|
HC W ACSHLD CF AMNION 2.4 45UM
|
Facility
|
OP
|
$6,192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,758.56 |
| Rate for Payer: Aetna Commercial |
$5,226.05
|
| Rate for Payer: Aetna Medicare |
$2,043.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,043.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,556.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,870.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,349.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,247.70
|
| Rate for Payer: Cash Price |
$3,839.04
|
| Rate for Payer: Cash Price |
$3,839.04
|
| Rate for Payer: Centivo All Commercial |
$3,157.92
|
| Rate for Payer: Cigna All Commercial |
$5,343.70
|
| Rate for Payer: CORVEL All Commercial |
$5,758.56
|
| Rate for Payer: Coventry All Commercial |
$5,448.96
|
| Rate for Payer: Encore All Commercial |
$5,699.74
|
| Rate for Payer: Frontpath All Commercial |
$5,696.64
|
| Rate for Payer: Humana ChoiceCare |
$5,348.03
|
| Rate for Payer: Humana Medicare |
$3,157.92
|
| Rate for Payer: Lucent All Commercial |
$3,157.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,572.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,644.00
|
| Rate for Payer: PHP All Commercial |
$4,696.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,414.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,780.22
|
| Rate for Payer: Signature Care EPO |
$5,139.36
|
| Rate for Payer: Signature Care PPO |
$5,448.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,263.20
|
| Rate for Payer: United Healthcare Commercial |
$4,879.30
|
| Rate for Payer: United Healthcare Medicare |
$2,043.36
|
|
|
HC W ACSHLD CF AMNION 4.4 45UM
|
Facility
|
IP
|
$8,956.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,717.60 |
| Max. Negotiated Rate |
$8,329.82 |
| Rate for Payer: Aetna Commercial |
$7,738.68
|
| Rate for Payer: Cash Price |
$5,553.22
|
| Rate for Payer: Cigna All Commercial |
$7,729.72
|
| Rate for Payer: CORVEL All Commercial |
$8,329.82
|
| Rate for Payer: Coventry All Commercial |
$7,881.98
|
| Rate for Payer: Encore All Commercial |
$8,244.73
|
| Rate for Payer: Frontpath All Commercial |
$8,240.26
|
| Rate for Payer: Humana ChoiceCare |
$7,735.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,061.12
|
| Rate for Payer: PHCS All Commercial |
$6,717.60
|
| Rate for Payer: PHP All Commercial |
$6,792.84
|
| Rate for Payer: Sagamore Health Network All Products |
$6,914.65
|
| Rate for Payer: Signature Care EPO |
$7,434.14
|
| Rate for Payer: Signature Care PPO |
$7,881.98
|
| Rate for Payer: United Healthcare Commercial |
$7,057.96
|
|
|
HC W ACSHLD CF AMNION 4.4 45UM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,329.82 |
| Rate for Payer: Aetna Commercial |
$7,559.54
|
| Rate for Payer: Aetna Medicare |
$2,955.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,955.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,143.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,598.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,399.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,251.32
|
| Rate for Payer: Cash Price |
$5,553.22
|
| Rate for Payer: Cash Price |
$5,553.22
|
| Rate for Payer: Centivo All Commercial |
$4,567.97
|
| Rate for Payer: Cigna All Commercial |
$7,729.72
|
| Rate for Payer: CORVEL All Commercial |
$8,329.82
|
| Rate for Payer: Coventry All Commercial |
$7,881.98
|
| Rate for Payer: Encore All Commercial |
$8,244.73
|
| Rate for Payer: Frontpath All Commercial |
$8,240.26
|
| Rate for Payer: Humana ChoiceCare |
$7,735.99
|
| Rate for Payer: Humana Medicare |
$4,567.97
|
| Rate for Payer: Lucent All Commercial |
$4,567.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,061.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,717.60
|
| Rate for Payer: PHP All Commercial |
$6,792.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,493.15
|
| Rate for Payer: Sagamore Health Network All Products |
$6,914.65
|
| Rate for Payer: Signature Care EPO |
$7,434.14
|
| Rate for Payer: Signature Care PPO |
