|
HC W PLATE 10DG MTP MED R
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604969
|
|
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 R
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604969
|
|
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 10DG MTP SM L
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605127
|
|
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 10DG MTP SM L
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605127
|
|
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 SM R
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605128
|
|
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 10DG MTP SM R
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605128
|
|
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 10 EVANS OPN WEDGE
|
Facility
IP
|
$5,695.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605083
|
|
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 10 EVANS OPN WEDGE
|
Facility
OP
|
$5,695.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605083
|
|
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 10-H ST TUB
|
Facility
IP
|
$2,268.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.00 |
| Max. Negotiated Rate |
$2,109.24 |
| Rate for Payer: Aetna Commercial |
$1,959.55
|
| Rate for Payer: Cash Price |
$1,406.16
|
| Rate for Payer: Cigna All Commercial |
$1,957.28
|
| Rate for Payer: CORVEL All Commercial |
$2,109.24
|
| Rate for Payer: Coventry All Commercial |
$1,995.84
|
| Rate for Payer: Encore All Commercial |
$2,087.69
|
| Rate for Payer: Frontpath All Commercial |
$2,086.56
|
| Rate for Payer: Humana ChoiceCare |
$1,958.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,041.20
|
| Rate for Payer: PHCS All Commercial |
$1,701.00
|
| Rate for Payer: PHP All Commercial |
$1,720.05
|
| Rate for Payer: Sagamore Health Network All Products |
$1,750.90
|
| Rate for Payer: Signature Care EPO |
$1,882.44
|
| Rate for Payer: Signature Care PPO |
$1,995.84
|
| Rate for Payer: United Healthcare Commercial |
$1,787.18
|
|
|
HC W PLATE 10-H ST TUB
|
Facility
OP
|
$2,224.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,069.06 |
| Rate for Payer: Aetna Commercial |
$1,877.73
|
| Rate for Payer: Aetna Medicare |
$734.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$734.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,277.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,390.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$844.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$807.60
|
| Rate for Payer: Cash Price |
$1,379.38
|
| Rate for Payer: Cash Price |
$1,379.38
|
| Rate for Payer: Centivo All Commercial |
$1,134.65
|
| Rate for Payer: Cigna All Commercial |
$1,920.00
|
| Rate for Payer: CORVEL All Commercial |
$2,069.06
|
| Rate for Payer: Coventry All Commercial |
$1,957.82
|
| Rate for Payer: Encore All Commercial |
$2,047.93
|
| Rate for Payer: Frontpath All Commercial |
$2,046.82
|
| Rate for Payer: Humana ChoiceCare |
$1,921.56
|
| Rate for Payer: Humana Medicare |
$1,134.65
|
| Rate for Payer: Lucent All Commercial |
$1,134.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,668.60
|
| Rate for Payer: PHP All Commercial |
$1,687.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$867.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.55
|
| Rate for Payer: Signature Care EPO |
$1,846.58
|
| Rate for Payer: Signature Care PPO |
$1,957.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,891.08
|
| Rate for Payer: United Healthcare Commercial |
$1,753.14
|
| Rate for Payer: United Healthcare Medicare |
$734.18
|
|
|
HC W PLATE 10-H ST TUB
|
Facility
IP
|
$2,224.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.60 |
| Max. Negotiated Rate |
$2,069.06 |
| Rate for Payer: Aetna Commercial |
$1,922.23
|
| Rate for Payer: Cash Price |
$1,379.38
|
| Rate for Payer: Cigna All Commercial |
$1,920.00
|
| Rate for Payer: CORVEL All Commercial |
$2,069.06
|
| Rate for Payer: Coventry All Commercial |
$1,957.82
|
| Rate for Payer: Encore All Commercial |
$2,047.93
|
| Rate for Payer: Frontpath All Commercial |
$2,046.82
|
| Rate for Payer: Humana ChoiceCare |
$1,921.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,002.32
|
| Rate for Payer: PHCS All Commercial |
$1,668.60
|
| Rate for Payer: PHP All Commercial |
$1,687.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,717.55
|
| Rate for Payer: Signature Care EPO |
$1,846.58
|
| Rate for Payer: Signature Care PPO |
$1,957.82
|
| Rate for Payer: United Healthcare Commercial |
