|
HC Z GLEN REAMER GUIDE 4 PEG RT
|
Facility
|
OP
|
$1,403.00
|
|
| Hospital Charge Code |
41607036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,304.79 |
| Rate for Payer: Aetna Commercial |
$1,184.13
|
| Rate for Payer: Aetna Medicare |
$448.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$434.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$805.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$877.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$516.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$493.86
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Centivo All Commercial |
$763.23
|
| Rate for Payer: Cigna All Commercial |
$1,210.79
|
| Rate for Payer: CORVEL All Commercial |
$1,304.79
|
| Rate for Payer: Coventry All Commercial |
$1,234.64
|
| Rate for Payer: Encore All Commercial |
$1,291.46
|
| Rate for Payer: Frontpath All Commercial |
$1,290.76
|
| Rate for Payer: Humana ChoiceCare |
$1,211.77
|
| Rate for Payer: Humana Medicare |
$448.96
|
| Rate for Payer: Lucent All Commercial |
$763.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,262.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,052.25
|
| Rate for Payer: PHP All Commercial |
$1,064.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$547.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,083.12
|
| Rate for Payer: Signature Care EPO |
$1,164.49
|
| Rate for Payer: Signature Care PPO |
$1,234.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,192.55
|
| Rate for Payer: United Healthcare Commercial |
$1,105.56
|
| Rate for Payer: United Healthcare Medicare |
$448.96
|
|
|
HC Z GLEN REAMER GUIDE 4 PEG RT
|
Facility
|
IP
|
$1,403.00
|
|
| Hospital Charge Code |
41607036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.25 |
| Max. Negotiated Rate |
$1,304.79 |
| Rate for Payer: Aetna Commercial |
$1,212.19
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna All Commercial |
$1,210.79
|
| Rate for Payer: CORVEL All Commercial |
$1,304.79
|
| Rate for Payer: Coventry All Commercial |
$1,234.64
|
| Rate for Payer: Encore All Commercial |
$1,291.46
|
| Rate for Payer: Frontpath All Commercial |
$1,290.76
|
| Rate for Payer: Humana ChoiceCare |
$1,211.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,262.70
|
| Rate for Payer: PHCS All Commercial |
$1,052.25
|
| Rate for Payer: PHP All Commercial |
$1,064.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,083.12
|
| Rate for Payer: Signature Care EPO |
$1,164.49
|
| Rate for Payer: Signature Care PPO |
$1,234.64
|
| Rate for Payer: United Healthcare Commercial |
$1,105.56
|
|
|
HC Z GRAFT SEMITENDINOSUS ASP
|
Facility
|
IP
|
$4,453.24
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,339.93 |
| Max. Negotiated Rate |
$4,141.51 |
| Rate for Payer: Aetna Commercial |
$3,847.60
|
| Rate for Payer: Cash Price |
$2,671.94
|
| Rate for Payer: Cigna All Commercial |
$3,843.15
|
| Rate for Payer: CORVEL All Commercial |
$4,141.51
|
| Rate for Payer: Coventry All Commercial |
$3,918.85
|
| Rate for Payer: Encore All Commercial |
$4,099.21
|
| Rate for Payer: Frontpath All Commercial |
$4,096.98
|
| Rate for Payer: Humana ChoiceCare |
$3,846.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,007.92
|
| Rate for Payer: PHCS All Commercial |
$3,339.93
|
| Rate for Payer: PHP All Commercial |
$3,377.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,437.90
|
| Rate for Payer: Signature Care EPO |
$3,696.19
|
| Rate for Payer: Signature Care PPO |
$3,918.85
|
| Rate for Payer: United Healthcare Commercial |
$3,509.15
|
|
|
HC Z GRAFT SEMITENDINOSUS ASP
|
Facility
|
OP
|
$4,453.24
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,141.51 |
| Rate for Payer: Aetna Commercial |
$3,758.53
|
| Rate for Payer: Aetna Medicare |
