|
HC W ALMTRX BONE PUTTY INJ 10 ML
|
Facility
|
OP
|
$4,222.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,927.20 |
| Rate for Payer: Aetna Commercial |
$3,564.04
|
| Rate for Payer: Aetna Medicare |
$1,393.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,393.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,425.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,639.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,602.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,532.88
|
| Rate for Payer: Cash Price |
$2,618.14
|
| Rate for Payer: Cash Price |
$2,618.14
|
| Rate for Payer: Centivo All Commercial |
$2,153.63
|
| Rate for Payer: Cigna All Commercial |
$3,644.28
|
| Rate for Payer: CORVEL All Commercial |
$3,927.20
|
| Rate for Payer: Coventry All Commercial |
$3,716.06
|
| Rate for Payer: Encore All Commercial |
$3,887.09
|
| Rate for Payer: Frontpath All Commercial |
$3,884.98
|
| Rate for Payer: Humana ChoiceCare |
$3,647.23
|
| Rate for Payer: Humana Medicare |
$2,153.63
|
| Rate for Payer: Lucent All Commercial |
$2,153.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,800.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,167.10
|
| Rate for Payer: PHP All Commercial |
$3,202.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,646.89
|
| Rate for Payer: Sagamore Health Network All Products |
$3,260.00
|
| Rate for Payer: Signature Care EPO |
$3,504.92
|
| Rate for Payer: Signature Care PPO |
$3,716.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,589.38
|
| Rate for Payer: United Healthcare Commercial |
$3,327.57
|
| Rate for Payer: United Healthcare Medicare |
$1,393.52
|
|
|
HC W ALMTRX BONE PUTTY INJ 10 ML
|
Facility
|
IP
|
$4,222.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,167.10 |
| Max. Negotiated Rate |
$3,927.20 |
| Rate for Payer: Aetna Commercial |
$3,648.50
|
| Rate for Payer: Cash Price |
$2,618.14
|
| Rate for Payer: Cigna All Commercial |
$3,644.28
|
| Rate for Payer: CORVEL All Commercial |
$3,927.20
|
| Rate for Payer: Coventry All Commercial |
$3,716.06
|
| Rate for Payer: Encore All Commercial |
$3,887.09
|
| Rate for Payer: Frontpath All Commercial |
$3,884.98
|
| Rate for Payer: Humana ChoiceCare |
$3,647.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,800.52
|
| Rate for Payer: PHCS All Commercial |
$3,167.10
|
| Rate for Payer: PHP All Commercial |
$3,202.57
|
| Rate for Payer: Sagamore Health Network All Products |
$3,260.00
|
| Rate for Payer: Signature Care EPO |
$3,504.92
|
| Rate for Payer: Signature Care PPO |
$3,716.06
|
| Rate for Payer: United Healthcare Commercial |
$3,327.57
|
|
|
HC W ALMTRX BONE PUTTY INJ 1 ML
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$1,074.15 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Aetna Medicare |
$381.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$381.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$663.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$438.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$419.26
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Centivo All Commercial |
$589.05
|
| Rate for Payer: Cigna All Commercial |
$996.76
|
| Rate for Payer: CORVEL All Commercial |
$1,074.15
|
| Rate for Payer: Coventry All Commercial |
$1,016.40
|
| Rate for Payer: Encore All Commercial |
$1,063.18
|
| Rate for Payer: Frontpath All Commercial |
$1,062.60
|
| Rate for Payer: Humana ChoiceCare |
$997.57
|
| Rate for Payer: Humana Medicare |
$589.05
|
| Rate for Payer: Lucent All Commercial |
$589.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$866.25
|
| Rate for Payer: PHP All Commercial |
$875.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.45
|
| Rate for Payer: Sagamore Health Network All Products |
$891.66
|
| Rate for Payer: Signature Care EPO |
$958.65
|
| Rate for Payer: Signature Care PPO |
$1,016.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.75
|
| Rate for Payer: United Healthcare Commercial |
$910.14
|
| Rate for Payer: United Healthcare Medicare |
$381.15
|
|
|
HC W ALMTRX BONE PUTTY INJ 1 ML
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.25 |
| Max. Negotiated Rate |
$1,074.15 |
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cigna All Commercial |
$996.76
|