$7,881.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,613.28
|
| Rate for Payer: United Healthcare Commercial |
$7,057.96
|
| Rate for Payer: United Healthcare Medicare |
$2,955.74
|
|
|
HC W ACSHLD CF AMNION 4.8 45UM
|
Facility
|
IP
|
$14,385.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,789.20 |
| Max. Negotiated Rate |
$13,378.61 |
| Rate for Payer: Aetna Commercial |
$12,429.16
|
| Rate for Payer: Cash Price |
$8,919.07
|
| Rate for Payer: Cigna All Commercial |
$12,414.77
|
| Rate for Payer: CORVEL All Commercial |
$13,378.61
|
| Rate for Payer: Coventry All Commercial |
$12,659.33
|
| Rate for Payer: Encore All Commercial |
$13,241.94
|
| Rate for Payer: Frontpath All Commercial |
$13,234.75
|
| Rate for Payer: Humana ChoiceCare |
$12,424.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,947.04
|
| Rate for Payer: PHCS All Commercial |
$10,789.20
|
| Rate for Payer: PHP All Commercial |
$10,910.04
|
| Rate for Payer: Sagamore Health Network All Products |
$11,105.68
|
| Rate for Payer: Signature Care EPO |
$11,940.05
|
| Rate for Payer: Signature Care PPO |
$12,659.33
|
| Rate for Payer: United Healthcare Commercial |
$11,335.85
|
|
|
HC W ACSHLD CF AMNION 4.8 45UM
|
Facility
|
OP
|
$14,385.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$13,378.61 |
| Rate for Payer: Aetna Commercial |
$12,141.45
|
| Rate for Payer: Aetna Medicare |
$4,747.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,747.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,261.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,992.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,459.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,221.97
|
| Rate for Payer: Cash Price |
$8,919.07
|
| Rate for Payer: Cash Price |
$8,919.07
|
| Rate for Payer: Centivo All Commercial |
$7,336.66
|
| Rate for Payer: Cigna All Commercial |
$12,414.77
|
| Rate for Payer: CORVEL All Commercial |
$13,378.61
|
| Rate for Payer: Coventry All Commercial |
$12,659.33
|
| Rate for Payer: Encore All Commercial |
$13,241.94
|
| Rate for Payer: Frontpath All Commercial |
$13,234.75
|
| Rate for Payer: Humana ChoiceCare |
$12,424.84
|
| Rate for Payer: Humana Medicare |
$7,336.66
|
| Rate for Payer: Lucent All Commercial |
$7,336.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,947.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,789.20
|
| Rate for Payer: PHP All Commercial |
$10,910.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,610.38
|
| Rate for Payer: Sagamore Health Network All Products |
$11,105.68
|
| Rate for Payer: Signature Care EPO |
$11,940.05
|
| Rate for Payer: Signature Care PPO |
$12,659.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,227.76
|
| Rate for Payer: United Healthcare Commercial |
$11,335.85
|
| Rate for Payer: United Healthcare Medicare |
$4,747.25
|
|
|
HC WAFER 2 3/4 IN
|
Facility
|
IP
|
$9.32
|
|
| Hospital Charge Code |
41602246
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna Commercial |
$8.05
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cigna All Commercial |
$8.04
|
| Rate for Payer: CORVEL All Commercial |
$8.67
|
| Rate for Payer: Coventry All Commercial |
$8.20
|
| Rate for Payer: Encore All Commercial |
$8.58
|
| Rate for Payer: Frontpath All Commercial |
$8.57
|
| Rate for Payer: Humana ChoiceCare |
$8.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.39
|
| Rate for Payer: PHCS All Commercial |
$6.99
|
| Rate for Payer: PHP All Commercial |
$7.07
|
| Rate for Payer: Sagamore Health Network All Products |
$7.20
|
| Rate for Payer: Signature Care EPO |
$7.74
|
| Rate for Payer: Signature Care PPO |
$8.20
|
| Rate for Payer: United Healthcare Commercial |
$7.34
|
|
|
HC WAFER 2 3/4 IN
|
Facility
|
OP
|
$9.32
|
|
| Hospital Charge Code |
41602246
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$81.94 |
| Rate for Payer: Aetna Commercial |
$7.87
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.38
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Centivo All Commercial |
$4.75
|
| Rate for Payer: Cigna All Commercial |
$8.04
|
| Rate for Payer: CORVEL All Commercial |
