$3,816.72 |
| Rate for Payer: Aetna Commercial |
$3,545.86
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cigna All Commercial |
$3,541.75
|
| Rate for Payer: CORVEL All Commercial |
$3,816.72
|
| Rate for Payer: Coventry All Commercial |
$3,611.52
|
| Rate for Payer: Encore All Commercial |
$3,777.73
|
| Rate for Payer: Frontpath All Commercial |
$3,775.68
|
| Rate for Payer: Humana ChoiceCare |
$3,544.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,693.60
|
| Rate for Payer: PHCS All Commercial |
$3,078.00
|
| Rate for Payer: PHP All Commercial |
$3,112.47
|
| Rate for Payer: Sagamore Health Network All Products |
$3,168.29
|
| Rate for Payer: Signature Care EPO |
$3,406.32
|
| Rate for Payer: Signature Care PPO |
$3,611.52
|
| Rate for Payer: United Healthcare Commercial |
$3,233.95
|
|
|
HC Z COUNTERSINK 1.3/1.5
|
Facility
|
OP
|
$657.51
|
|
| Hospital Charge Code |
41608225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$210.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.44
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Centivo All Commercial |
$357.69
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$210.40
|
| Rate for Payer: Lucent All Commercial |
$357.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$210.40
|
|
|
HC Z COUNTERSINK 1.3/1.5
|
Facility
|
IP
|
$657.51
|
|
| Hospital Charge Code |
41608225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z CR 10 MM VE 8-11 EF R
|
Facility
|
IP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
|
|
HC Z CR 10 MM VE 8-11 EF R
|
Facility
|
OP
|
$6,624.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,119.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,053.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,437.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,331.65
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Centivo All Commercial |
$3,603.46
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$2,119.68
|
| Rate for Payer: Lucent All Commercial |
$3,603.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,119.68
|
|
|
HC Z DELTA 28 FEM HD T1
|
Facility
|
OP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,289.49
|
| Rate for Payer: Aetna Medicare |
$2,384.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,310.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,279.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,658.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,742.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,623.10
|
| Rate for Payer: Cash Price |
$4,471.20
|
| Rate for Payer: Cash Price |
$4,471.20
|
| Rate for Payer: Centivo All Commercial |
$4,053.89
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Humana Medicare |
$2,384.64
|
| Rate for Payer: Lucent All Commercial |
$4,053.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,906.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,334.20
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
| Rate for Payer: United Healthcare Medicare |
$2,384.64
|
|
|
HC Z DELTA 28 FEM HD T1
|
Facility
|
IP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,589.00 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,438.53
|
| Rate for Payer: Cash Price |
$4,471.20
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
|
|
HC Z DM BRG 28X46 VIV-E G
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
|
HC Z DM BRG 28X46 VIV-E G
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Medicare |
$1,728.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,987.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,900.80
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Centivo All Commercial |
$2,937.60
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Humana Medicare |
$1,728.00
|
| Rate for Payer: Lucent All Commercial |
$2,937.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
| Rate for Payer: United Healthcare Medicare |
$1,728.00
|
|
|
HC Z DRILL 2.5 STD
|
Facility
|
OP
|
$699.09
|
|
| Hospital Charge Code |