| Rate for Payer: CORVEL All Commercial |
$1,074.15
|
| Rate for Payer: Coventry All Commercial |
$1,016.40
|
| Rate for Payer: Encore All Commercial |
$1,063.18
|
| Rate for Payer: Frontpath All Commercial |
$1,062.60
|
| Rate for Payer: Humana ChoiceCare |
$997.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.50
|
| Rate for Payer: PHCS All Commercial |
$866.25
|
| Rate for Payer: PHP All Commercial |
$875.95
|
| Rate for Payer: Sagamore Health Network All Products |
$891.66
|
| Rate for Payer: Signature Care EPO |
$958.65
|
| Rate for Payer: Signature Care PPO |
$1,016.40
|
| Rate for Payer: United Healthcare Commercial |
$910.14
|
|
|
HC W ALMTRX BONE PUTTY INJ 20 ML
|
Facility
|
OP
|
$7,678.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,141.28 |
| Rate for Payer: Aetna Commercial |
$6,480.91
|
| Rate for Payer: Aetna Medicare |
$2,534.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,534.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,409.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,800.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,914.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,787.40
|
| Rate for Payer: Cash Price |
$4,760.86
|
| Rate for Payer: Cash Price |
$4,760.86
|
| Rate for Payer: Centivo All Commercial |
$3,916.19
|
| Rate for Payer: Cigna All Commercial |
$6,626.80
|
| Rate for Payer: CORVEL All Commercial |
$7,141.28
|
| Rate for Payer: Coventry All Commercial |
$6,757.34
|
| Rate for Payer: Encore All Commercial |
$7,068.34
|
| Rate for Payer: Frontpath All Commercial |
$7,064.50
|
| Rate for Payer: Humana ChoiceCare |
$6,632.18
|
| Rate for Payer: Humana Medicare |
$3,916.19
|
| Rate for Payer: Lucent All Commercial |
$3,916.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,910.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,759.10
|
| Rate for Payer: PHP All Commercial |
$5,823.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,994.73
|
| Rate for Payer: Sagamore Health Network All Products |
$5,928.03
|
| Rate for Payer: Signature Care EPO |
$6,373.40
|
| Rate for Payer: Signature Care PPO |
$6,757.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,526.98
|
| Rate for Payer: United Healthcare Commercial |
$6,050.89
|
| Rate for Payer: United Healthcare Medicare |
$2,534.00
|
|
|
HC W ALMTRX BONE PUTTY INJ 20 ML
|
Facility
|
IP
|
$7,678.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,759.10 |
| Max. Negotiated Rate |
$7,141.28 |
| Rate for Payer: Aetna Commercial |
$6,634.48
|
| Rate for Payer: Cash Price |
$4,760.86
|
| Rate for Payer: Cigna All Commercial |
$6,626.80
|
| Rate for Payer: CORVEL All Commercial |
$7,141.28
|
| Rate for Payer: Coventry All Commercial |
$6,757.34
|
| Rate for Payer: Encore All Commercial |
$7,068.34
|
| Rate for Payer: Frontpath All Commercial |
$7,064.50
|
| Rate for Payer: Humana ChoiceCare |
$6,632.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,910.92
|
| Rate for Payer: PHCS All Commercial |
$5,759.10
|
| Rate for Payer: PHP All Commercial |
$5,823.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,928.03
|
| Rate for Payer: Signature Care EPO |
$6,373.40
|
| Rate for Payer: Signature Care PPO |
$6,757.34
|
| Rate for Payer: United Healthcare Commercial |
$6,050.89
|
|
|
HC W ALMTRX BONE PUTTY INJ 5 ML
|
Facility
|
OP
|
$2,775.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,581.31 |
| Rate for Payer: Aetna Commercial |
$2,342.61
|
| Rate for Payer: Aetna Medicare |
$915.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$915.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,594.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,735.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,053.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,007.54
|
| Rate for Payer: Cash Price |
$1,720.87
|
| Rate for Payer: Cash Price |
$1,720.87
|
| Rate for Payer: Centivo All Commercial |
$1,415.56
|
| Rate for Payer: Cigna All Commercial |
$2,395.34
|
| Rate for Payer: CORVEL All Commercial |
$2,581.31
|
| Rate for Payer: Coventry All Commercial |
$2,442.53
|
| Rate for Payer: Encore All Commercial |
$2,554.94
|
| Rate for Payer: Frontpath All Commercial |
$2,553.55
|
| Rate for Payer: Humana ChoiceCare |
$2,397.29
|
| Rate for Payer: Humana Medicare |
