|
HC Z PSN TIB SZ D L 0 DEG
|
Facility
|
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,471.20 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,150.82
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
|
|
HC Z PSN TIB SZ D L 0 DEG
|
Facility
|
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,907.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,848.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,193.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,098.48
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Centivo All Commercial |
$3,243.11
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$1,907.71
|
| Rate for Payer: Lucent All Commercial |
$3,243.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,907.71
|
|
|
HC Z PSN TIB SZ D R 0 DEG
|
Facility
|
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,471.20 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,150.82
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
|
|
HC Z PSN TIB SZ D R 0 DEG
|
Facility
|
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,907.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,848.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,193.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,098.48
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Centivo All Commercial |
$3,243.11
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$1,907.71
|
| Rate for Payer: Lucent All Commercial |
$3,243.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,907.71
|
|
|
HC Z PSN TIB SZ F L
|
Facility
|
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,471.20 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,150.82
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
|
|
HC Z PSN TIB SZ F L
|
Facility
|
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,907.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,848.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,193.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,098.48
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Centivo All Commercial |
$3,243.11
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$1,907.71
|
| Rate for Payer: Lucent All Commercial |
$3,243.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,907.71
|
|
|
HC Z PSN TIB SZ F R 0 DEG
|
Facility
|
IP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,471.20 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,150.82
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
|
|
HC Z PSN TIB SZ F R 0 DEG
|
Facility
|
OP
|
$5,961.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,544.29 |
| Rate for Payer: Aetna Commercial |
$5,031.59
|
| Rate for Payer: Aetna Medicare |
$1,907.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,848.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,423.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,726.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,193.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,098.48
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Cash Price |
$3,576.96
|
| Rate for Payer: Centivo All Commercial |
$3,243.11
|
| Rate for Payer: Cigna All Commercial |
$5,144.86
|
| Rate for Payer: CORVEL All Commercial |
$5,544.29
|
| Rate for Payer: Coventry All Commercial |
$5,246.21
|
| Rate for Payer: Encore All Commercial |
$5,487.65
|
| Rate for Payer: Frontpath All Commercial |
$5,484.67
|
| Rate for Payer: Humana ChoiceCare |
$5,149.03
|
| Rate for Payer: Humana Medicare |
$1,907.71
|
| Rate for Payer: Lucent All Commercial |
$3,243.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,365.44
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,471.20
|
| Rate for Payer: PHP All Commercial |
$4,521.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,325.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,602.36
|
| Rate for Payer: Signature Care EPO |
$4,948.13
|
| Rate for Payer: Signature Care PPO |
$5,246.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,067.36
|
| Rate for Payer: United Healthcare Commercial |
$4,697.74
|
| Rate for Payer: United Healthcare Medicare |
$1,907.71
|
|
|
HC Z PULSAVAC PLUS FAN KIT
|
Facility
|
IP
|
$286.65
|
|
| Hospital Charge Code |
41603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.99 |
| Max. Negotiated Rate |
$266.58 |
| Rate for Payer: Aetna Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Cigna All Commercial |
$247.38
|
| Rate for Payer: CORVEL All Commercial |
$266.58
|
| Rate for Payer: Coventry All Commercial |
$252.25
|
| Rate for Payer: Encore All Commercial |
$263.86
|
| Rate for Payer: Frontpath All Commercial |
$263.72
|
| Rate for Payer: Humana ChoiceCare |
$247.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$257.99
|
| Rate for Payer: PHCS All Commercial |
$214.99
|
| Rate for Payer: PHP All Commercial |
$217.40
|
| Rate for Payer: Sagamore Health Network All Products |
$221.29
|
| Rate for Payer: Signature Care EPO |
$237.92
|
| Rate for Payer: Signature Care PPO |
$252.25
|
| Rate for Payer: United Healthcare Commercial |
$225.88
|
|
|
HC Z PULSAVAC PLUS FAN KIT
|
Facility
|
OP
|
$286.65
|
|
| Hospital Charge Code |
41603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$266.58 |
| Rate for Payer: Aetna Commercial |
$241.93
|
| Rate for Payer: Aetna Medicare |
$91.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$164.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$179.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.90