41606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$223.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.08
|
| Rate for Payer: Cash Price |
$419.45
|
| Rate for Payer: Cash Price |
$419.45
|
| Rate for Payer: Centivo All Commercial |
$380.30
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$223.71
|
| Rate for Payer: Lucent All Commercial |
$380.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$223.71
|
|
|
HC Z DRILL 2.5 STD
|
Facility
|
IP
|
$699.09
|
|
| Hospital Charge Code |
41606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$419.45
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z DRILL 2.5X245 NCB
|
Facility
|
IP
|
$722.40
|
|
| Hospital Charge Code |
41608278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$541.80 |
| Max. Negotiated Rate |
$671.83 |
| Rate for Payer: Aetna Commercial |
$624.15
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$623.43
|
| Rate for Payer: CORVEL All Commercial |
$671.83
|
| Rate for Payer: Coventry All Commercial |
$635.71
|
| Rate for Payer: Encore All Commercial |
$664.97
|
| Rate for Payer: Frontpath All Commercial |
$664.61
|
| Rate for Payer: Humana ChoiceCare |
$623.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$650.16
|
| Rate for Payer: PHCS All Commercial |
$541.80
|
| Rate for Payer: PHP All Commercial |
$547.87
|
| Rate for Payer: Sagamore Health Network All Products |
$557.69
|
| Rate for Payer: Signature Care EPO |
$599.59
|
| Rate for Payer: Signature Care PPO |
$635.71
|
| Rate for Payer: United Healthcare Commercial |
$569.25
|
|
|
HC Z DRILL 2.5X245 NCB
|
Facility
|
OP
|
$722.40
|
|
| Hospital Charge Code |
41608278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$671.83 |
| Rate for Payer: Aetna Commercial |
$609.71
|
| Rate for Payer: Aetna Medicare |
$231.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$223.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$414.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.28
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$392.99
|
| Rate for Payer: Cigna All Commercial |
$623.43
|
| Rate for Payer: CORVEL All Commercial |
$671.83
|
| Rate for Payer: Coventry All Commercial |
$635.71
|
| Rate for Payer: Encore All Commercial |
$664.97
|
| Rate for Payer: Frontpath All Commercial |
$664.61
|
| Rate for Payer: Humana ChoiceCare |
$623.94
|
| Rate for Payer: Humana Medicare |
$231.17
|
| Rate for Payer: Lucent All Commercial |
$392.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$650.16
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$541.80
|
| Rate for Payer: PHP All Commercial |
$547.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$281.74
|
| Rate for Payer: Sagamore Health Network All Products |
$557.69
|
| Rate for Payer: Signature Care EPO |
$599.59
|
| Rate for Payer: Signature Care PPO |
$635.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$614.04
|
| Rate for Payer: United Healthcare Commercial |
$569.25
|
| Rate for Payer: United Healthcare Medicare |
$231.17
|
|
|
HC Z DRILL 3.3 AFFIX HUM
|
Facility
|
OP
|
$1,916.50
|
|
| Hospital Charge Code |
41607420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,782.35 |
| Rate for Payer: Aetna Commercial |
$1,617.53
|
| Rate for Payer: Aetna Medicare |
$613.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$594.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,100.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,198.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$705.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$674.61
|
| Rate for Payer: Cash Price |
$1,149.90
|
| Rate for Payer: Cash Price |
$1,149.90
|
| Rate for Payer: Centivo All Commercial |
$1,042.58
|
| Rate for Payer: Cigna All Commercial |
$1,653.94
|
| Rate for Payer: CORVEL All Commercial |
$1,782.35
|
| Rate for Payer: Coventry All Commercial |
$1,686.52
|
| Rate for Payer: Encore All Commercial |
$1,764.14
|
| Rate for Payer: Frontpath All Commercial |
$1,763.18
|
| Rate for Payer: Humana ChoiceCare |