$1,415.56
|
| Rate for Payer: Lucent All Commercial |
$1,415.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,498.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,081.70
|
| Rate for Payer: PHP All Commercial |
$2,105.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,082.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,142.76
|
| Rate for Payer: Signature Care EPO |
$2,303.75
|
| Rate for Payer: Signature Care PPO |
$2,442.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,359.26
|
| Rate for Payer: United Healthcare Commercial |
$2,187.17
|
| Rate for Payer: United Healthcare Medicare |
$915.95
|
|
|
HC W ALMTRX BONE PUTTY INJ 5 ML
|
Facility
|
IP
|
$2,775.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.70 |
| Max. Negotiated Rate |
$2,581.31 |
| Rate for Payer: Aetna Commercial |
$2,398.12
|
| Rate for Payer: Cash Price |
$1,720.87
|
| Rate for Payer: Cigna All Commercial |
$2,395.34
|
| Rate for Payer: CORVEL All Commercial |
$2,581.31
|
| Rate for Payer: Coventry All Commercial |
$2,442.53
|
| Rate for Payer: Encore All Commercial |
$2,554.94
|
| Rate for Payer: Frontpath All Commercial |
$2,553.55
|
| Rate for Payer: Humana ChoiceCare |
$2,397.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,498.04
|
| Rate for Payer: PHCS All Commercial |
$2,081.70
|
| Rate for Payer: PHP All Commercial |
$2,105.02
|
| Rate for Payer: Sagamore Health Network All Products |
$2,142.76
|
| Rate for Payer: Signature Care EPO |
$2,303.75
|
| Rate for Payer: Signature Care PPO |
$2,442.53
|
| Rate for Payer: United Healthcare Commercial |
$2,187.17
|
|
|
HC W ALMTRX RCS 12 ML
|
Facility
|
OP
|
$3,596.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,344.65 |
| Rate for Payer: Aetna Commercial |
$3,035.36
|
| Rate for Payer: Aetna Medicare |
$1,186.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,186.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,065.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,248.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,364.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,305.49
|
| Rate for Payer: Cash Price |
$2,229.77
|
| Rate for Payer: Cash Price |
$2,229.77
|
| Rate for Payer: Centivo All Commercial |
$1,834.16
|
| Rate for Payer: Cigna All Commercial |
$3,103.69
|
| Rate for Payer: CORVEL All Commercial |
$3,344.65
|
| Rate for Payer: Coventry All Commercial |
$3,164.83
|
| Rate for Payer: Encore All Commercial |
$3,310.49
|
| Rate for Payer: Frontpath All Commercial |
$3,308.69
|
| Rate for Payer: Humana ChoiceCare |
$3,106.21
|
| Rate for Payer: Humana Medicare |
$1,834.16
|
| Rate for Payer: Lucent All Commercial |
$1,834.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,236.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,697.30
|
| Rate for Payer: PHP All Commercial |
$2,727.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,402.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,776.42
|
| Rate for Payer: Signature Care EPO |
$2,985.01
|
| Rate for Payer: Signature Care PPO |
$3,164.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,056.94
|
| Rate for Payer: United Healthcare Commercial |
$2,833.96
|
| Rate for Payer: United Healthcare Medicare |
$1,186.81
|
|
|
HC W ALMTRX RCS 12 ML
|
Facility
|
IP
|
$3,596.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,697.30 |
| Max. Negotiated Rate |
$3,344.65 |
| Rate for Payer: Aetna Commercial |
$3,107.29
|
| Rate for Payer: Cash Price |
$2,229.77
|
| Rate for Payer: Cigna All Commercial |
$3,103.69
|
| Rate for Payer: CORVEL All Commercial |
$3,344.65
|
| Rate for Payer: Coventry All Commercial |
$3,164.83
|
| Rate for Payer: Encore All Commercial |
$3,310.49
|
| Rate for Payer: Frontpath All Commercial |
$3,308.69
|
| Rate for Payer: Humana ChoiceCare |
$3,106.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,236.76
|
| Rate for Payer: PHCS All Commercial |
$2,697.30
|
| Rate for Payer: PHP All Commercial |
$2,727.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,776.42
|
| Rate for Payer: Signature Care EPO |
$2,985.01
|
| Rate for Payer: Signature Care PPO |
$3,164.83
|
| Rate for Payer: United Healthcare Commercial |
$2,833.96
|
|
|
HC W ALMTRX RCS 7 ML
|
Facility
|
OP
|