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Cash Price |
$171.99
|
| Rate for Payer: Centivo All Commercial |
$155.94
|
| Rate for Payer: Cigna All Commercial |
$247.38
|
| Rate for Payer: CORVEL All Commercial |
$266.58
|
| Rate for Payer: Coventry All Commercial |
$252.25
|
| Rate for Payer: Encore All Commercial |
$263.86
|
| Rate for Payer: Frontpath All Commercial |
$263.72
|
| Rate for Payer: Humana ChoiceCare |
$247.58
|
| Rate for Payer: Humana Medicare |
$91.73
|
| Rate for Payer: Lucent All Commercial |
$155.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$257.99
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$214.99
|
| Rate for Payer: PHP All Commercial |
$217.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.79
|
| Rate for Payer: Sagamore Health Network All Products |
$221.29
|
| Rate for Payer: Signature Care EPO |
$237.92
|
| Rate for Payer: Signature Care PPO |
$252.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$243.65
|
| Rate for Payer: United Healthcare Commercial |
$225.88
|
| Rate for Payer: United Healthcare Medicare |
$91.73
|
|
|
HC Z QUICK-VAC MIXING BOWL
|
Facility
|
IP
|
$658.00
|
|
| Hospital Charge Code |
41602623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$611.94 |
| Rate for Payer: Aetna Commercial |
$568.51
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna All Commercial |
$567.85
|
| Rate for Payer: CORVEL All Commercial |
$611.94
|
| Rate for Payer: Coventry All Commercial |
$579.04
|
| Rate for Payer: Encore All Commercial |
$605.69
|
| Rate for Payer: Frontpath All Commercial |
$605.36
|
| Rate for Payer: Humana ChoiceCare |
$568.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$592.20
|
| Rate for Payer: PHCS All Commercial |
$493.50
|
| Rate for Payer: PHP All Commercial |
$499.03
|
| Rate for Payer: Sagamore Health Network All Products |
$507.98
|
| Rate for Payer: Signature Care EPO |
$546.14
|
| Rate for Payer: Signature Care PPO |
$579.04
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
|
|
HC Z QUICK-VAC MIXING BOWL
|
Facility
|
OP
|
$658.00
|
|
| Hospital Charge Code |
41602623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$611.94 |
| Rate for Payer: Aetna Commercial |
$555.35
|
| Rate for Payer: Aetna Medicare |
$210.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$242.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.62
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Centivo All Commercial |
$357.95
|
| Rate for Payer: Cigna All Commercial |
$567.85
|
| Rate for Payer: CORVEL All Commercial |
$611.94
|
| Rate for Payer: Coventry All Commercial |
$579.04
|
| Rate for Payer: Encore All Commercial |
$605.69
|
| Rate for Payer: Frontpath All Commercial |
$605.36
|
| Rate for Payer: Humana ChoiceCare |
$568.31
|
| Rate for Payer: Humana Medicare |
$210.56
|
| Rate for Payer: Lucent All Commercial |
$357.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$592.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$493.50
|
| Rate for Payer: PHP All Commercial |
$499.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.62
|
| Rate for Payer: Sagamore Health Network All Products |
$507.98
|
| Rate for Payer: Signature Care EPO |
$546.14
|
| Rate for Payer: Signature Care PPO |
$579.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$559.30
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
| Rate for Payer: United Healthcare Medicare |
$210.56
|
|
|
HC Z REAMER GUID BUSHING
|
Facility
|
IP
|
$528.08
|
|
| Hospital Charge Code |
41606611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.06 |
| Max. Negotiated Rate |
$491.11 |
| Rate for Payer: Aetna Commercial |
$456.26
|
| Rate for Payer: Cash Price |
$316.85
|
| Rate for Payer: Cigna All Commercial |
$455.73
|
| Rate for Payer: CORVEL All Commercial |
$491.11
|
| Rate for Payer: Coventry All Commercial |
$464.71
|
| Rate for Payer: Encore All Commercial |
$486.10
|
| Rate for Payer: Frontpath All Commercial |
$485.83
|
| Rate for Payer: Humana ChoiceCare |
$456.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.27
|
| Rate for Payer: PHCS All Commercial |
$396.06
|
| Rate for Payer: PHP All Commercial |
$400.50
|
| Rate for Payer: Sagamore Health Network All Products |
$407.68
|
| Rate for Payer: Signature Care EPO |
$438.31
|
| Rate for Payer: Signature Care PPO |
$464.71
|
| Rate for Payer: United Healthcare Commercial |
$416.13
|
|
|
HC Z REAMER GUID BUSHING
|
Facility
|
OP
|
$528.08
|
|
| Hospital Charge Code |
41606611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$491.11 |
| Rate for Payer: Aetna Commercial |
$445.70
|
| Rate for Payer: Aetna Medicare |
$168.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$163.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$303.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$330.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.88
|
| Rate for Payer: Cash Price |
$316.85
|
| Rate for Payer: Cash Price |
$316.85
|
| Rate for Payer: Centivo All Commercial |
$287.28
|
| Rate for Payer: Cigna All Commercial |
$455.73
|
| Rate for Payer: CORVEL All Commercial |
$491.11
|
| Rate for Payer: Coventry All Commercial |
$464.71
|
| Rate for Payer: Encore All Commercial |
$486.10
|
| Rate for Payer: Frontpath All Commercial |
$485.83
|
| Rate for Payer: Humana ChoiceCare |
$456.10
|