$1,655.28
|
| Rate for Payer: Humana Medicare |
$613.28
|
| Rate for Payer: Lucent All Commercial |
$1,042.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,724.85
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,437.38
|
| Rate for Payer: PHP All Commercial |
$1,453.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$747.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,479.54
|
| Rate for Payer: Signature Care EPO |
$1,590.69
|
| Rate for Payer: Signature Care PPO |
$1,686.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,629.03
|
| Rate for Payer: United Healthcare Commercial |
$1,510.20
|
| Rate for Payer: United Healthcare Medicare |
$613.28
|
|
|
HC Z DRILL 3.3 AFFIX HUM
|
Facility
|
IP
|
$1,916.50
|
|
| Hospital Charge Code |
41607420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,437.38 |
| Max. Negotiated Rate |
$1,782.35 |
| Rate for Payer: Aetna Commercial |
$1,655.86
|
| Rate for Payer: Cash Price |
$1,149.90
|
| Rate for Payer: Cigna All Commercial |
$1,653.94
|
| Rate for Payer: CORVEL All Commercial |
$1,782.35
|
| Rate for Payer: Coventry All Commercial |
$1,686.52
|
| Rate for Payer: Encore All Commercial |
$1,764.14
|
| Rate for Payer: Frontpath All Commercial |
$1,763.18
|
| Rate for Payer: Humana ChoiceCare |
$1,655.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,724.85
|
| Rate for Payer: PHCS All Commercial |
$1,437.38
|
| Rate for Payer: PHP All Commercial |
$1,453.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,479.54
|
| Rate for Payer: Signature Care EPO |
$1,590.69
|
| Rate for Payer: Signature Care PPO |
$1,686.52
|
| Rate for Payer: United Healthcare Commercial |
$1,510.20
|
|
|
HC Z DRILL 4.3 DISTAL GRAD
|
Facility
|
IP
|
$1,191.80
|
|
| Hospital Charge Code |
41606240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$893.85 |
| Max. Negotiated Rate |
$1,108.37 |
| Rate for Payer: Aetna Commercial |
$1,029.72
|
| Rate for Payer: Cash Price |
$715.08
|
| Rate for Payer: Cigna All Commercial |
$1,028.52
|
| Rate for Payer: CORVEL All Commercial |
$1,108.37
|
| Rate for Payer: Coventry All Commercial |
$1,048.78
|
| Rate for Payer: Encore All Commercial |
$1,097.05
|
| Rate for Payer: Frontpath All Commercial |
$1,096.46
|
| Rate for Payer: Humana ChoiceCare |
$1,029.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,072.62
|
| Rate for Payer: PHCS All Commercial |
$893.85
|
| Rate for Payer: PHP All Commercial |
$903.86
|
| Rate for Payer: Sagamore Health Network All Products |
$920.07
|
| Rate for Payer: Signature Care EPO |
$989.19
|
| Rate for Payer: Signature Care PPO |
$1,048.78
|
| Rate for Payer: United Healthcare Commercial |
$939.14
|
|
|
HC Z DRILL 4.3 DISTAL GRAD
|
Facility
|
OP
|
$1,191.80
|
|
| Hospital Charge Code |
41606240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,108.37 |
| Rate for Payer: Aetna Commercial |
$1,005.88
|
| Rate for Payer: Aetna Medicare |
$381.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$369.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$684.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$744.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$438.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$419.51
|
| Rate for Payer: Cash Price |
$715.08
|
| Rate for Payer: Cash Price |
$715.08
|
| Rate for Payer: Centivo All Commercial |
$648.34
|
| Rate for Payer: Cigna All Commercial |
$1,028.52
|
| Rate for Payer: CORVEL All Commercial |
$1,108.37
|
| Rate for Payer: Coventry All Commercial |
$1,048.78
|
| Rate for Payer: Encore All Commercial |
$1,097.05
|
| Rate for Payer: Frontpath All Commercial |
$1,096.46
|
| Rate for Payer: Humana ChoiceCare |
$1,029.36
|
| Rate for Payer: Humana Medicare |
$381.38
|
| Rate for Payer: Lucent All Commercial |
$648.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,072.62
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$893.85
|
| Rate for Payer: PHP All Commercial |
$903.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$464.80
