|
HC W PLATE 0DG MTP MED L
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
|
HC W PLATE 0DG MTP MED R
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.25
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Centivo All Commercial |
$2,496.96
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$2,496.96
|
| Rate for Payer: Lucent All Commercial |
$2,496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,615.68
|
|
|
HC W PLATE 0DG MTP MED R
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
|
HC W PLATE 0DG MTP SM L
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.25
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Centivo All Commercial |
$2,496.96
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$2,496.96
|
| Rate for Payer: Lucent All Commercial |
$2,496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,615.68
|
|
|
HC W PLATE 0DG MTP SM L
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
|
HC W PLATE 0DG MTP SM R
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
|
HC W PLATE 0DG MTP SM R
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.25
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Centivo All Commercial |
$2,496.96
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$2,496.96
|
| Rate for Payer: Lucent All Commercial |
$2,496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,615.68
|
|
|
HC W PLATE 0 EVANS OPN WEDGE
|
Facility
OP
|
$5,695.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,296.54 |
| Rate for Payer: Aetna Commercial |
$4,806.75
|
| Rate for Payer: Aetna Medicare |
$1,879.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,879.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,270.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,560.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,161.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,067.36
|
| Rate for Payer: Cash Price |
$3,531.02
|
| Rate for Payer: Cash Price |
$3,531.02
|
| Rate for Payer: Centivo All Commercial |
$2,904.55
|
| Rate for Payer: Cigna All Commercial |
$4,914.96
|
| Rate for Payer: CORVEL All Commercial |
$5,296.54
|
| Rate for Payer: Coventry All Commercial |
$5,011.78
|
| Rate for Payer: Encore All Commercial |
$5,242.43
|
| Rate for Payer: Frontpath All Commercial |
$5,239.58
|
| Rate for Payer: Humana ChoiceCare |
$4,918.94
|
| Rate for Payer: Humana Medicare |
$2,904.55
|
| Rate for Payer: Lucent All Commercial |
$2,904.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,125.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,271.40
|
| Rate for Payer: PHP All Commercial |
$4,319.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,221.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4,396.69
|
| Rate for Payer: Signature Care EPO |
$4,727.02
|
| Rate for Payer: Signature Care PPO |
$5,011.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,840.92
|
| Rate for Payer: United Healthcare Commercial |
$4,487.82
|
| Rate for Payer: United Healthcare Medicare |
$1,879.42
|
|
|
HC W PLATE 0 EVANS OPN WEDGE
|
Facility
IP
|
$5,695.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,271.40 |
| Max. Negotiated Rate |
$5,296.54 |
| Rate for Payer: Aetna Commercial |
$4,920.65
|
| Rate for Payer: Cash Price |
$3,531.02
|
| Rate for Payer: Cigna All Commercial |
$4,914.96
|
| Rate for Payer: CORVEL All Commercial |
$5,296.54
|
| Rate for Payer: Coventry All Commercial |
$5,011.78
|
| Rate for Payer: Encore All Commercial |
$5,242.43
|
| Rate for Payer: Frontpath All Commercial |
$5,239.58
|
| Rate for Payer: Humana ChoiceCare |
$4,918.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,125.68
|
| Rate for Payer: PHCS All Commercial |
$4,271.40
|
| Rate for Payer: PHP All Commercial |
$4,319.24
|
| Rate for Payer: Sagamore Health Network All Products |
$4,396.69
|
| Rate for Payer: Signature Care EPO |
$4,727.02
|
| Rate for Payer: Signature Care PPO |
$5,011.78
|
| Rate for Payer: United Healthcare Commercial |
$4,487.82
|
|
|
HC W PLATE 0 LAPIDUS
|
Facility
OP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,507.46 |
| Rate for Payer: Aetna Commercial |
$4,998.17
|
| Rate for Payer: Aetna Medicare |
$1,954.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,954.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,401.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,701.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,247.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.69
|
| Rate for Payer: Cash Price |
$3,671.64
|
| Rate for Payer: Cash Price |
$3,671.64
|
| Rate for Payer: Centivo All Commercial |
$3,020.22
|
| Rate for Payer: Cigna All Commercial |
$5,110.69
|
| Rate for Payer: CORVEL All Commercial |
$5,507.46
|
| Rate for Payer: Coventry All Commercial |
$5,211.36
|
| Rate for Payer: Encore All Commercial |
$5,451.20
|
| Rate for Payer: Frontpath All Commercial |
$5,448.24
|
| Rate for Payer: Humana ChoiceCare |
$5,114.83
|
| Rate for Payer: Humana Medicare |
$3,020.22
|
| Rate for Payer: Lucent All Commercial |
$3,020.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,441.50
|