$1,425.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,380.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,557.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,783.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,638.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,567.54
|
| Rate for Payer: Cash Price |
$2,671.94
|
| Rate for Payer: Cash Price |
$2,671.94
|
| Rate for Payer: Centivo All Commercial |
$2,422.56
|
| Rate for Payer: Cigna All Commercial |
$3,843.15
|
| Rate for Payer: CORVEL All Commercial |
$4,141.51
|
| Rate for Payer: Coventry All Commercial |
$3,918.85
|
| Rate for Payer: Encore All Commercial |
$4,099.21
|
| Rate for Payer: Frontpath All Commercial |
$4,096.98
|
| Rate for Payer: Humana ChoiceCare |
$3,846.26
|
| Rate for Payer: Humana Medicare |
$1,425.04
|
| Rate for Payer: Lucent All Commercial |
$2,422.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,007.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,339.93
|
| Rate for Payer: PHP All Commercial |
$3,377.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,736.76
|
| Rate for Payer: Sagamore Health Network All Products |
$3,437.90
|
| Rate for Payer: Signature Care EPO |
$3,696.19
|
| Rate for Payer: Signature Care PPO |
$3,918.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,785.25
|
| Rate for Payer: United Healthcare Commercial |
$3,509.15
|
| Rate for Payer: United Healthcare Medicare |
$1,425.04
|
|
|
HC Z GUIDE PIN 1.6X6 PT
|
Facility
|
OP
|
$116.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$98.33
|
| Rate for Payer: Aetna Medicare |
$37.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.01
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Centivo All Commercial |
$63.38
|
| Rate for Payer: Cigna All Commercial |
$100.55
|
| Rate for Payer: CORVEL All Commercial |
$108.35
|
| Rate for Payer: Coventry All Commercial |
$102.53
|
| Rate for Payer: Encore All Commercial |
$107.25
|
| Rate for Payer: Frontpath All Commercial |
$107.19
|
| Rate for Payer: Humana ChoiceCare |
$100.63
|
| Rate for Payer: Humana Medicare |
$37.28
|
| Rate for Payer: Lucent All Commercial |
$63.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.86
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$87.38
|
| Rate for Payer: PHP All Commercial |
$88.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.44
|
| Rate for Payer: Sagamore Health Network All Products |
$89.95
|
| Rate for Payer: Signature Care EPO |
$96.70
|
| Rate for Payer: Signature Care PPO |
$102.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.03
|
| Rate for Payer: United Healthcare Commercial |
$91.81
|
| Rate for Payer: United Healthcare Medicare |
$37.28
|
|
|
HC Z GUIDE PIN 1.6X6 PT
|
Facility
|
IP
|
$116.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$108.35 |
| Rate for Payer: Aetna Commercial |
$100.66
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cigna All Commercial |
$100.55
|
| Rate for Payer: CORVEL All Commercial |
$108.35
|
| Rate for Payer: Coventry All Commercial |
$102.53
|
| Rate for Payer: Encore All Commercial |
$107.25
|
| Rate for Payer: Frontpath All Commercial |
$107.19
|
| Rate for Payer: Humana ChoiceCare |
$100.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.86
|
| Rate for Payer: PHCS All Commercial |
$87.38
|
| Rate for Payer: PHP All Commercial |
$88.36
|
| Rate for Payer: Sagamore Health Network All Products |
$89.95
|
| Rate for Payer: Signature Care EPO |
$96.70
|
| Rate for Payer: Signature Care PPO |
$102.53
|
| Rate for Payer: United Healthcare Commercial |
$91.81
|
|
|
HC Z GUIDE PIN 2.5
|
Facility
|
IP
|
$176.75
|
|
| Hospital Charge Code |
41607421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.56 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Cash Price |
$106.05
|
| Rate for Payer: Cigna All Commercial |
$152.54
|
| Rate for Payer: CORVEL All Commercial |
$164.38
|
| Rate for Payer: Coventry All Commercial |