$8.67
|
| Rate for Payer: Coventry All Commercial |
$8.20
|
| Rate for Payer: Encore All Commercial |
$8.58
|
| Rate for Payer: Frontpath All Commercial |
$8.57
|
| Rate for Payer: Humana ChoiceCare |
$8.05
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Lucent All Commercial |
$4.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.39
|
| Rate for Payer: Managed Health Services Medicaid |
$81.94
|
| Rate for Payer: MDWise Medicaid |
$81.94
|
| Rate for Payer: PHCS All Commercial |
$6.99
|
| Rate for Payer: PHP All Commercial |
$7.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.63
|
| Rate for Payer: Sagamore Health Network All Products |
$7.20
|
| Rate for Payer: Signature Care EPO |
$7.74
|
| Rate for Payer: Signature Care PPO |
$8.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$7.34
|
| Rate for Payer: United Healthcare Medicare |
$3.08
|
|
|
HC W ALLOMATRIX BONE PUTTY 3 ML
|
Facility
|
IP
|
$2,559.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,919.70 |
| Max. Negotiated Rate |
$2,380.43 |
| Rate for Payer: Aetna Commercial |
$2,211.49
|
| Rate for Payer: Cash Price |
$1,586.95
|
| Rate for Payer: Cigna All Commercial |
$2,208.93
|
| Rate for Payer: CORVEL All Commercial |
$2,380.43
|
| Rate for Payer: Coventry All Commercial |
$2,252.45
|
| Rate for Payer: Encore All Commercial |
$2,356.11
|
| Rate for Payer: Frontpath All Commercial |
$2,354.83
|
| Rate for Payer: Humana ChoiceCare |
$2,210.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,303.64
|
| Rate for Payer: PHCS All Commercial |
$1,919.70
|
| Rate for Payer: PHP All Commercial |
$1,941.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,976.01
|
| Rate for Payer: Signature Care EPO |
$2,124.47
|
| Rate for Payer: Signature Care PPO |
$2,252.45
|
| Rate for Payer: United Healthcare Commercial |
$2,016.96
|
|
|
HC W ALLOMATRIX BONE PUTTY 3 ML
|
Facility
|
OP
|
$2,559.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,380.43 |
| Rate for Payer: Aetna Commercial |
$2,160.30
|
| Rate for Payer: Aetna Medicare |
$844.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$844.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,469.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,600.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$971.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$929.13
|
| Rate for Payer: Cash Price |
$1,586.95
|
| Rate for Payer: Cash Price |
$1,586.95
|
| Rate for Payer: Centivo All Commercial |
$1,305.40
|
| Rate for Payer: Cigna All Commercial |
$2,208.93
|
| Rate for Payer: CORVEL All Commercial |
$2,380.43
|
| Rate for Payer: Coventry All Commercial |
$2,252.45
|
| Rate for Payer: Encore All Commercial |
$2,356.11
|
| Rate for Payer: Frontpath All Commercial |
$2,354.83
|
| Rate for Payer: Humana ChoiceCare |
$2,210.73
|
| Rate for Payer: Humana Medicare |
$1,305.40
|
| Rate for Payer: Lucent All Commercial |
$1,305.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,303.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,919.70
|
| Rate for Payer: PHP All Commercial |
$1,941.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$998.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,976.01
|
| Rate for Payer: Signature Care EPO |
$2,124.47
|
| Rate for Payer: Signature Care PPO |
$2,252.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,175.66
|
| Rate for Payer: United Healthcare Commercial |
$2,016.96
|
| Rate for Payer: United Healthcare Medicare |
$844.67
|
|
|
HC W ALLOPURE PLUS 10MM
|
Facility
|
OP
|
$8,985.60
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,356.61 |
| Rate for Payer: Aetna Commercial |
$7,583.85
|
| Rate for Payer: Aetna Medicare |
$2,965.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,965.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,160.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,616.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,410.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,261.77
|
| Rate for Payer: Cash Price |
$5,571.07
|
| Rate for Payer: Cash Price |