| Rate for Payer: PHP All Commercial |
$4,491.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,309.58
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.78
|
| Rate for Payer: Signature Care EPO |
$4,915.26
|
| Rate for Payer: Signature Care PPO |
$5,211.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,033.70
|
| Rate for Payer: United Healthcare Commercial |
$4,666.54
|
| Rate for Payer: United Healthcare Medicare |
$1,954.26
|
|
|
HC W PLATE 0 LAPIDUS
|
Facility
IP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.50 |
| Max. Negotiated Rate |
$5,507.46 |
| Rate for Payer: Aetna Commercial |
$5,116.61
|
| Rate for Payer: Cash Price |
$3,671.64
|
| Rate for Payer: Cigna All Commercial |
$5,110.69
|
| Rate for Payer: CORVEL All Commercial |
$5,507.46
|
| Rate for Payer: Coventry All Commercial |
$5,211.36
|
| Rate for Payer: Encore All Commercial |
$5,451.20
|
| Rate for Payer: Frontpath All Commercial |
$5,448.24
|
| Rate for Payer: Humana ChoiceCare |
$5,114.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,329.80
|
| Rate for Payer: PHCS All Commercial |
$4,441.50
|
| Rate for Payer: PHP All Commercial |
$4,491.24
|
| Rate for Payer: Sagamore Health Network All Products |
$4,571.78
|
| Rate for Payer: Signature Care EPO |
$4,915.26
|
| Rate for Payer: Signature Care PPO |
$5,211.36
|
| Rate for Payer: United Healthcare Commercial |
$4,666.54
|
|
|
HC W PLATE 0 LAP L
|
Facility
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,201.37
|
| Rate for Payer: Aetna Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,219.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,592.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,788.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,667.18
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Centivo All Commercial |
$3,747.28
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Humana Medicare |
$3,747.28
|
| Rate for Payer: Lucent All Commercial |
$3,747.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,865.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,245.46
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
| Rate for Payer: United Healthcare Medicare |
$2,424.71
|
|
|
HC W PLATE 0 LAP L
|
Facility
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.70 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,348.33
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
|
|
HC W PLATE 0 LAP R
|
Facility
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,201.37
|
| Rate for Payer: Aetna Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,219.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,592.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,788.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,667.18
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Centivo All Commercial |
$3,747.28
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Humana Medicare |
$3,747.28
|
| Rate for Payer: Lucent All Commercial |
$3,747.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,865.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,245.46
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
| Rate for Payer: United Healthcare Medicare |
$2,424.71
|
|
|
HC W PLATE 0 LAP R
|
Facility
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.70 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,348.33
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
|
|
HC W PLATE 101MM LT FIB L
|
Facility
IP
|
$5,529.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,147.20 |
| Max. Negotiated Rate |
$5,142.53 |
| Rate for Payer: Aetna Commercial |
$4,777.57
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Cigna All Commercial |
$4,772.04
|
| Rate for Payer: CORVEL All Commercial |
$5,142.53
|
| Rate for Payer: Coventry All Commercial |
$4,866.05
|
| Rate for Payer: Encore All Commercial |
$5,090.00
|
| Rate for Payer: Frontpath All Commercial |
$5,087.23
|
| Rate for Payer: Humana ChoiceCare |
$4,775.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,976.64
|
| Rate for Payer: PHCS All Commercial |
$4,147.20
|
| Rate for Payer: PHP All Commercial |
$4,193.65
|
| Rate for Payer: Sagamore Health Network All Products |
$4,268.85
|
| Rate for Payer: Signature Care EPO |
$4,589.57
|
| Rate for Payer: Signature Care PPO |
$4,866.05
|
| Rate for Payer: United Healthcare Commercial |
$4,357.32
|
|
|
HC W PLATE 101MM LT FIB L
|
Facility
OP
|
$5,529.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,142.53 |
| Rate for Payer: Aetna Commercial |
$4,666.98
|
| Rate for Payer: Aetna Medicare |
$1,824.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,824.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,175.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,456.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,098.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,007.24
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Centivo All Commercial |
$2,820.10
|
| Rate for Payer: Cigna All Commercial |
$4,772.04
|
| Rate for Payer: CORVEL All Commercial |
$5,142.53
|
| Rate for Payer: Coventry All Commercial |