$155.54
|
| Rate for Payer: Encore All Commercial |
$162.70
|
| Rate for Payer: Frontpath All Commercial |
$162.61
|
| Rate for Payer: Humana ChoiceCare |
$152.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.07
|
| Rate for Payer: PHCS All Commercial |
$132.56
|
| Rate for Payer: PHP All Commercial |
$134.05
|
| Rate for Payer: Sagamore Health Network All Products |
$136.45
|
| Rate for Payer: Signature Care EPO |
$146.70
|
| Rate for Payer: Signature Care PPO |
$155.54
|
| Rate for Payer: United Healthcare Commercial |
$139.28
|
|
|
HC Z GUIDE PIN 2.5
|
Facility
|
OP
|
$176.75
|
|
| Hospital Charge Code |
41607421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Aetna Commercial |
$149.18
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$101.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.22
|
| Rate for Payer: Cash Price |
$106.05
|
| Rate for Payer: Cash Price |
$106.05
|
| Rate for Payer: Centivo All Commercial |
$96.15
|
| Rate for Payer: Cigna All Commercial |
$152.54
|
| Rate for Payer: CORVEL All Commercial |
$164.38
|
| Rate for Payer: Coventry All Commercial |
$155.54
|
| Rate for Payer: Encore All Commercial |
$162.70
|
| Rate for Payer: Frontpath All Commercial |
$162.61
|
| Rate for Payer: Humana ChoiceCare |
$152.66
|
| Rate for Payer: Humana Medicare |
$56.56
|
| Rate for Payer: Lucent All Commercial |
$96.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.07
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$132.56
|
| Rate for Payer: PHP All Commercial |
$134.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.93
|
| Rate for Payer: Sagamore Health Network All Products |
$136.45
|
| Rate for Payer: Signature Care EPO |
$146.70
|
| Rate for Payer: Signature Care PPO |
$155.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.24
|
| Rate for Payer: United Healthcare Commercial |
$139.28
|
| Rate for Payer: United Healthcare Medicare |
$56.56
|
|
|
HC Z GUIDE PIN 3.2X12 TRO
|
Facility
|
OP
|
$116.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$98.33
|
| Rate for Payer: Aetna Medicare |
$37.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.01
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Centivo All Commercial |
$63.38
|
| Rate for Payer: Cigna All Commercial |
$100.55
|
| Rate for Payer: CORVEL All Commercial |
$108.35
|
| Rate for Payer: Coventry All Commercial |
$102.53
|
| Rate for Payer: Encore All Commercial |
$107.25
|
| Rate for Payer: Frontpath All Commercial |
$107.19
|
| Rate for Payer: Humana ChoiceCare |
$100.63
|
| Rate for Payer: Humana Medicare |
$37.28
|
| Rate for Payer: Lucent All Commercial |
$63.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.86
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$87.38
|
| Rate for Payer: PHP All Commercial |
$88.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.44
|
| Rate for Payer: Sagamore Health Network All Products |
$89.95
|
| Rate for Payer: Signature Care EPO |
$96.70
|
| Rate for Payer: Signature Care PPO |
$102.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.03
|
| Rate for Payer: United Healthcare Commercial |
$91.81
|
| Rate for Payer: United Healthcare Medicare |
$37.28
|
|
|
HC Z GUIDE PIN 3.2X12 TRO
|
Facility
|
IP
|
$116.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$108.35 |
| Rate for Payer: Aetna Commercial |
$100.66
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cigna All Commercial |
$100.55
|
| Rate for Payer: CORVEL All Commercial |
$108.35
|
| Rate for Payer: Coventry All Commercial |
$102.53
|
| Rate for Payer: Encore All Commercial |
$107.25
|
| Rate for Payer: Frontpath All Commercial |
$107.19
|
| Rate for Payer: Humana ChoiceCare |
$100.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.86
|
| Rate for Payer: PHCS All Commercial |
$87.38
|
| Rate for Payer: PHP All Commercial |
$88.36
|