$5,571.07
|
| Rate for Payer: Centivo All Commercial |
$4,582.66
|
| Rate for Payer: Cigna All Commercial |
$7,754.57
|
| Rate for Payer: CORVEL All Commercial |
$8,356.61
|
| Rate for Payer: Coventry All Commercial |
$7,907.33
|
| Rate for Payer: Encore All Commercial |
$8,271.24
|
| Rate for Payer: Frontpath All Commercial |
$8,266.75
|
| Rate for Payer: Humana ChoiceCare |
$7,760.86
|
| Rate for Payer: Humana Medicare |
$4,582.66
|
| Rate for Payer: Lucent All Commercial |
$4,582.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,087.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,739.20
|
| Rate for Payer: PHP All Commercial |
$6,814.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,504.38
|
| Rate for Payer: Sagamore Health Network All Products |
$6,936.88
|
| Rate for Payer: Signature Care EPO |
$7,458.05
|
| Rate for Payer: Signature Care PPO |
$7,907.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,637.76
|
| Rate for Payer: United Healthcare Commercial |
$7,080.65
|
| Rate for Payer: United Healthcare Medicare |
$2,965.25
|
|
|
HC W ALLOPURE PLUS 10MM
|
Facility
|
IP
|
$8,985.60
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,739.20 |
| Max. Negotiated Rate |
$8,356.61 |
| Rate for Payer: Aetna Commercial |
$7,763.56
|
| Rate for Payer: Cash Price |
$5,571.07
|
| Rate for Payer: Cigna All Commercial |
$7,754.57
|
| Rate for Payer: CORVEL All Commercial |
$8,356.61
|
| Rate for Payer: Coventry All Commercial |
$7,907.33
|
| Rate for Payer: Encore All Commercial |
$8,271.24
|
| Rate for Payer: Frontpath All Commercial |
$8,266.75
|
| Rate for Payer: Humana ChoiceCare |
$7,760.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,087.04
|
| Rate for Payer: PHCS All Commercial |
$6,739.20
|
| Rate for Payer: PHP All Commercial |
$6,814.68
|
| Rate for Payer: Sagamore Health Network All Products |
$6,936.88
|
| Rate for Payer: Signature Care EPO |
$7,458.05
|
| Rate for Payer: Signature Care PPO |
$7,907.33
|
| Rate for Payer: United Healthcare Commercial |
$7,080.65
|
|
|
HC W ALLOPURE PLUS 12MM
|
Facility
|
OP
|
$8,985.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,356.61 |
| Rate for Payer: Aetna Commercial |
$7,583.85
|
| Rate for Payer: Aetna Medicare |
$2,965.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,965.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,160.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,616.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,410.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,261.77
|
| Rate for Payer: Cash Price |
$5,571.07
|
| Rate for Payer: Cash Price |
$5,571.07
|
| Rate for Payer: Centivo All Commercial |
$4,582.66
|
| Rate for Payer: Cigna All Commercial |
$7,754.57
|
| Rate for Payer: CORVEL All Commercial |
$8,356.61
|
| Rate for Payer: Coventry All Commercial |
$7,907.33
|
| Rate for Payer: Encore All Commercial |
$8,271.24
|
| Rate for Payer: Frontpath All Commercial |
$8,266.75
|
| Rate for Payer: Humana ChoiceCare |
$7,760.86
|
| Rate for Payer: Humana Medicare |
$4,582.66
|
| Rate for Payer: Lucent All Commercial |
$4,582.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,087.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,739.20
|
| Rate for Payer: PHP All Commercial |
$6,814.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,504.38
|
| Rate for Payer: Sagamore Health Network All Products |
$6,936.88
|
| Rate for Payer: Signature Care EPO |
$7,458.05
|
| Rate for Payer: Signature Care PPO |
$7,907.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,637.76
|
| Rate for Payer: United Healthcare Commercial |
$7,080.65
|
| Rate for Payer: United Healthcare Medicare |
$2,965.25
|
|
|
HC W ALLOPURE PLUS 12MM
|
Facility
|
IP
|
$8,985.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,739.20 |
| Max. Negotiated Rate |
$8,356.61 |
| Rate for Payer: Aetna Commercial |
$7,763.56
|
| Rate for Payer: Cash Price |
$5,571.07
|
| Rate for Payer: Cigna All Commercial |
$7,754.57
|
| Rate for Payer: CORVEL All Commercial |
$8,356.61
|
| Rate for Payer: Coventry All Commercial |