| Rate for Payer: Humana Medicare |
$168.99
|
| Rate for Payer: Lucent All Commercial |
$287.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.27
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$396.06
|
| Rate for Payer: PHP All Commercial |
$400.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$205.95
|
| Rate for Payer: Sagamore Health Network All Products |
$407.68
|
| Rate for Payer: Signature Care EPO |
$438.31
|
| Rate for Payer: Signature Care PPO |
$464.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$448.87
|
| Rate for Payer: United Healthcare Commercial |
$416.13
|
| Rate for Payer: United Healthcare Medicare |
$168.99
|
|
|
HC Z REAMER GUIDE SCREW
|
Facility
|
IP
|
$528.08
|
|
| Hospital Charge Code |
41606610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.06 |
| Max. Negotiated Rate |
$491.11 |
| Rate for Payer: Aetna Commercial |
$456.26
|
| Rate for Payer: Cash Price |
$316.85
|
| Rate for Payer: Cigna All Commercial |
$455.73
|
| Rate for Payer: CORVEL All Commercial |
$491.11
|
| Rate for Payer: Coventry All Commercial |
$464.71
|
| Rate for Payer: Encore All Commercial |
$486.10
|
| Rate for Payer: Frontpath All Commercial |
$485.83
|
| Rate for Payer: Humana ChoiceCare |
$456.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.27
|
| Rate for Payer: PHCS All Commercial |
$396.06
|
| Rate for Payer: PHP All Commercial |
$400.50
|
| Rate for Payer: Sagamore Health Network All Products |
$407.68
|
| Rate for Payer: Signature Care EPO |
$438.31
|
| Rate for Payer: Signature Care PPO |
$464.71
|
| Rate for Payer: United Healthcare Commercial |
$416.13
|
|
|
HC Z REAMER GUIDE SCREW
|
Facility
|
OP
|
$528.08
|
|
| Hospital Charge Code |
41606610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$491.11 |
| Rate for Payer: Aetna Commercial |
$445.70
|
| Rate for Payer: Aetna Medicare |
$168.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$163.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$303.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$330.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.88
|
| Rate for Payer: Cash Price |
$316.85
|
| Rate for Payer: Cash Price |
$316.85
|
| Rate for Payer: Centivo All Commercial |
$287.28
|
| Rate for Payer: Cigna All Commercial |
$455.73
|
| Rate for Payer: CORVEL All Commercial |
$491.11
|
| Rate for Payer: Coventry All Commercial |
$464.71
|
| Rate for Payer: Encore All Commercial |
$486.10
|
| Rate for Payer: Frontpath All Commercial |
$485.83
|
| Rate for Payer: Humana ChoiceCare |
$456.10
|
| Rate for Payer: Humana Medicare |
$168.99
|
| Rate for Payer: Lucent All Commercial |
$287.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.27
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$396.06
|
| Rate for Payer: PHP All Commercial |
$400.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$205.95
|
| Rate for Payer: Sagamore Health Network All Products |
$407.68
|
| Rate for Payer: Signature Care EPO |
$438.31
|
| Rate for Payer: Signature Care PPO |
$464.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$448.87
|
| Rate for Payer: United Healthcare Commercial |
$416.13
|
| Rate for Payer: United Healthcare Medicare |
$168.99
|
|
|
HC Z RVRS SHOULDER 25MM
|
Facility
|
OP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,450.89
|
| Rate for Payer: Aetna Medicare |
$2,066.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,002.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,709.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,037.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,376.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,273.36
|
| Rate for Payer: Cash Price |
$3,875.04
|
| Rate for Payer: Cash Price |
$3,875.04
|
| Rate for Payer: Centivo All Commercial |
$3,513.37
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Humana Medicare |
$2,066.69
|
| Rate for Payer: Lucent All Commercial |
$3,513.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,518.78
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,489.64
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
| Rate for Payer: United Healthcare Medicare |
$2,066.69
|
|
|
HC Z RVRS SHOULDER 25MM
|
Facility
|
IP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,843.80 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,580.06
|
| Rate for Payer: Cash Price |
$3,875.04
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
|
|
HC Z RVRS SHOULDER 36MM +3
|
Facility
|
OP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,276.85
|
| Rate for Payer: Aetna Medicare |
$1,621.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,570.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,910.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,167.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,864.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,783.71
|
| Rate for Payer: Cash Price |
$3,040.42
|
| Rate for Payer: Cash Price |
$3,040.42
|
| Rate for Payer: Centivo All Commercial |
$2,756.64
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Humana Medicare |
$1,621.56
|
| Rate for Payer: Lucent All Commercial |
$2,756.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,976.27
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,307.26
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
| Rate for Payer: United Healthcare Medicare |
$1,621.56
|
|
|
HC Z RVRS SHOULDER 36MM +3
|
Facility
|