| Rate for Payer: Sagamore Health Network All Products |
$89.95
|
| Rate for Payer: Signature Care EPO |
$96.70
|
| Rate for Payer: Signature Care PPO |
$102.53
|
| Rate for Payer: United Healthcare Commercial |
$91.81
|
|
|
HC Z GUIDE PIN 3.2X444
|
Facility
|
IP
|
$968.59
|
|
| Hospital Charge Code |
41606242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.44 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$836.86
|
| Rate for Payer: Cash Price |
$581.15
|
| Rate for Payer: Cigna All Commercial |
$835.89
|
| Rate for Payer: CORVEL All Commercial |
$900.79
|
| Rate for Payer: Coventry All Commercial |
$852.36
|
| Rate for Payer: Encore All Commercial |
$891.59
|
| Rate for Payer: Frontpath All Commercial |
$891.10
|
| Rate for Payer: Humana ChoiceCare |
$836.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.73
|
| Rate for Payer: PHCS All Commercial |
$726.44
|
| Rate for Payer: PHP All Commercial |
$734.58
|
| Rate for Payer: Sagamore Health Network All Products |
$747.75
|
| Rate for Payer: Signature Care EPO |
$803.93
|
| Rate for Payer: Signature Care PPO |
$852.36
|
| Rate for Payer: United Healthcare Commercial |
$763.25
|
|
|
HC Z GUIDE PIN 3.2X444
|
Facility
|
OP
|
$968.59
|
|
| Hospital Charge Code |
41606242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$817.49
|
| Rate for Payer: Aetna Medicare |
$309.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$300.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$556.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$605.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$356.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$340.94
|
| Rate for Payer: Cash Price |
$581.15
|
| Rate for Payer: Cash Price |
$581.15
|
| Rate for Payer: Centivo All Commercial |
$526.91
|
| Rate for Payer: Cigna All Commercial |
$835.89
|
| Rate for Payer: CORVEL All Commercial |
$900.79
|
| Rate for Payer: Coventry All Commercial |
$852.36
|
| Rate for Payer: Encore All Commercial |
$891.59
|
| Rate for Payer: Frontpath All Commercial |
$891.10
|
| Rate for Payer: Humana ChoiceCare |
$836.57
|
| Rate for Payer: Humana Medicare |
$309.95
|
| Rate for Payer: Lucent All Commercial |
$526.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.73
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$726.44
|
| Rate for Payer: PHP All Commercial |
$734.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.75
|
| Rate for Payer: Sagamore Health Network All Products |
$747.75
|
| Rate for Payer: Signature Care EPO |
$803.93
|
| Rate for Payer: Signature Care PPO |
$852.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$823.30
|
| Rate for Payer: United Healthcare Commercial |
$763.25
|
| Rate for Payer: United Healthcare Medicare |
$309.95
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
|
OP
|
$116.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$98.33
|
| Rate for Payer: Aetna Medicare |
$37.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.01
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Centivo All Commercial |
$63.38
|
| Rate for Payer: Cigna All Commercial |
$100.55
|
| Rate for Payer: CORVEL All Commercial |
$108.35
|
| Rate for Payer: Coventry All Commercial |
$102.53
|
| Rate for Payer: Encore All Commercial |
$107.25
|
| Rate for Payer: Frontpath All Commercial |
$107.19
|
| Rate for Payer: Humana ChoiceCare |
$100.63
|
| Rate for Payer: Humana Medicare |
$37.28
|
| Rate for Payer: Lucent All Commercial |
$63.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.86
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$87.38
|
| Rate for Payer: PHP All Commercial |
$88.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.44
|
| Rate for Payer: Sagamore Health Network All Products |
$89.95
|
| Rate for Payer: Signature Care EPO |
$96.70
|
| Rate for Payer: Signature Care PPO |