$7,907.33
|
| Rate for Payer: Encore All Commercial |
$8,271.24
|
| Rate for Payer: Frontpath All Commercial |
$8,266.75
|
| Rate for Payer: Humana ChoiceCare |
$7,760.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,087.04
|
| Rate for Payer: PHCS All Commercial |
$6,739.20
|
| Rate for Payer: PHP All Commercial |
$6,814.68
|
| Rate for Payer: Sagamore Health Network All Products |
$6,936.88
|
| Rate for Payer: Signature Care EPO |
$7,458.05
|
| Rate for Payer: Signature Care PPO |
$7,907.33
|
| Rate for Payer: United Healthcare Commercial |
$7,080.65
|
|
|
HC W ALLOPURE PLUS 6MM
|
Facility
|
IP
|
$7,398.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,548.50 |
| Max. Negotiated Rate |
$6,880.14 |
| Rate for Payer: Aetna Commercial |
$6,391.87
|
| Rate for Payer: Cash Price |
$4,586.76
|
| Rate for Payer: Cigna All Commercial |
$6,384.47
|
| Rate for Payer: CORVEL All Commercial |
$6,880.14
|
| Rate for Payer: Coventry All Commercial |
$6,510.24
|
| Rate for Payer: Encore All Commercial |
$6,809.86
|
| Rate for Payer: Frontpath All Commercial |
$6,806.16
|
| Rate for Payer: Humana ChoiceCare |
$6,389.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,658.20
|
| Rate for Payer: PHCS All Commercial |
$5,548.50
|
| Rate for Payer: PHP All Commercial |
$5,610.64
|
| Rate for Payer: Sagamore Health Network All Products |
$5,711.26
|
| Rate for Payer: Signature Care EPO |
$6,140.34
|
| Rate for Payer: Signature Care PPO |
$6,510.24
|
| Rate for Payer: United Healthcare Commercial |
$5,829.62
|
|
|
HC W ALLOPURE PLUS 6MM
|
Facility
|
OP
|
$7,398.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41607020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,880.14 |
| Rate for Payer: Aetna Commercial |
$6,243.91
|
| Rate for Payer: Aetna Medicare |
$2,441.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,441.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,248.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,624.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,807.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,685.47
|
| Rate for Payer: Cash Price |
$4,586.76
|
| Rate for Payer: Cash Price |
$4,586.76
|
| Rate for Payer: Centivo All Commercial |
$3,772.98
|
| Rate for Payer: Cigna All Commercial |
$6,384.47
|
| Rate for Payer: CORVEL All Commercial |
$6,880.14
|
| Rate for Payer: Coventry All Commercial |
$6,510.24
|
| Rate for Payer: Encore All Commercial |
$6,809.86
|
| Rate for Payer: Frontpath All Commercial |
$6,806.16
|
| Rate for Payer: Humana ChoiceCare |
$6,389.65
|
| Rate for Payer: Humana Medicare |
$3,772.98
|
| Rate for Payer: Lucent All Commercial |
$3,772.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,658.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,548.50
|
| Rate for Payer: PHP All Commercial |
$5,610.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,885.22
|
| Rate for Payer: Sagamore Health Network All Products |
$5,711.26
|
| Rate for Payer: Signature Care EPO |
$6,140.34
|
| Rate for Payer: Signature Care PPO |
$6,510.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,288.30
|
| Rate for Payer: United Healthcare Commercial |
$5,829.62
|
| Rate for Payer: United Healthcare Medicare |
$2,441.34
|
|
|
HC W ALMTRX BONE PUTTY 10 ML
|
Facility
|
OP
|
$5,605.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,212.84 |
| Rate for Payer: Aetna Commercial |
$4,730.79
|
| Rate for Payer: Aetna Medicare |
$1,849.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,849.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,219.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,503.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,127.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,034.69
|
| Rate for Payer: Cash Price |
$3,475.22
|
| Rate for Payer: Cash Price |
$3,475.22
|
| Rate for Payer: Centivo All Commercial |
$2,858.65
|
| Rate for Payer: Cigna All Commercial |
$4,837.29
|
| Rate for Payer: CORVEL All Commercial |
$5,212.84
|
| Rate for Payer: Coventry All Commercial |
$4,932.58
|
| Rate for Payer: Encore All Commercial |