$1,753.14
|
|
|
HC W PLATE 10-H ST TUB
|
Facility
OP
|
$2,268.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,109.24 |
| Rate for Payer: Aetna Commercial |
$1,914.19
|
| Rate for Payer: Aetna Medicare |
$748.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$748.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,417.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$860.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$823.28
|
| Rate for Payer: Cash Price |
$1,406.16
|
| Rate for Payer: Cash Price |
$1,406.16
|
| Rate for Payer: Centivo All Commercial |
$1,156.68
|
| Rate for Payer: Cigna All Commercial |
$1,957.28
|
| Rate for Payer: CORVEL All Commercial |
$2,109.24
|
| Rate for Payer: Coventry All Commercial |
$1,995.84
|
| Rate for Payer: Encore All Commercial |
$2,087.69
|
| Rate for Payer: Frontpath All Commercial |
$2,086.56
|
| Rate for Payer: Humana ChoiceCare |
$1,958.87
|
| Rate for Payer: Humana Medicare |
$1,156.68
|
| Rate for Payer: Lucent All Commercial |
$1,156.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,041.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,701.00
|
| Rate for Payer: PHP All Commercial |
$1,720.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$884.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,750.90
|
| Rate for Payer: Signature Care EPO |
$1,882.44
|
| Rate for Payer: Signature Care PPO |
$1,995.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,927.80
|
| Rate for Payer: United Healthcare Commercial |
$1,787.18
|
| Rate for Payer: United Healthcare Medicare |
$748.44
|
|
|
HC W PLATE 113MM LT FIB L
|
Facility
IP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,239.00 |
| Max. Negotiated Rate |
$5,256.36 |
| Rate for Payer: Aetna Commercial |
$4,883.33
|
| Rate for Payer: Cash Price |
$3,504.24
|
| Rate for Payer: Cigna All Commercial |
$4,877.68
|
| Rate for Payer: CORVEL All Commercial |
$5,256.36
|
| Rate for Payer: Coventry All Commercial |
$4,973.76
|
| Rate for Payer: Encore All Commercial |
$5,202.67
|
| Rate for Payer: Frontpath All Commercial |
$5,199.84
|
| Rate for Payer: Humana ChoiceCare |
$4,881.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,086.80
|
| Rate for Payer: PHCS All Commercial |
$4,239.00
|
| Rate for Payer: PHP All Commercial |
$4,286.48
|
| Rate for Payer: Sagamore Health Network All Products |
$4,363.34
|
| Rate for Payer: Signature Care EPO |
$4,691.16
|
| Rate for Payer: Signature Care PPO |
$4,973.76
|
| Rate for Payer: United Healthcare Commercial |
$4,453.78
|
|
|
HC W PLATE 113MM LT FIB L
|
Facility
OP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,256.36 |
| Rate for Payer: Aetna Commercial |
$4,770.29
|
| Rate for Payer: Aetna Medicare |
$1,865.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,865.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,245.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,533.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,144.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,051.68
|
| Rate for Payer: Cash Price |
$3,504.24
|
| Rate for Payer: Cash Price |
$3,504.24
|
| Rate for Payer: Centivo All Commercial |
$2,882.52
|
| Rate for Payer: Cigna All Commercial |
$4,877.68
|
| Rate for Payer: CORVEL All Commercial |
$5,256.36
|
| Rate for Payer: Coventry All Commercial |
$4,973.76
|
| Rate for Payer: Encore All Commercial |
$5,202.67
|
| Rate for Payer: Frontpath All Commercial |
$5,199.84
|
| Rate for Payer: Humana ChoiceCare |
$4,881.63
|
| Rate for Payer: Humana Medicare |
$2,882.52
|
| Rate for Payer: Lucent All Commercial |
$2,882.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,086.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,239.00
|
| Rate for Payer: PHP All Commercial |
$4,286.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,204.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,363.34
|
| Rate for Payer: Signature Care EPO |
$4,691.16
|
| Rate for Payer: Signature Care PPO |
$4,973.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,804.20
|
| Rate for Payer: United Healthcare Commercial |
$4,453.78
|
| Rate for Payer: United Healthcare Medicare |
$1,865.16
|
|
|
HC W PLATE 113MM LT FIB R
|
Facility
OP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,256.36 |
| Rate for Payer: Aetna Commercial |
$4,770.29
|
| Rate for Payer: Aetna Medicare |
$1,865.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,865.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,245.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,533.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,144.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,051.68