$102.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.03
|
| Rate for Payer: United Healthcare Commercial |
$91.81
|
| Rate for Payer: United Healthcare Medicare |
$37.28
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
|
IP
|
$158.47
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.85 |
| Max. Negotiated Rate |
$147.38 |
| Rate for Payer: Aetna Commercial |
$136.92
|
| Rate for Payer: Cash Price |
$95.08
|
| Rate for Payer: Cigna All Commercial |
$136.76
|
| Rate for Payer: CORVEL All Commercial |
$147.38
|
| Rate for Payer: Coventry All Commercial |
$139.45
|
| Rate for Payer: Encore All Commercial |
$145.87
|
| Rate for Payer: Frontpath All Commercial |
$145.79
|
| Rate for Payer: Humana ChoiceCare |
$136.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.62
|
| Rate for Payer: PHCS All Commercial |
$118.85
|
| Rate for Payer: PHP All Commercial |
$120.18
|
| Rate for Payer: Sagamore Health Network All Products |
$122.34
|
| Rate for Payer: Signature Care EPO |
$131.53
|
| Rate for Payer: Signature Care PPO |
$139.45
|
| Rate for Payer: United Healthcare Commercial |
$124.87
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
|
OP
|
$158.47
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$147.38 |
| Rate for Payer: Aetna Commercial |
$133.75
|
| Rate for Payer: Aetna Medicare |
$50.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.78
|
| Rate for Payer: Cash Price |
$95.08
|
| Rate for Payer: Cash Price |
$95.08
|
| Rate for Payer: Centivo All Commercial |
$86.21
|
| Rate for Payer: Cigna All Commercial |
$136.76
|
| Rate for Payer: CORVEL All Commercial |
$147.38
|
| Rate for Payer: Coventry All Commercial |
$139.45
|
| Rate for Payer: Encore All Commercial |
$145.87
|
| Rate for Payer: Frontpath All Commercial |
$145.79
|
| Rate for Payer: Humana ChoiceCare |
$136.87
|
| Rate for Payer: Humana Medicare |
$50.71
|
| Rate for Payer: Lucent All Commercial |
$86.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.62
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$118.85
|
| Rate for Payer: PHP All Commercial |
$120.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.80
|
| Rate for Payer: Sagamore Health Network All Products |
$122.34
|
| Rate for Payer: Signature Care EPO |
$131.53
|
| Rate for Payer: Signature Care PPO |
$139.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134.70
|
| Rate for Payer: United Healthcare Commercial |
$124.87
|
| Rate for Payer: United Healthcare Medicare |
$50.71
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
|
IP
|
$116.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$108.35 |
| Rate for Payer: Aetna Commercial |
$100.66
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cigna All Commercial |
$100.55
|
| Rate for Payer: CORVEL All Commercial |
$108.35
|
| Rate for Payer: Coventry All Commercial |
$102.53
|
| Rate for Payer: Encore All Commercial |
$107.25
|
| Rate for Payer: Frontpath All Commercial |
$107.19
|
| Rate for Payer: Humana ChoiceCare |
$100.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.86
|
| Rate for Payer: PHCS All Commercial |
$87.38
|
| Rate for Payer: PHP All Commercial |
$88.36
|
| Rate for Payer: Sagamore Health Network All Products |
$89.95
|
| Rate for Payer: Signature Care EPO |
$96.70
|
| Rate for Payer: Signature Care PPO |
$102.53
|
| Rate for Payer: United Healthcare Commercial |
$91.81
|
|
|
HC Z GUIDEWIRE AFFIX HUM
|
Facility
|
IP
|
$1,610.95
|
|
| Hospital Charge Code |
41607423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,208.21 |
| Max. Negotiated Rate |
$1,498.18 |
| Rate for Payer: Aetna Commercial |
$1,391.86
|
| Rate for Payer: Cash Price |
$966.57
|
| Rate for Payer: Cigna All Commercial |
$1,390.25
|
| Rate for Payer: CORVEL All Commercial |
$1,498.18
|
| Rate for Payer: Coventry All Commercial |
$1,417.64
|
| Rate for Payer: Encore All Commercial |