$5,159.59
|
| Rate for Payer: Frontpath All Commercial |
$5,156.78
|
| Rate for Payer: Humana ChoiceCare |
$4,841.21
|
| Rate for Payer: Humana Medicare |
$2,858.65
|
| Rate for Payer: Lucent All Commercial |
$2,858.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,044.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,203.90
|
| Rate for Payer: PHP All Commercial |
$4,250.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,186.03
|
| Rate for Payer: Sagamore Health Network All Products |
$4,327.21
|
| Rate for Payer: Signature Care EPO |
$4,652.32
|
| Rate for Payer: Signature Care PPO |
$4,932.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,764.42
|
| Rate for Payer: United Healthcare Commercial |
$4,416.90
|
| Rate for Payer: United Healthcare Medicare |
$1,849.72
|
|
|
HC W ALMTRX BONE PUTTY 10 ML
|
Facility
|
IP
|
$5,605.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,203.90 |
| Max. Negotiated Rate |
$5,212.84 |
| Rate for Payer: Aetna Commercial |
$4,842.89
|
| Rate for Payer: Cash Price |
$3,475.22
|
| Rate for Payer: Cigna All Commercial |
$4,837.29
|
| Rate for Payer: CORVEL All Commercial |
$5,212.84
|
| Rate for Payer: Coventry All Commercial |
$4,932.58
|
| Rate for Payer: Encore All Commercial |
$5,159.59
|
| Rate for Payer: Frontpath All Commercial |
$5,156.78
|
| Rate for Payer: Humana ChoiceCare |
$4,841.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,044.68
|
| Rate for Payer: PHCS All Commercial |
$4,203.90
|
| Rate for Payer: PHP All Commercial |
$4,250.98
|
| Rate for Payer: Sagamore Health Network All Products |
$4,327.21
|
| Rate for Payer: Signature Care EPO |
$4,652.32
|
| Rate for Payer: Signature Care PPO |
$4,932.58
|
| Rate for Payer: United Healthcare Commercial |
$4,416.90
|
|
|
HC W ALMTRX BONE PUTTY 5 ML
|
Facility
|
OP
|
$3,844.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,575.66 |
| Rate for Payer: Aetna Commercial |
$3,245.01
|
| Rate for Payer: Aetna Medicare |
$1,268.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,268.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,208.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,403.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,459.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,395.66
|
| Rate for Payer: Cash Price |
$2,383.78
|
| Rate for Payer: Cash Price |
$2,383.78
|
| Rate for Payer: Centivo All Commercial |
$1,960.85
|
| Rate for Payer: Cigna All Commercial |
$3,318.06
|
| Rate for Payer: CORVEL All Commercial |
$3,575.66
|
| Rate for Payer: Coventry All Commercial |
$3,383.42
|
| Rate for Payer: Encore All Commercial |
$3,539.14
|
| Rate for Payer: Frontpath All Commercial |
$3,537.22
|
| Rate for Payer: Humana ChoiceCare |
$3,320.75
|
| Rate for Payer: Humana Medicare |
$1,960.85
|
| Rate for Payer: Lucent All Commercial |
$1,960.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,460.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,883.60
|
| Rate for Payer: PHP All Commercial |
$2,915.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,499.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,968.19
|
| Rate for Payer: Signature Care EPO |
$3,191.18
|
| Rate for Payer: Signature Care PPO |
$3,383.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,268.08
|
| Rate for Payer: United Healthcare Commercial |
$3,029.70
|
| Rate for Payer: United Healthcare Medicare |
$1,268.78
|
|
|
HC W ALMTRX BONE PUTTY 5 ML
|
Facility
|
IP
|
$3,844.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.60 |
| Max. Negotiated Rate |
$3,575.66 |
| Rate for Payer: Aetna Commercial |
$3,321.91
|
| Rate for Payer: Cash Price |
$2,383.78
|
| Rate for Payer: Cigna All Commercial |
$3,318.06
|
| Rate for Payer: CORVEL All Commercial |
$3,575.66
|
| Rate for Payer: Coventry All Commercial |
$3,383.42
|
| Rate for Payer: Encore All Commercial |
$3,539.14
|
| Rate for Payer: Frontpath All Commercial |
$3,537.22
|
| Rate for Payer: Humana ChoiceCare |
$3,320.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,460.32
|
| Rate for Payer: PHCS All Commercial |