$2,937.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,731.97 |
| Rate for Payer: Aetna Commercial |
$2,479.33
|
| Rate for Payer: Aetna Medicare |
$969.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$969.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,687.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,836.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,114.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,066.35
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Centivo All Commercial |
$1,498.18
|
| Rate for Payer: Cigna All Commercial |
$2,535.15
|
| Rate for Payer: CORVEL All Commercial |
$2,731.97
|
| Rate for Payer: Coventry All Commercial |
$2,585.09
|
| Rate for Payer: Encore All Commercial |
$2,704.06
|
| Rate for Payer: Frontpath All Commercial |
$2,702.59
|
| Rate for Payer: Humana ChoiceCare |
$2,537.21
|
| Rate for Payer: Humana Medicare |
$1,498.18
|
| Rate for Payer: Lucent All Commercial |
$1,498.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,643.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,203.20
|
| Rate for Payer: PHP All Commercial |
$2,227.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,145.66
|
| Rate for Payer: Sagamore Health Network All Products |
$2,267.83
|
| Rate for Payer: Signature Care EPO |
$2,438.21
|
| Rate for Payer: Signature Care PPO |
$2,585.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,496.96
|
| Rate for Payer: United Healthcare Commercial |
$2,314.83
|
| Rate for Payer: United Healthcare Medicare |
$969.41
|
|
|
HC W ALMTRX RCS 7 ML
|
Facility
|
IP
|
$2,937.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.20 |
| Max. Negotiated Rate |
$2,731.97 |
| Rate for Payer: Aetna Commercial |
$2,538.09
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cigna All Commercial |
$2,535.15
|
| Rate for Payer: CORVEL All Commercial |
$2,731.97
|
| Rate for Payer: Coventry All Commercial |
$2,585.09
|
| Rate for Payer: Encore All Commercial |
$2,704.06
|
| Rate for Payer: Frontpath All Commercial |
$2,702.59
|
| Rate for Payer: Humana ChoiceCare |
$2,537.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,643.84
|
| Rate for Payer: PHCS All Commercial |
$2,203.20
|
| Rate for Payer: PHP All Commercial |
$2,227.88
|
| Rate for Payer: Sagamore Health Network All Products |
$2,267.83
|
| Rate for Payer: Signature Care EPO |
$2,438.21
|
| Rate for Payer: Signature Care PPO |
$2,585.09
|
| Rate for Payer: United Healthcare Commercial |
$2,314.83
|
|
|
HC W ANCHOR INST KIT
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
41605874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
|
|
HC W ANCHOR INST KIT
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
41605874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC WAND RF SABER 30
|
Facility
|
OP
|
$2,455.00
|
|
| Hospital Charge Code |
41601259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,283.15 |
| Rate for Payer: Aetna Commercial |
$2,072.02
|
| Rate for Payer: Aetna Medicare |
$810.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$810.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,409.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,534.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$931.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$891.16
|
| Rate for Payer: Cash Price |
$1,522.10
|
| Rate for Payer: Cash Price |
$1,522.10
|
| Rate for Payer: Centivo All Commercial |
$1,252.05
|
| Rate for Payer: Cigna All Commercial |
$2,118.66
|
| Rate for Payer: CORVEL All Commercial |
$2,283.15
|
| Rate for Payer: Coventry All Commercial |
$2,160.40
|
| Rate for Payer: Encore All Commercial |
$2,259.83
|
| Rate for Payer: Frontpath All Commercial |
$2,258.60
|
| Rate for Payer: Humana ChoiceCare |
$2,120.38
|
| Rate for Payer: Humana Medicare |
$1,252.05
|
| Rate for Payer: Lucent All Commercial |
$1,252.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,209.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,841.25
|
| Rate for Payer: PHP All Commercial |
$1,861.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$957.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1,895.26
|
| Rate for Payer: Signature Care EPO |
$2,037.65
|
| Rate for Payer: Signature Care PPO |
$2,160.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,086.75