$1,482.88
|
| Rate for Payer: Frontpath All Commercial |
$1,482.07
|
| Rate for Payer: Humana ChoiceCare |
$1,391.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.86
|
| Rate for Payer: PHCS All Commercial |
$1,208.21
|
| Rate for Payer: PHP All Commercial |
$1,221.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,243.65
|
| Rate for Payer: Signature Care EPO |
$1,337.09
|
| Rate for Payer: Signature Care PPO |
$1,417.64
|
| Rate for Payer: United Healthcare Commercial |
$1,269.43
|
|
|
HC Z GUIDEWIRE AFFIX HUM
|
Facility
|
OP
|
$1,610.95
|
|
| Hospital Charge Code |
41607423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,498.18 |
| Rate for Payer: Aetna Commercial |
$1,359.64
|
| Rate for Payer: Aetna Medicare |
$515.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$499.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$925.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,007.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$592.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$567.05
|
| Rate for Payer: Cash Price |
$966.57
|
| Rate for Payer: Cash Price |
$966.57
|
| Rate for Payer: Centivo All Commercial |
$876.36
|
| Rate for Payer: Cigna All Commercial |
$1,390.25
|
| Rate for Payer: CORVEL All Commercial |
$1,498.18
|
| Rate for Payer: Coventry All Commercial |
$1,417.64
|
| Rate for Payer: Encore All Commercial |
$1,482.88
|
| Rate for Payer: Frontpath All Commercial |
$1,482.07
|
| Rate for Payer: Humana ChoiceCare |
$1,391.38
|
| Rate for Payer: Humana Medicare |
$515.50
|
| Rate for Payer: Lucent All Commercial |
$876.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.86
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,208.21
|
| Rate for Payer: PHP All Commercial |
$1,221.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$628.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,243.65
|
| Rate for Payer: Signature Care EPO |
$1,337.09
|
| Rate for Payer: Signature Care PPO |
$1,417.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,369.31
|
| Rate for Payer: United Healthcare Commercial |
$1,269.43
|
| Rate for Payer: United Healthcare Medicare |
$515.50
|
|
|
HC Z GUIDEWIRE BALL NOSE 3.0X100
|
Facility
|
OP
|
$933.24
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$867.91 |
| Rate for Payer: Aetna Commercial |
$787.65
|
| Rate for Payer: Aetna Medicare |
$298.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$289.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$535.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$583.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$343.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$328.50
|
| Rate for Payer: Cash Price |
$559.94
|
| Rate for Payer: Cash Price |
$559.94
|
| Rate for Payer: Centivo All Commercial |
$507.68
|
| Rate for Payer: Cigna All Commercial |
$805.39
|
| Rate for Payer: CORVEL All Commercial |
$867.91
|
| Rate for Payer: Coventry All Commercial |
$821.25
|
| Rate for Payer: Encore All Commercial |
$859.05
|
| Rate for Payer: Frontpath All Commercial |
$858.58
|
| Rate for Payer: Humana ChoiceCare |
$806.04
|
| Rate for Payer: Humana Medicare |
$298.64
|
| Rate for Payer: Lucent All Commercial |
$507.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$699.93
|
| Rate for Payer: PHP All Commercial |
$707.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.96
|
| Rate for Payer: Sagamore Health Network All Products |
$720.46
|
| Rate for Payer: Signature Care EPO |
$774.59
|
| Rate for Payer: Signature Care PPO |
$821.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$793.25
|
| Rate for Payer: United Healthcare Commercial |
$735.39
|
| Rate for Payer: United Healthcare Medicare |
$298.64
|
|
|
HC Z GUIDEWIRE BALL NOSE 3.0X100
|
Facility
|
IP
|
$933.24
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.93 |