$2,883.60
|
| Rate for Payer: PHP All Commercial |
$2,915.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2,968.19
|
| Rate for Payer: Signature Care EPO |
$3,191.18
|
| Rate for Payer: Signature Care PPO |
$3,383.42
|
| Rate for Payer: United Healthcare Commercial |
$3,029.70
|
|
|
HC W ALMTRX BONE PUTTY CANC 10 ML
|
Facility
|
OP
|
$4,460.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,148.17 |
| Rate for Payer: Aetna Commercial |
$3,764.58
|
| Rate for Payer: Aetna Medicare |
$1,471.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,471.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,561.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,788.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,692.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,619.13
|
| Rate for Payer: Cash Price |
$2,765.45
|
| Rate for Payer: Cash Price |
$2,765.45
|
| Rate for Payer: Centivo All Commercial |
$2,274.80
|
| Rate for Payer: Cigna All Commercial |
$3,849.33
|
| Rate for Payer: CORVEL All Commercial |
$4,148.17
|
| Rate for Payer: Coventry All Commercial |
$3,925.15
|
| Rate for Payer: Encore All Commercial |
$4,105.80
|
| Rate for Payer: Frontpath All Commercial |
$4,103.57
|
| Rate for Payer: Humana ChoiceCare |
$3,852.45
|
| Rate for Payer: Humana Medicare |
$2,274.80
|
| Rate for Payer: Lucent All Commercial |
$2,274.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,014.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,345.30
|
| Rate for Payer: PHP All Commercial |
$3,382.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,739.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3,443.43
|
| Rate for Payer: Signature Care EPO |
$3,702.13
|
| Rate for Payer: Signature Care PPO |
$3,925.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,791.34
|
| Rate for Payer: United Healthcare Commercial |
$3,514.80
|
| Rate for Payer: United Healthcare Medicare |
$1,471.93
|
|
|
HC W ALMTRX BONE PUTTY CANC 10 ML
|
Facility
|
IP
|
$4,460.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,345.30 |
| Max. Negotiated Rate |
$4,148.17 |
| Rate for Payer: Aetna Commercial |
$3,853.79
|
| Rate for Payer: Cash Price |
$2,765.45
|
| Rate for Payer: Cigna All Commercial |
$3,849.33
|
| Rate for Payer: CORVEL All Commercial |
$4,148.17
|
| Rate for Payer: Coventry All Commercial |
$3,925.15
|
| Rate for Payer: Encore All Commercial |
$4,105.80
|
| Rate for Payer: Frontpath All Commercial |
$4,103.57
|
| Rate for Payer: Humana ChoiceCare |
$3,852.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,014.36
|
| Rate for Payer: PHCS All Commercial |
$3,345.30
|
| Rate for Payer: PHP All Commercial |
$3,382.77
|
| Rate for Payer: Sagamore Health Network All Products |
$3,443.43
|
| Rate for Payer: Signature Care EPO |
$3,702.13
|
| Rate for Payer: Signature Care PPO |
$3,925.15
|
| Rate for Payer: United Healthcare Commercial |
$3,514.80
|
|
|
HC W ALMTRX BONE PUTTY CANC 20 ML
|
Facility
|
IP
|
$7,549.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,661.90 |
| Max. Negotiated Rate |
$7,020.76 |
| Rate for Payer: Aetna Commercial |
$6,522.51
|
| Rate for Payer: Cash Price |
$4,680.50
|
| Rate for Payer: Cigna All Commercial |
$6,514.96
|
| Rate for Payer: CORVEL All Commercial |
$7,020.76
|
| Rate for Payer: Coventry All Commercial |
$6,643.30
|
| Rate for Payer: Encore All Commercial |
$6,949.04
|
| Rate for Payer: Frontpath All Commercial |
$6,945.26
|
| Rate for Payer: Humana ChoiceCare |
$6,520.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,794.28
|
| Rate for Payer: PHCS All Commercial |
$5,661.90
|
| Rate for Payer: PHP All Commercial |
$5,725.31
|
| Rate for Payer: Sagamore Health Network All Products |
$5,827.98
|
| Rate for Payer: Signature Care EPO |
$6,265.84
|
| Rate for Payer: Signature Care PPO |
$6,643.30
|
| Rate for Payer: United Healthcare Commercial |
$5,948.77
|
|
|
HC W ALMTRX BONE PUTTY CANC 20 ML
|
Facility
|
OP
|
$7,549.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,020.76 |
| Rate for Payer: Aetna Commercial |
$6,371.52
|
| Rate for Payer: Aetna Medicare |