|
| Rate for Payer: United Healthcare Commercial |
$1,934.54
|
| Rate for Payer: United Healthcare Medicare |
$810.15
|
|
|
HC WAND RF SABER 30
|
Facility
|
IP
|
$2,455.00
|
|
| Hospital Charge Code |
41601259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.25 |
| Max. Negotiated Rate |
$2,283.15 |
| Rate for Payer: Aetna Commercial |
$2,121.12
|
| Rate for Payer: Cash Price |
$1,522.10
|
| Rate for Payer: Cigna All Commercial |
$2,118.66
|
| Rate for Payer: CORVEL All Commercial |
$2,283.15
|
| Rate for Payer: Coventry All Commercial |
$2,160.40
|
| Rate for Payer: Encore All Commercial |
$2,259.83
|
| Rate for Payer: Frontpath All Commercial |
$2,258.60
|
| Rate for Payer: Humana ChoiceCare |
$2,120.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,209.50
|
| Rate for Payer: PHCS All Commercial |
$1,841.25
|
| Rate for Payer: PHP All Commercial |
$1,861.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,895.26
|
| Rate for Payer: Signature Care EPO |
$2,037.65
|
| Rate for Payer: Signature Care PPO |
$2,160.40
|
| Rate for Payer: United Healthcare Commercial |
$1,934.54
|
|
|
HC WAND RF STAR VAC 50
|
Facility
|
IP
|
$1,095.00
|
|
| Hospital Charge Code |
41601260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.25 |
| Max. Negotiated Rate |
$1,018.35 |
| Rate for Payer: Aetna Commercial |
$946.08
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna All Commercial |
$944.98
|
| Rate for Payer: CORVEL All Commercial |
$1,018.35
|
| Rate for Payer: Coventry All Commercial |
$963.60
|
| Rate for Payer: Encore All Commercial |
$1,007.95
|
| Rate for Payer: Frontpath All Commercial |
$1,007.40
|
| Rate for Payer: Humana ChoiceCare |
$945.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.50
|
| Rate for Payer: PHCS All Commercial |
$821.25
|
| Rate for Payer: PHP All Commercial |
$830.45
|
| Rate for Payer: Sagamore Health Network All Products |
$845.34
|
| Rate for Payer: Signature Care EPO |
$908.85
|
| Rate for Payer: Signature Care PPO |
$963.60
|
| Rate for Payer: United Healthcare Commercial |
$862.86
|
|
|
HC WAND RF STAR VAC 50
|
Facility
|
OP
|
$1,095.00
|
|
| Hospital Charge Code |
41601260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,018.35 |
| Rate for Payer: Aetna Commercial |
$924.18
|
| Rate for Payer: Aetna Medicare |
$361.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$628.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$415.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$397.48
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Centivo All Commercial |
$558.45
|
| Rate for Payer: Cigna All Commercial |
$944.98
|
| Rate for Payer: CORVEL All Commercial |
$1,018.35
|
| Rate for Payer: Coventry All Commercial |
$963.60
|
| Rate for Payer: Encore All Commercial |
$1,007.95
|
| Rate for Payer: Frontpath All Commercial |
$1,007.40
|
| Rate for Payer: Humana ChoiceCare |
$945.75
|
| Rate for Payer: Humana Medicare |
$558.45
|
| Rate for Payer: Lucent All Commercial |
$558.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$821.25
|
| Rate for Payer: PHP All Commercial |
$830.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.05
|
| Rate for Payer: Sagamore Health Network All Products |
$845.34
|
| Rate for Payer: Signature Care EPO |
$908.85
|
| Rate for Payer: Signature Care PPO |
$963.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.75
|
| Rate for Payer: United Healthcare Commercial |
$862.86
|
| Rate for Payer: United Healthcare Medicare |
$361.35
|
|
|
HC WAND RF STAR VAC 90
|
Facility
|
OP
|
$1,095.00
|
|
| Hospital Charge Code |
41601261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,018.35 |
| Rate for Payer: Aetna Commercial |
$924.18
|
| Rate for Payer: Aetna Medicare |
$361.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$628.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$415.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$397.48
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Centivo All Commercial |
$558.45
|
| Rate for Payer: Cigna All Commercial |
$944.98
|
| Rate for Payer: CORVEL All Commercial |
$1,018.35
|
| Rate for Payer: Coventry All Commercial |
$963.60
|
| Rate for Payer: Encore All Commercial |
$1,007.95
|