|
| Rate for Payer: Cash Price |
$3,504.24
|
| Rate for Payer: Cash Price |
$3,504.24
|
| Rate for Payer: Centivo All Commercial |
$2,882.52
|
| Rate for Payer: Cigna All Commercial |
$4,877.68
|
| Rate for Payer: CORVEL All Commercial |
$5,256.36
|
| Rate for Payer: Coventry All Commercial |
$4,973.76
|
| Rate for Payer: Encore All Commercial |
$5,202.67
|
| Rate for Payer: Frontpath All Commercial |
$5,199.84
|
| Rate for Payer: Humana ChoiceCare |
$4,881.63
|
| Rate for Payer: Humana Medicare |
$2,882.52
|
| Rate for Payer: Lucent All Commercial |
$2,882.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,086.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,239.00
|
| Rate for Payer: PHP All Commercial |
$4,286.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,204.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,363.34
|
| Rate for Payer: Signature Care EPO |
$4,691.16
|
| Rate for Payer: Signature Care PPO |
$4,973.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,804.20
|
| Rate for Payer: United Healthcare Commercial |
$4,453.78
|
| Rate for Payer: United Healthcare Medicare |
$1,865.16
|
|
|
HC W PLATE 113MM LT FIB R
|
Facility
IP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,239.00 |
| Max. Negotiated Rate |
$5,256.36 |
| Rate for Payer: Aetna Commercial |
$4,883.33
|
| Rate for Payer: Cash Price |
$3,504.24
|
| Rate for Payer: Cigna All Commercial |
$4,877.68
|
| Rate for Payer: CORVEL All Commercial |
$5,256.36
|
| Rate for Payer: Coventry All Commercial |
$4,973.76
|
| Rate for Payer: Encore All Commercial |
$5,202.67
|
| Rate for Payer: Frontpath All Commercial |
$5,199.84
|
| Rate for Payer: Humana ChoiceCare |
$4,881.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,086.80
|
| Rate for Payer: PHCS All Commercial |
$4,239.00
|
| Rate for Payer: PHP All Commercial |
$4,286.48
|
| Rate for Payer: Sagamore Health Network All Products |
$4,363.34
|
| Rate for Payer: Signature Care EPO |
$4,691.16
|
| Rate for Payer: Signature Care PPO |
$4,973.76
|
| Rate for Payer: United Healthcare Commercial |
$4,453.78
|
|
|
HC W PLATE 113MM OFFSET LAT FIB L
|
Facility
IP
|
$5,889.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,417.20 |
| Max. Negotiated Rate |
$5,477.33 |
| Rate for Payer: Aetna Commercial |
$5,088.61
|
| Rate for Payer: Cash Price |
$3,651.55
|
| Rate for Payer: Cigna All Commercial |
$5,082.72
|
| Rate for Payer: CORVEL All Commercial |
$5,477.33
|
| Rate for Payer: Coventry All Commercial |
$5,182.85
|
| Rate for Payer: Encore All Commercial |
$5,421.38
|
| Rate for Payer: Frontpath All Commercial |
$5,418.43
|
| Rate for Payer: Humana ChoiceCare |
$5,086.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,300.64
|
| Rate for Payer: PHCS All Commercial |
$4,417.20
|
| Rate for Payer: PHP All Commercial |
$4,466.67
|
| Rate for Payer: Sagamore Health Network All Products |
$4,546.77
|
| Rate for Payer: Signature Care EPO |
$4,888.37
|
| Rate for Payer: Signature Care PPO |
$5,182.85
|
| Rate for Payer: United Healthcare Commercial |
$4,641.00
|
|
|
HC W PLATE 113MM OFFSET LAT FIB L
|
Facility
OP
|
$5,889.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,477.33 |
| Rate for Payer: Aetna Commercial |
$4,970.82
|
| Rate for Payer: Aetna Medicare |
$1,943.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,943.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,382.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,681.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,235.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,137.92
|
| Rate for Payer: Cash Price |
$3,651.55
|
| Rate for Payer: Cash Price |
$3,651.55
|
| Rate for Payer: Centivo All Commercial |
$3,003.70
|
| Rate for Payer: Cigna All Commercial |
$5,082.72
|
| Rate for Payer: CORVEL All Commercial |
$5,477.33
|
| Rate for Payer: Coventry All Commercial |
$5,182.85
|
| Rate for Payer: Encore All Commercial |
$5,421.38
|
| Rate for Payer: Frontpath All Commercial |
$5,418.43
|
| Rate for Payer: Humana ChoiceCare |
$5,086.85
|
| Rate for Payer: Humana Medicare |
$3,003.70
|
| Rate for Payer: Lucent All Commercial |
$3,003.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,300.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,417.20
|
| Rate for Payer: PHP All Commercial |
$4,466.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,296.94
|