$2,491.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,491.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,335.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,719.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,864.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,740.36
|
| Rate for Payer: Cash Price |
$4,680.50
|
| Rate for Payer: Cash Price |
$4,680.50
|
| Rate for Payer: Centivo All Commercial |
$3,850.09
|
| Rate for Payer: Cigna All Commercial |
$6,514.96
|
| Rate for Payer: CORVEL All Commercial |
$7,020.76
|
| Rate for Payer: Coventry All Commercial |
$6,643.30
|
| Rate for Payer: Encore All Commercial |
$6,949.04
|
| Rate for Payer: Frontpath All Commercial |
$6,945.26
|
| Rate for Payer: Humana ChoiceCare |
$6,520.24
|
| Rate for Payer: Humana Medicare |
$3,850.09
|
| Rate for Payer: Lucent All Commercial |
$3,850.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,794.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,661.90
|
| Rate for Payer: PHP All Commercial |
$5,725.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,944.19
|
| Rate for Payer: Sagamore Health Network All Products |
$5,827.98
|
| Rate for Payer: Signature Care EPO |
$6,265.84
|
| Rate for Payer: Signature Care PPO |
$6,643.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,416.82
|
| Rate for Payer: United Healthcare Commercial |
$5,948.77
|
| Rate for Payer: United Healthcare Medicare |
$2,491.24
|
|
|
HC W ALMTRX BONE PUTTY CANC 5 ML
|
Facility
|
IP
|
$3,013.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,259.90 |
| Max. Negotiated Rate |
$2,802.28 |
| Rate for Payer: Aetna Commercial |
$2,603.40
|
| Rate for Payer: Cash Price |
$1,868.18
|
| Rate for Payer: Cigna All Commercial |
$2,600.39
|
| Rate for Payer: CORVEL All Commercial |
$2,802.28
|
| Rate for Payer: Coventry All Commercial |
$2,651.62
|
| Rate for Payer: Encore All Commercial |
$2,773.65
|
| Rate for Payer: Frontpath All Commercial |
$2,772.14
|
| Rate for Payer: Humana ChoiceCare |
$2,602.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,711.88
|
| Rate for Payer: PHCS All Commercial |
$2,259.90
|
| Rate for Payer: PHP All Commercial |
$2,285.21
|
| Rate for Payer: Sagamore Health Network All Products |
$2,326.19
|
| Rate for Payer: Signature Care EPO |
$2,500.96
|
| Rate for Payer: Signature Care PPO |
$2,651.62
|
| Rate for Payer: United Healthcare Commercial |
$2,374.40
|
|
|
HC W ALMTRX BONE PUTTY CANC 5 ML
|
Facility
|
OP
|
$3,013.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,802.28 |
| Rate for Payer: Aetna Commercial |
$2,543.14
|
| Rate for Payer: Aetna Medicare |
$994.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$994.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,730.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,883.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,143.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,093.79
|
| Rate for Payer: Cash Price |
$1,868.18
|
| Rate for Payer: Cash Price |
$1,868.18
|
| Rate for Payer: Centivo All Commercial |
$1,536.73
|
| Rate for Payer: Cigna All Commercial |
$2,600.39
|
| Rate for Payer: CORVEL All Commercial |
$2,802.28
|
| Rate for Payer: Coventry All Commercial |
$2,651.62
|
| Rate for Payer: Encore All Commercial |
$2,773.65
|
| Rate for Payer: Frontpath All Commercial |
$2,772.14
|
| Rate for Payer: Humana ChoiceCare |
$2,602.50
|
| Rate for Payer: Humana Medicare |
$1,536.73
|
| Rate for Payer: Lucent All Commercial |
$1,536.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,711.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,259.90
|
| Rate for Payer: PHP All Commercial |
$2,285.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,175.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,326.19
|
| Rate for Payer: Signature Care EPO |
$2,500.96
|
| Rate for Payer: Signature Care PPO |
$2,651.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,561.22
|
| Rate for Payer: United Healthcare Commercial |
$2,374.40
|
| Rate for Payer: United Healthcare Medicare |
$994.36
|
|