| Rate for Payer: Frontpath All Commercial |
$1,007.40
|
| Rate for Payer: Humana ChoiceCare |
$945.75
|
| Rate for Payer: Humana Medicare |
$558.45
|
| Rate for Payer: Lucent All Commercial |
$558.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$821.25
|
| Rate for Payer: PHP All Commercial |
$830.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.05
|
| Rate for Payer: Sagamore Health Network All Products |
$845.34
|
| Rate for Payer: Signature Care EPO |
$908.85
|
| Rate for Payer: Signature Care PPO |
$963.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.75
|
| Rate for Payer: United Healthcare Commercial |
$862.86
|
| Rate for Payer: United Healthcare Medicare |
$361.35
|
|
|
HC WAND RF STAR VAC 90
|
Facility
|
IP
|
$1,095.00
|
|
| Hospital Charge Code |
41601261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.25 |
| Max. Negotiated Rate |
$1,018.35 |
| Rate for Payer: Aetna Commercial |
$946.08
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna All Commercial |
$944.98
|
| Rate for Payer: CORVEL All Commercial |
$1,018.35
|
| Rate for Payer: Coventry All Commercial |
$963.60
|
| Rate for Payer: Encore All Commercial |
$1,007.95
|
| Rate for Payer: Frontpath All Commercial |
$1,007.40
|
| Rate for Payer: Humana ChoiceCare |
$945.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.50
|
| Rate for Payer: PHCS All Commercial |
$821.25
|
| Rate for Payer: PHP All Commercial |
$830.45
|
| Rate for Payer: Sagamore Health Network All Products |
$845.34
|
| Rate for Payer: Signature Care EPO |
$908.85
|
| Rate for Payer: Signature Care PPO |
$963.60
|
| Rate for Payer: United Healthcare Commercial |
$862.86
|
|
|
HC WAND SERFAS ENERGY 50-S
|
Facility
|
OP
|
$786.05
|
|
| Hospital Charge Code |
41602628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$731.03 |
| Rate for Payer: Aetna Commercial |
$663.43
|
| Rate for Payer: Aetna Medicare |
$259.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$259.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$451.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$491.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$298.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$285.34
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Centivo All Commercial |
$400.89
|
| Rate for Payer: Cigna All Commercial |
$678.36
|
| Rate for Payer: CORVEL All Commercial |
$731.03
|
| Rate for Payer: Coventry All Commercial |
$691.72
|
| Rate for Payer: Encore All Commercial |
$723.56
|
| Rate for Payer: Frontpath All Commercial |
$723.17
|
| Rate for Payer: Humana ChoiceCare |
$678.91
|
| Rate for Payer: Humana Medicare |
$400.89
|
| Rate for Payer: Lucent All Commercial |
$400.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$707.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$589.54
|
| Rate for Payer: PHP All Commercial |
$596.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.56
|
| Rate for Payer: Sagamore Health Network All Products |
$606.83
|
| Rate for Payer: Signature Care EPO |
$652.42
|
| Rate for Payer: Signature Care PPO |
$691.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$668.14
|
| Rate for Payer: United Healthcare Commercial |
$619.41
|
| Rate for Payer: United Healthcare Medicare |
$259.40
|
|
|
HC WAND SERFAS ENERGY 50-S
|
Facility
|
IP
|
$786.05
|
|
| Hospital Charge Code |
41602628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.54 |
| Max. Negotiated Rate |
$731.03 |
| Rate for Payer: Aetna Commercial |
$679.15
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cigna All Commercial |
$678.36
|
| Rate for Payer: CORVEL All Commercial |
$731.03
|
| Rate for Payer: Coventry All Commercial |
$691.72
|
| Rate for Payer: Encore All Commercial |
$723.56
|
| Rate for Payer: Frontpath All Commercial |
$723.17
|
| Rate for Payer: Humana ChoiceCare |
$678.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$707.44
|
| Rate for Payer: PHCS All Commercial |
$589.54
|
| Rate for Payer: PHP All Commercial |
$596.14
|
| Rate for Payer: Sagamore Health Network All Products |
$606.83
|
| Rate for Payer: Signature Care EPO |
$652.42
|
| Rate for Payer: Signature Care PPO |
$691.72
|
| Rate for Payer: United Healthcare Commercial |
$619.41
|
|
|
HC WAND SERFAS ENERGY 50-S SWEEP
|
Facility
|
IP
|
$1,812.20