$4,866.05
|
| Rate for Payer: Encore All Commercial |
$5,090.00
|
| Rate for Payer: Frontpath All Commercial |
$5,087.23
|
| Rate for Payer: Humana ChoiceCare |
$4,775.92
|
| Rate for Payer: Humana Medicare |
$2,820.10
|
| Rate for Payer: Lucent All Commercial |
$2,820.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,976.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,147.20
|
| Rate for Payer: PHP All Commercial |
$4,193.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,156.54
|
| Rate for Payer: Sagamore Health Network All Products |
$4,268.85
|
| Rate for Payer: Signature Care EPO |
$4,589.57
|
| Rate for Payer: Signature Care PPO |
$4,866.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.16
|
| Rate for Payer: United Healthcare Commercial |
$4,357.32
|
| Rate for Payer: United Healthcare Medicare |
$1,824.77
|
|
|
HC W PLATE 101MM LT FIB R
|
Facility
OP
|
$5,529.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,142.53 |
| Rate for Payer: Aetna Commercial |
$4,666.98
|
| Rate for Payer: Aetna Medicare |
$1,824.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,824.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,175.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,456.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,098.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,007.24
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Centivo All Commercial |
$2,820.10
|
| Rate for Payer: Cigna All Commercial |
$4,772.04
|
| Rate for Payer: CORVEL All Commercial |
$5,142.53
|
| Rate for Payer: Coventry All Commercial |
$4,866.05
|
| Rate for Payer: Encore All Commercial |
$5,090.00
|
| Rate for Payer: Frontpath All Commercial |
$5,087.23
|
| Rate for Payer: Humana ChoiceCare |
$4,775.92
|
| Rate for Payer: Humana Medicare |
$2,820.10
|
| Rate for Payer: Lucent All Commercial |
$2,820.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,976.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,147.20
|
| Rate for Payer: PHP All Commercial |
$4,193.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,156.54
|
| Rate for Payer: Sagamore Health Network All Products |
$4,268.85
|
| Rate for Payer: Signature Care EPO |
$4,589.57
|
| Rate for Payer: Signature Care PPO |
$4,866.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.16
|
| Rate for Payer: United Healthcare Commercial |
$4,357.32
|
| Rate for Payer: United Healthcare Medicare |
$1,824.77
|
|
|
HC W PLATE 101MM LT FIB R
|
Facility
IP
|
$5,529.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,147.20 |
| Max. Negotiated Rate |
$5,142.53 |
| Rate for Payer: Aetna Commercial |
$4,777.57
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Cigna All Commercial |
$4,772.04
|
| Rate for Payer: CORVEL All Commercial |
$5,142.53
|
| Rate for Payer: Coventry All Commercial |
$4,866.05
|
| Rate for Payer: Encore All Commercial |
$5,090.00
|
| Rate for Payer: Frontpath All Commercial |
$5,087.23
|
| Rate for Payer: Humana ChoiceCare |
$4,775.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,976.64
|
| Rate for Payer: PHCS All Commercial |
$4,147.20
|
| Rate for Payer: PHP All Commercial |
$4,193.65
|
| Rate for Payer: Sagamore Health Network All Products |
$4,268.85
|
| Rate for Payer: Signature Care EPO |
$4,589.57
|
| Rate for Payer: Signature Care PPO |
$4,866.05
|
| Rate for Payer: United Healthcare Commercial |
$4,357.32
|
|
|
HC W PLATE 101MM OFFSET LAT FIB L
|
Facility
IP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.40 |
| Max. Negotiated Rate |
$5,363.50 |
| Rate for Payer: Aetna Commercial |
$4,982.86
|
| Rate for Payer: Cash Price |
$3,575.66
|
| Rate for Payer: Cigna All Commercial |
$4,977.09
|
| Rate for Payer: CORVEL All Commercial |
$5,363.50
|
| Rate for Payer: Coventry All Commercial |
$5,075.14
|
| Rate for Payer: Encore All Commercial |
$5,308.71
|
| Rate for Payer: Frontpath All Commercial |
$5,305.82
|
| Rate for Payer: Humana ChoiceCare |
$4,981.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,190.48
|
| Rate for Payer: PHCS All Commercial |
$4,325.40
|
| Rate for Payer: PHP All Commercial |
$4,373.84
|
| Rate for Payer: Sagamore Health Network All Products |
$4,452.28
|
| Rate for Payer: Signature Care EPO |
$4,786.78
|
| Rate for Payer: Signature Care PPO |
$5,075.14
|
| Rate for Payer: United Healthcare Commercial |
$4,544.55
|
|
|
HC W PLATE 101MM OFFSET LAT FIB L
|
Facility
OP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,363.50 |
| Rate for Payer: Aetna Commercial |
$4,867.52
|
| Rate for Payer: Aetna Medicare |
$1,903.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,903.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,312.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,605.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,188.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,093.49
|
| Rate for Payer: Cash Price |
$3,575.66
|
| Rate for Payer: Cash Price |
$3,575.66
|
| Rate for Payer: Centivo All Commercial |
$2,941.27
|
| Rate for Payer: Cigna All Commercial |
$4,977.09
|
| Rate for Payer: CORVEL All Commercial |