| Max. Negotiated Rate |
$867.91 |
| Rate for Payer: Aetna Commercial |
$806.32
|
| Rate for Payer: Cash Price |
$559.94
|
| Rate for Payer: Cigna All Commercial |
$805.39
|
| Rate for Payer: CORVEL All Commercial |
$867.91
|
| Rate for Payer: Coventry All Commercial |
$821.25
|
| Rate for Payer: Encore All Commercial |
$859.05
|
| Rate for Payer: Frontpath All Commercial |
$858.58
|
| Rate for Payer: Humana ChoiceCare |
$806.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.92
|
| Rate for Payer: PHCS All Commercial |
$699.93
|
| Rate for Payer: PHP All Commercial |
$707.77
|
| Rate for Payer: Sagamore Health Network All Products |
$720.46
|
| Rate for Payer: Signature Care EPO |
$774.59
|
| Rate for Payer: Signature Care PPO |
$821.25
|
| Rate for Payer: United Healthcare Commercial |
$735.39
|
|
|
HC Z HI PLATE HUM PXML 90 4-H L
|
Facility
|
IP
|
$5,359.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,019.59 |
| Max. Negotiated Rate |
$4,984.30 |
| Rate for Payer: Aetna Commercial |
$4,630.57
|
| Rate for Payer: Cash Price |
$3,215.68
|
| Rate for Payer: Cigna All Commercial |
$4,625.21
|
| Rate for Payer: CORVEL All Commercial |
$4,984.30
|
| Rate for Payer: Coventry All Commercial |
$4,716.32
|
| Rate for Payer: Encore All Commercial |
$4,933.38
|
| Rate for Payer: Frontpath All Commercial |
$4,930.70
|
| Rate for Payer: Humana ChoiceCare |
$4,628.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,823.51
|
| Rate for Payer: PHCS All Commercial |
$4,019.59
|
| Rate for Payer: PHP All Commercial |
$4,064.61
|
| Rate for Payer: Sagamore Health Network All Products |
$4,137.50
|
| Rate for Payer: Signature Care EPO |
$4,448.35
|
| Rate for Payer: Signature Care PPO |
$4,716.32
|
| Rate for Payer: United Healthcare Commercial |
$4,223.25
|
|
|
HC Z HI PLATE HUM PXML 90 4-H L
|
Facility
|
OP
|
$5,359.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,984.30 |
| Rate for Payer: Aetna Commercial |
$4,523.38
|
| Rate for Payer: Aetna Medicare |
$1,715.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,661.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,077.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,350.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,972.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,886.53
|
| Rate for Payer: Cash Price |
$3,215.68
|
| Rate for Payer: Cash Price |
$3,215.68
|
| Rate for Payer: Centivo All Commercial |
$2,915.55
|
| Rate for Payer: Cigna All Commercial |
$4,625.21
|
| Rate for Payer: CORVEL All Commercial |
$4,984.30
|
| Rate for Payer: Coventry All Commercial |
$4,716.32
|
| Rate for Payer: Encore All Commercial |
$4,933.38
|
| Rate for Payer: Frontpath All Commercial |
$4,930.70
|
| Rate for Payer: Humana ChoiceCare |
$4,628.97
|
| Rate for Payer: Humana Medicare |
$1,715.03
|
| Rate for Payer: Lucent All Commercial |
$2,915.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,823.51
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,019.59
|
| Rate for Payer: PHP All Commercial |
$4,064.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,090.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,137.50
|
| Rate for Payer: Signature Care EPO |
$4,448.35
|
| Rate for Payer: Signature Care PPO |
$4,716.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,555.54
|
| Rate for Payer: United Healthcare Commercial |
$4,223.25
|
| Rate for Payer: United Healthcare Medicare |
$1,715.03
|
|
|
HC Z HI PLATE HUM PXML 90 4-H R
|
Facility
|
OP
|
$5,359.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,984.30 |
| Rate for Payer: Aetna Commercial |
$4,523.38
|
| Rate for Payer: Aetna Medicare |
$1,715.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,661.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,077.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,350.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,972.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,886.53