IP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.52 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,378.20
|
| Rate for Payer: Cash Price |
$3,040.42
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
|
|
HC Z RVRS SHOULDER 40 LO +3
|
Facility
|
IP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,265.00 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$6,065.28
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
|
|
HC Z RVRS SHOULDER 40 LO +3
|
Facility
|
OP
|
$7,020.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,528.60 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Medicare |
$2,246.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,176.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,031.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,388.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,583.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,471.04
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Cash Price |
$4,212.00
|
| Rate for Payer: Centivo All Commercial |
$3,818.88
|
| Rate for Payer: Cigna All Commercial |
$6,058.26
|
| Rate for Payer: CORVEL All Commercial |
$6,528.60
|
| Rate for Payer: Coventry All Commercial |
$6,177.60
|
| Rate for Payer: Encore All Commercial |
$6,461.91
|
| Rate for Payer: Frontpath All Commercial |
$6,458.40
|
| Rate for Payer: Humana ChoiceCare |
$6,063.17
|
| Rate for Payer: Humana Medicare |
$2,246.40
|
| Rate for Payer: Lucent All Commercial |
$3,818.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,318.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,265.00
|
| Rate for Payer: PHP All Commercial |
$5,323.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,737.80
|
| Rate for Payer: Sagamore Health Network All Products |
$5,419.44
|
| Rate for Payer: Signature Care EPO |
$5,826.60
|
| Rate for Payer: Signature Care PPO |
$6,177.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,967.00
|
| Rate for Payer: United Healthcare Commercial |
$5,531.76
|
| Rate for Payer: United Healthcare Medicare |
$2,246.40
|
|
|
HC Z RVRS SHOULDER STD 36 MM
|
Facility
|
IP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.52 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,378.20
|
| Rate for Payer: Cash Price |
$3,040.42
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
|
|
HC Z RVRS SHOULDER STD 36 MM
|
Facility
|
OP
|
$5,067.36
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$4,276.85
|
| Rate for Payer: Aetna Medicare |
$1,621.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,570.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,910.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,167.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,864.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,783.71
|
| Rate for Payer: Cash Price |
$3,040.42
|
| Rate for Payer: Cash Price |
$3,040.42
|
| Rate for Payer: Centivo All Commercial |
$2,756.64
|
| Rate for Payer: Cigna All Commercial |
$4,373.13
|
| Rate for Payer: CORVEL All Commercial |
$4,712.64
|
| Rate for Payer: Coventry All Commercial |
$4,459.28
|
| Rate for Payer: Encore All Commercial |
$4,664.50
|
| Rate for Payer: Frontpath All Commercial |
$4,661.97
|
| Rate for Payer: Humana ChoiceCare |
$4,376.68
|
| Rate for Payer: Humana Medicare |
$1,621.56
|
| Rate for Payer: Lucent All Commercial |
$2,756.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,560.62
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,800.52
|
| Rate for Payer: PHP All Commercial |
$3,843.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,976.27
|
| Rate for Payer: Sagamore Health Network All Products |
$3,912.00
|
| Rate for Payer: Signature Care EPO |
$4,205.91
|
| Rate for Payer: Signature Care PPO |
$4,459.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,307.26
|
| Rate for Payer: United Healthcare Commercial |
$3,993.08
|
| Rate for Payer: United Healthcare Medicare |
$1,621.56
|
|
|
HC Z SCREW 1.5X10 NON LOCK
|
Facility
|
OP
|
$579.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$539.16 |
| Rate for Payer: Aetna Commercial |
$489.30
|
| Rate for Payer: Aetna Medicare |
$185.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$332.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$362.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.07
|
| Rate for Payer: Cash Price |
$347.84
|
| Rate for Payer: Cash Price |
$347.84
|
| Rate for Payer: Centivo All Commercial |
$315.38
|
| Rate for Payer: Cigna All Commercial |
$500.32
|
| Rate for Payer: CORVEL All Commercial |
$539.16
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Encore All Commercial |
$533.65
|
| Rate for Payer: Frontpath All Commercial |
$533.36
|
| Rate for Payer: Humana ChoiceCare |
$500.72
|
| Rate for Payer: Humana Medicare |
$185.52
|
| Rate for Payer: Lucent All Commercial |
$315.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$521.77
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$434.81
|
| Rate for Payer: PHP All Commercial |
$439.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$226.10
|
| Rate for Payer: Sagamore Health Network All Products |
$447.56
|
| Rate for Payer: Signature Care EPO |
$481.18
|
| Rate for Payer: Signature Care PPO |
$510.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$492.78
|
| Rate for Payer: United Healthcare Commercial |
$456.84
|
| Rate for Payer: United Healthcare Medicare |
$185.52
|
|