| Rate for Payer: Sagamore Health Network All Products |
$4,546.77
|
| Rate for Payer: Signature Care EPO |
$4,888.37
|
| Rate for Payer: Signature Care PPO |
$5,182.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,006.16
|
| Rate for Payer: United Healthcare Commercial |
$4,641.00
|
| Rate for Payer: United Healthcare Medicare |
$1,943.57
|
|
|
HC W PLATE 113MM OFFSET LAT FIB R
|
Facility
OP
|
$5,889.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,477.33 |
| Rate for Payer: Aetna Commercial |
$4,970.82
|
| Rate for Payer: Aetna Medicare |
$1,943.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,943.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,382.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,681.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,235.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,137.92
|
| Rate for Payer: Cash Price |
$3,651.55
|
| Rate for Payer: Cash Price |
$3,651.55
|
| Rate for Payer: Centivo All Commercial |
$3,003.70
|
| Rate for Payer: Cigna All Commercial |
$5,082.72
|
| Rate for Payer: CORVEL All Commercial |
$5,477.33
|
| Rate for Payer: Coventry All Commercial |
$5,182.85
|
| Rate for Payer: Encore All Commercial |
$5,421.38
|
| Rate for Payer: Frontpath All Commercial |
$5,418.43
|
| Rate for Payer: Humana ChoiceCare |
$5,086.85
|
| Rate for Payer: Humana Medicare |
$3,003.70
|
| Rate for Payer: Lucent All Commercial |
$3,003.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,300.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,417.20
|
| Rate for Payer: PHP All Commercial |
$4,466.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,296.94
|
| Rate for Payer: Sagamore Health Network All Products |
$4,546.77
|
| Rate for Payer: Signature Care EPO |
$4,888.37
|
| Rate for Payer: Signature Care PPO |
$5,182.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,006.16
|
| Rate for Payer: United Healthcare Commercial |
$4,641.00
|
| Rate for Payer: United Healthcare Medicare |
$1,943.57
|
|
|
HC W PLATE 113MM OFFSET LAT FIB R
|
Facility
IP
|
$5,889.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,417.20 |
| Max. Negotiated Rate |
$5,477.33 |
| Rate for Payer: Aetna Commercial |
$5,088.61
|
| Rate for Payer: Cash Price |
$3,651.55
|
| Rate for Payer: Cigna All Commercial |
$5,082.72
|
| Rate for Payer: CORVEL All Commercial |
$5,477.33
|
| Rate for Payer: Coventry All Commercial |
$5,182.85
|
| Rate for Payer: Encore All Commercial |
$5,421.38
|
| Rate for Payer: Frontpath All Commercial |
$5,418.43
|
| Rate for Payer: Humana ChoiceCare |
$5,086.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,300.64
|
| Rate for Payer: PHCS All Commercial |
$4,417.20
|
| Rate for Payer: PHP All Commercial |
$4,466.67
|
| Rate for Payer: Sagamore Health Network All Products |
$4,546.77
|
| Rate for Payer: Signature Care EPO |
$4,888.37
|
| Rate for Payer: Signature Care PPO |
$5,182.85
|
| Rate for Payer: United Healthcare Commercial |
$4,641.00
|
|
|
HC W PLATE 125MM LT FIB L
|
Facility
OP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605016
|
|
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 125MM LT FIB L
|
Facility
IP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605016
|
|
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 125MM LT FIB R
|
Facility
OP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605017
|
|
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 125MM LT FIB R
|
Facility
IP
|
$5,767.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605017
|
|
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 125MM OFFSET LAT FIB L
|
Facility
IP
|
$6,004.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,503.60 |
| Max. Negotiated Rate |
$5,584.46 |
| Rate for Payer: Aetna Commercial |
$5,188.15
|
| Rate for Payer: Cash Price |
$3,722.98
|
| Rate for Payer: Cigna All Commercial |
$5,182.14
|
| Rate for Payer: CORVEL All Commercial |
$5,584.46
|
| Rate for Payer: Coventry All Commercial |
$5,284.22
|
| Rate for Payer: Encore All Commercial |
$5,527.42
|
| Rate for Payer: Frontpath All Commercial |
$5,524.42
|
| Rate for Payer: Humana ChoiceCare |
$5,186.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,404.32
|
| Rate for Payer: PHCS All Commercial |
$4,503.60
|
| Rate for Payer: PHP All Commercial |
$4,554.04
|
| Rate for Payer: Sagamore Health Network All Products |
$4,635.71
|
| Rate for Payer: Signature Care EPO |
$4,983.98
|
| Rate for Payer: Signature Care PPO |
$5,284.22
|
| Rate for Payer: United Healthcare Commercial |
$4,731.78
|
|