|
|
| Hospital Charge Code |
41606316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,359.15 |
| Max. Negotiated Rate |
$1,685.35 |
| Rate for Payer: Aetna Commercial |
$1,565.74
|
| Rate for Payer: Cash Price |
$1,123.56
|
| Rate for Payer: Cigna All Commercial |
$1,563.93
|
| Rate for Payer: CORVEL All Commercial |
$1,685.35
|
| Rate for Payer: Coventry All Commercial |
$1,594.74
|
| Rate for Payer: Encore All Commercial |
$1,668.13
|
| Rate for Payer: Frontpath All Commercial |
$1,667.22
|
| Rate for Payer: Humana ChoiceCare |
$1,565.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,630.98
|
| Rate for Payer: PHCS All Commercial |
$1,359.15
|
| Rate for Payer: PHP All Commercial |
$1,374.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,399.02
|
| Rate for Payer: Signature Care EPO |
$1,504.13
|
| Rate for Payer: Signature Care PPO |
$1,594.74
|
| Rate for Payer: United Healthcare Commercial |
$1,428.01
|
|
|
HC WAND SERFAS ENERGY 50-S SWEEP
|
Facility
|
OP
|
$1,812.20
|
|
| Hospital Charge Code |
41606316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,685.35 |
| Rate for Payer: Aetna Commercial |
$1,529.50
|
| Rate for Payer: Aetna Medicare |
$598.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$598.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,040.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,132.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$687.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$657.83
|
| Rate for Payer: Cash Price |
$1,123.56
|
| Rate for Payer: Cash Price |
$1,123.56
|
| Rate for Payer: Centivo All Commercial |
$924.22
|
| Rate for Payer: Cigna All Commercial |
$1,563.93
|
| Rate for Payer: CORVEL All Commercial |
$1,685.35
|
| Rate for Payer: Coventry All Commercial |
$1,594.74
|
| Rate for Payer: Encore All Commercial |
$1,668.13
|
| Rate for Payer: Frontpath All Commercial |
$1,667.22
|
| Rate for Payer: Humana ChoiceCare |
$1,565.20
|
| Rate for Payer: Humana Medicare |
$924.22
|
| Rate for Payer: Lucent All Commercial |
$924.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,630.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,359.15
|
| Rate for Payer: PHP All Commercial |
$1,374.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$706.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,399.02
|
| Rate for Payer: Signature Care EPO |
$1,504.13
|
| Rate for Payer: Signature Care PPO |
$1,594.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,540.37
|
| Rate for Payer: United Healthcare Commercial |
$1,428.01
|
| Rate for Payer: United Healthcare Medicare |
$598.03
|
|
|
HC WAND SERFAS ENERGY 90-S
|
Facility
|
OP
|
$870.45
|
|
| Hospital Charge Code |
41602567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$809.52 |
| Rate for Payer: Aetna Commercial |
$734.66
|
| Rate for Payer: Aetna Medicare |
$287.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$287.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$499.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$544.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$330.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$315.97
|
| Rate for Payer: Cash Price |
$539.68
|
| Rate for Payer: Cash Price |
$539.68
|
| Rate for Payer: Centivo All Commercial |
$443.93
|
| Rate for Payer: Cigna All Commercial |
$751.20
|
| Rate for Payer: CORVEL All Commercial |
$809.52
|
| Rate for Payer: Coventry All Commercial |
$766.00
|
| Rate for Payer: Encore All Commercial |
$801.25
|
| Rate for Payer: Frontpath All Commercial |
$800.81
|
| Rate for Payer: Humana ChoiceCare |
$751.81
|
| Rate for Payer: Humana Medicare |
$443.93
|
| Rate for Payer: Lucent All Commercial |
$443.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$783.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$652.84
|
| Rate for Payer: PHP All Commercial |
$660.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.48
|
| Rate for Payer: Sagamore Health Network All Products |
$671.99
|
| Rate for Payer: Signature Care EPO |
$722.47
|
| Rate for Payer: Signature Care PPO |
$766.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$739.88
|
| Rate for Payer: United Healthcare Commercial |
$685.91
|
| Rate for Payer: United Healthcare Medicare |
$287.25
|
|