|
| Rate for Payer: Sagamore Health Network All Products |
$920.07
|
| Rate for Payer: Signature Care EPO |
$989.19
|
| Rate for Payer: Signature Care PPO |
$1,048.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,013.03
|
| Rate for Payer: United Healthcare Commercial |
$939.14
|
| Rate for Payer: United Healthcare Medicare |
$381.38
|
|
|
HC Z DRILL 4.3 DISTAL GRAD SHRT
|
Facility
|
IP
|
$1,191.80
|
|
| Hospital Charge Code |
41606656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$893.85 |
| Max. Negotiated Rate |
$1,108.37 |
| Rate for Payer: Aetna Commercial |
$1,029.72
|
| Rate for Payer: Cash Price |
$715.08
|
| Rate for Payer: Cigna All Commercial |
$1,028.52
|
| Rate for Payer: CORVEL All Commercial |
$1,108.37
|
| Rate for Payer: Coventry All Commercial |
$1,048.78
|
| Rate for Payer: Encore All Commercial |
$1,097.05
|
| Rate for Payer: Frontpath All Commercial |
$1,096.46
|
| Rate for Payer: Humana ChoiceCare |
$1,029.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,072.62
|
| Rate for Payer: PHCS All Commercial |
$893.85
|
| Rate for Payer: PHP All Commercial |
$903.86
|
| Rate for Payer: Sagamore Health Network All Products |
$920.07
|
| Rate for Payer: Signature Care EPO |
$989.19
|
| Rate for Payer: Signature Care PPO |
$1,048.78
|
| Rate for Payer: United Healthcare Commercial |
$939.14
|
|
|
HC Z DRILL 4.3 DISTAL GRAD SHRT
|
Facility
|
OP
|
$1,191.80
|
|
| Hospital Charge Code |
41606656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,108.37 |
| Rate for Payer: Aetna Commercial |
$1,005.88
|
| Rate for Payer: Aetna Medicare |
$381.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$369.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$684.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$744.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$438.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$419.51
|
| Rate for Payer: Cash Price |
$715.08
|
| Rate for Payer: Cash Price |
$715.08
|
| Rate for Payer: Centivo All Commercial |
$648.34
|
| Rate for Payer: Cigna All Commercial |
$1,028.52
|
| Rate for Payer: CORVEL All Commercial |
$1,108.37
|
| Rate for Payer: Coventry All Commercial |
$1,048.78
|
| Rate for Payer: Encore All Commercial |
$1,097.05
|
| Rate for Payer: Frontpath All Commercial |
$1,096.46
|
| Rate for Payer: Humana ChoiceCare |
$1,029.36
|
| Rate for Payer: Humana Medicare |
$381.38
|
| Rate for Payer: Lucent All Commercial |
$648.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,072.62
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$893.85
|
| Rate for Payer: PHP All Commercial |
$903.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$464.80
|
| Rate for Payer: Sagamore Health Network All Products |
$920.07
|
| Rate for Payer: Signature Care EPO |
$989.19
|
| Rate for Payer: Signature Care PPO |
$1,048.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,013.03
|
| Rate for Payer: United Healthcare Commercial |
$939.14
|
| Rate for Payer: United Healthcare Medicare |
$381.38
|
|
|
HC Z DRILL AUG 2.7
|
Facility
|
IP
|
$754.40
|
|
| Hospital Charge Code |
41606609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.80 |
| Max. Negotiated Rate |
$701.59 |
| Rate for Payer: Aetna Commercial |
$651.80
|
| Rate for Payer: Cash Price |
$452.64
|
| Rate for Payer: Cigna All Commercial |
$651.05
|
| Rate for Payer: CORVEL All Commercial |
$701.59
|
| Rate for Payer: Coventry All Commercial |
$663.87
|
| Rate for Payer: Encore All Commercial |
$694.43
|
| Rate for Payer: Frontpath All Commercial |
$694.05
|
| Rate for Payer: Humana ChoiceCare |
$651.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$678.96
|
| Rate for Payer: PHCS All Commercial |
$565.80
|
| Rate for Payer: PHP All Commercial |
$572.14
|
| Rate for Payer: Sagamore Health Network All Products |
$582.40
|
| Rate for Payer: Signature Care EPO |
$626.15
|
| Rate for Payer: Signature Care PPO |
$663.87
|
| Rate for Payer: United Healthcare Commercial |
$594.47
|
|