|
| Rate for Payer: Cash Price |
$3,215.68
|
| Rate for Payer: Cash Price |
$3,215.68
|
| Rate for Payer: Centivo All Commercial |
$2,915.55
|
| Rate for Payer: Cigna All Commercial |
$4,625.21
|
| Rate for Payer: CORVEL All Commercial |
$4,984.30
|
| Rate for Payer: Coventry All Commercial |
$4,716.32
|
| Rate for Payer: Encore All Commercial |
$4,933.38
|
| Rate for Payer: Frontpath All Commercial |
$4,930.70
|
| Rate for Payer: Humana ChoiceCare |
$4,628.97
|
| Rate for Payer: Humana Medicare |
$1,715.03
|
| Rate for Payer: Lucent All Commercial |
$2,915.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,823.51
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,019.59
|
| Rate for Payer: PHP All Commercial |
$4,064.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,090.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,137.50
|
| Rate for Payer: Signature Care EPO |
$4,448.35
|
| Rate for Payer: Signature Care PPO |
$4,716.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,555.54
|
| Rate for Payer: United Healthcare Commercial |
$4,223.25
|
| Rate for Payer: United Healthcare Medicare |
$1,715.03
|
|
|
HC Z HI PLATE HUM PXML 90 4-H R
|
Facility
|
IP
|
$5,359.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,019.59 |
| Max. Negotiated Rate |
$4,984.30 |
| Rate for Payer: Aetna Commercial |
$4,630.57
|
| Rate for Payer: Cash Price |
$3,215.68
|
| Rate for Payer: Cigna All Commercial |
$4,625.21
|
| Rate for Payer: CORVEL All Commercial |
$4,984.30
|
| Rate for Payer: Coventry All Commercial |
$4,716.32
|
| Rate for Payer: Encore All Commercial |
$4,933.38
|
| Rate for Payer: Frontpath All Commercial |
$4,930.70
|
| Rate for Payer: Humana ChoiceCare |
$4,628.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,823.51
|
| Rate for Payer: PHCS All Commercial |
$4,019.59
|
| Rate for Payer: PHP All Commercial |
$4,064.61
|
| Rate for Payer: Sagamore Health Network All Products |
$4,137.50
|
| Rate for Payer: Signature Care EPO |
$4,448.35
|
| Rate for Payer: Signature Care PPO |
$4,716.32
|
| Rate for Payer: United Healthcare Commercial |
$4,223.25
|
|
|
HC Z HMRL BEARING 36MM STD PRLNG
|
Facility
|
OP
|
$6,660.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,193.80 |
| Rate for Payer: Aetna Commercial |
$5,621.04
|
| Rate for Payer: Aetna Medicare |
$2,131.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,064.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,824.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,163.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,450.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,344.32
|
| Rate for Payer: Cash Price |
$3,996.00
|
| Rate for Payer: Cash Price |
$3,996.00
|
| Rate for Payer: Centivo All Commercial |
$3,623.04
|
| Rate for Payer: Cigna All Commercial |
$5,747.58
|
| Rate for Payer: CORVEL All Commercial |
$6,193.80
|
| Rate for Payer: Coventry All Commercial |
$5,860.80
|
| Rate for Payer: Encore All Commercial |
$6,130.53
|
| Rate for Payer: Frontpath All Commercial |
$6,127.20
|
| Rate for Payer: Humana ChoiceCare |
$5,752.24
|
| Rate for Payer: Humana Medicare |
$2,131.20
|
| Rate for Payer: Lucent All Commercial |
$3,623.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,994.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,995.00
|
| Rate for Payer: PHP All Commercial |
$5,050.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,597.40
|
| Rate for Payer: Sagamore Health Network All Products |
$5,141.52
|
| Rate for Payer: Signature Care EPO |
$5,527.80
|
| Rate for Payer: Signature Care PPO |
$5,860.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,661.00
|
| Rate for Payer: United Healthcare Commercial |
$5,248.08
|
| Rate for Payer: United Healthcare Medicare |
$2,131.20
|
|