$5,363.50
|
| Rate for Payer: Coventry All Commercial |
$5,075.14
|
| Rate for Payer: Encore All Commercial |
$5,308.71
|
| Rate for Payer: Frontpath All Commercial |
$5,305.82
|
| Rate for Payer: Humana ChoiceCare |
$4,981.13
|
| Rate for Payer: Humana Medicare |
$2,941.27
|
| Rate for Payer: Lucent All Commercial |
$2,941.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,190.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,325.40
|
| Rate for Payer: PHP All Commercial |
$4,373.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,249.21
|
| Rate for Payer: Sagamore Health Network All Products |
$4,452.28
|
| Rate for Payer: Signature Care EPO |
$4,786.78
|
| Rate for Payer: Signature Care PPO |
$5,075.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,902.12
|
| Rate for Payer: United Healthcare Commercial |
$4,544.55
|
| Rate for Payer: United Healthcare Medicare |
$1,903.18
|
|
|
HC W PLATE 101MM OFFSET LAT FIB R
|
Facility
IP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.40 |
| Max. Negotiated Rate |
$5,363.50 |
| Rate for Payer: Aetna Commercial |
$4,982.86
|
| Rate for Payer: Cash Price |
$3,575.66
|
| Rate for Payer: Cigna All Commercial |
$4,977.09
|
| Rate for Payer: CORVEL All Commercial |
$5,363.50
|
| Rate for Payer: Coventry All Commercial |
$5,075.14
|
| Rate for Payer: Encore All Commercial |
$5,308.71
|
| Rate for Payer: Frontpath All Commercial |
$5,305.82
|
| Rate for Payer: Humana ChoiceCare |
$4,981.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,190.48
|
| Rate for Payer: PHCS All Commercial |
$4,325.40
|
| Rate for Payer: PHP All Commercial |
$4,373.84
|
| Rate for Payer: Sagamore Health Network All Products |
$4,452.28
|
| Rate for Payer: Signature Care EPO |
$4,786.78
|
| Rate for Payer: Signature Care PPO |
$5,075.14
|
| Rate for Payer: United Healthcare Commercial |
$4,544.55
|
|
|
HC W PLATE 101MM OFFSET LAT FIB R
|
Facility
OP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,363.50 |
| Rate for Payer: Aetna Commercial |
$4,867.52
|
| Rate for Payer: Aetna Medicare |
$1,903.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,903.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,312.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,605.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,188.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,093.49
|
| Rate for Payer: Cash Price |
$3,575.66
|
| Rate for Payer: Cash Price |
$3,575.66
|
| Rate for Payer: Centivo All Commercial |
$2,941.27
|
| Rate for Payer: Cigna All Commercial |
$4,977.09
|
| Rate for Payer: CORVEL All Commercial |
$5,363.50
|
| Rate for Payer: Coventry All Commercial |
$5,075.14
|
| Rate for Payer: Encore All Commercial |
$5,308.71
|
| Rate for Payer: Frontpath All Commercial |
$5,305.82
|
| Rate for Payer: Humana ChoiceCare |
$4,981.13
|
| Rate for Payer: Humana Medicare |
$2,941.27
|
| Rate for Payer: Lucent All Commercial |
$2,941.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,190.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,325.40
|
| Rate for Payer: PHP All Commercial |
$4,373.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,249.21
|
| Rate for Payer: Sagamore Health Network All Products |
$4,452.28
|
| Rate for Payer: Signature Care EPO |
$4,786.78
|
| Rate for Payer: Signature Care PPO |
$5,075.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,902.12
|
| Rate for Payer: United Healthcare Commercial |
$4,544.55
|
| Rate for Payer: United Healthcare Medicare |
$1,903.18
|
|
|
HC W PLATE 10DG MTP MED L
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,132.22
|
| Rate for Payer: Aetna Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,615.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,811.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,060.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.25
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Centivo All Commercial |
$2,496.96
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Humana Medicare |
$2,496.96
|
| Rate for Payer: Lucent All Commercial |
$2,496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,909.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
| Rate for Payer: United Healthcare Medicare |
$1,615.68
|
|
|
HC W PLATE 10DG MTP MED L
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$4,230.14
|
| Rate for Payer: Cash Price |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,225.25
|
| Rate for Payer: CORVEL All Commercial |
$4,553.28
|
| Rate for Payer: Coventry All Commercial |
$4,308.48
|
| Rate for Payer: Encore All Commercial |
$4,506.77
|
| Rate for Payer: Frontpath All Commercial |
$4,504.32
|
| Rate for Payer: Humana ChoiceCare |
$4,228.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,406.40
|
| Rate for Payer: PHCS All Commercial |
$3,672.00
|
| Rate for Payer: PHP All Commercial |
$3,713.13
|
| Rate for Payer: Sagamore Health Network All Products |
$3,779.71
|
| Rate for Payer: Signature Care EPO |
$4,063.68
|
| Rate for Payer: Signature Care PPO |
$4,308.48
|
| Rate for Payer: United Healthcare Commercial |
$3,858.05
|
|
