|
HC W PLATE 125MM OFFSET LAT FIB L
|
Facility
|
OP
|
$6,004.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,584.46 |
| Rate for Payer: Aetna Commercial |
$5,068.05
|
| Rate for Payer: Aetna Medicare |
$1,981.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,981.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,448.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,753.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,278.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,179.74
|
| Rate for Payer: Cash Price |
$3,722.98
|
| Rate for Payer: Cash Price |
$3,722.98
|
| Rate for Payer: Centivo All Commercial |
$3,062.45
|
| 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: Humana Medicare |
$3,062.45
|
| Rate for Payer: Lucent All Commercial |
$3,062.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,404.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,503.60
|
| Rate for Payer: PHP All Commercial |
$4,554.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,341.87
|
| 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: Three Rivers Preferred All Commercial |
$5,104.08
|
| Rate for Payer: United Healthcare Commercial |
$4,731.78
|
| Rate for Payer: United Healthcare Medicare |
$1,981.58
|
|
|
HC W PLATE 125MM OFFSET LAT FIB R
|
Facility
|
OP
|
$6,004.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,584.46 |
| Rate for Payer: Aetna Commercial |
$5,068.05
|
| Rate for Payer: Aetna Medicare |
$1,981.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,981.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,448.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,753.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,278.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,179.74
|
| Rate for Payer: Cash Price |
$3,722.98
|
| Rate for Payer: Cash Price |
$3,722.98
|
| Rate for Payer: Centivo All Commercial |
$3,062.45
|
| 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: Humana Medicare |
$3,062.45
|
| Rate for Payer: Lucent All Commercial |
$3,062.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,404.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,503.60
|
| Rate for Payer: PHP All Commercial |
$4,554.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,341.87
|
| 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: Three Rivers Preferred All Commercial |
$5,104.08
|
| Rate for Payer: United Healthcare Commercial |
$4,731.78
|
| Rate for Payer: United Healthcare Medicare |
$1,981.58
|
|
|
HC W PLATE 125MM OFFSET LAT FIB R
|
Facility
|
IP
|
$6,004.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605028
|
|
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
|
|
|
HC W PLATE 12-H ST TUB
|
Facility
|
IP
|
$2,743.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.40 |
| Max. Negotiated Rate |
$2,551.18 |
| Rate for Payer: Aetna Commercial |
$2,370.12
|
| Rate for Payer: Cash Price |
$1,700.78
|
| Rate for Payer: Cigna All Commercial |
$2,367.38
|
| Rate for Payer: CORVEL All Commercial |
$2,551.18
|
| Rate for Payer: Coventry All Commercial |
$2,414.02
|
| Rate for Payer: Encore All Commercial |
$2,525.12
|
| Rate for Payer: Frontpath All Commercial |
$2,523.74
|
| Rate for Payer: Humana ChoiceCare |
$2,369.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,468.88
|
| Rate for Payer: PHCS All Commercial |
$2,057.40
|
| Rate for Payer: PHP All Commercial |
$2,080.44
|
| Rate for Payer: Sagamore Health Network All Products |
$2,117.75
|
| Rate for Payer: Signature Care EPO |
$2,276.86
|
| Rate for Payer: Signature Care PPO |
$2,414.02
|
| Rate for Payer: United Healthcare Commercial |
$2,161.64
|
|
|
HC W PLATE 12-H ST TUB
|
Facility
|
OP
|
$2,779.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,584.66 |
| Rate for Payer: Aetna Commercial |
$2,345.64
|
| Rate for Payer: Aetna Medicare |
$917.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$917.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,596.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,737.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,054.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,008.85
|
| Rate for Payer: Cash Price |
$1,723.10
|
| Rate for Payer: Cash Price |
$1,723.10
|
| Rate for Payer: Centivo All Commercial |
$1,417.39
|
| Rate for Payer: Cigna All Commercial |
$2,398.45
|
| Rate for Payer: CORVEL All Commercial |
$2,584.66
|
| Rate for Payer: Coventry All Commercial |
$2,445.70
|
| Rate for Payer: Encore All Commercial |
$2,558.25
|
| Rate for Payer: Frontpath All Commercial |
$2,556.86
|
| Rate for Payer: Humana ChoiceCare |
$2,400.40
|
| Rate for Payer: Humana Medicare |
$1,417.39
|
| Rate for Payer: Lucent All Commercial |
$1,417.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,501.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,084.40
|
| Rate for Payer: PHP All Commercial |
$2,107.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,083.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,145.54
|
| Rate for Payer: Signature Care EPO |
$2,306.74
|
| Rate for Payer: Signature Care PPO |
$2,445.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,362.32
|
| Rate for Payer: United Healthcare Commercial |
$2,190.01
|
| Rate for Payer: United Healthcare Medicare |
$917.14
|
|
|
HC W PLATE 12-H ST TUB
|
Facility
|
IP
|
$2,779.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.40 |
| Max. Negotiated Rate |
$2,584.66 |
| Rate for Payer: Aetna Commercial |
$2,401.23
|
| Rate for Payer: Cash Price |
$1,723.10
|
| Rate for Payer: Cigna All Commercial |
$2,398.45
|
| Rate for Payer: CORVEL All Commercial |
$2,584.66
|
| Rate for Payer: Coventry All Commercial |
$2,445.70
|
| Rate for Payer: Encore All Commercial |
$2,558.25
|
| Rate for Payer: Frontpath All Commercial |
$2,556.86
|
| Rate for Payer: Humana ChoiceCare |
$2,400.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,501.28
|
| Rate for Payer: PHCS All Commercial |
$2,084.40
|
| Rate for Payer: PHP All Commercial |
$2,107.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,145.54
|
| Rate for Payer: Signature Care EPO |
$2,306.74
|
| Rate for Payer: Signature Care PPO |
$2,445.70
|
| Rate for Payer: United Healthcare Commercial |
$2,190.01
|
|
|
HC W PLATE 12-H ST TUB
|
Facility
|
OP
|
$2,743.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,551.18 |
| Rate for Payer: Aetna Commercial |
$2,315.26
|
| Rate for Payer: Aetna Medicare |
$905.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$905.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,575.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,714.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,041.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$995.78
|
| Rate for Payer: Cash Price |
$1,700.78
|
| Rate for Payer: Cash Price |
$1,700.78
|
| Rate for Payer: Centivo All Commercial |
$1,399.03
|
| Rate for Payer: Cigna All Commercial |
$2,367.38
|
| Rate for Payer: CORVEL All Commercial |
$2,551.18
|
| Rate for Payer: Coventry All Commercial |
$2,414.02
|
| Rate for Payer: Encore All Commercial |
$2,525.12
|
| Rate for Payer: Frontpath All Commercial |
$2,523.74
|
| Rate for Payer: Humana ChoiceCare |
$2,369.30
|
| Rate for Payer: Humana Medicare |
$1,399.03
|
| Rate for Payer: Lucent All Commercial |
$1,399.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,468.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,057.40
|
| Rate for Payer: PHP All Commercial |
$2,080.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,069.85
|
| Rate for Payer: Sagamore Health Network All Products |
$2,117.75
|
| Rate for Payer: Signature Care EPO |
$2,276.86
|
| Rate for Payer: Signature Care PPO |
$2,414.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,331.72
|
| Rate for Payer: United Healthcare Commercial |
$2,161.64
|
| Rate for Payer: United Healthcare Medicare |
$905.26
|
|
|
HC W PLATE 14-H ST TUB
|
Facility
|
IP
|
$2,779.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.40 |
| Max. Negotiated Rate |
$2,584.66 |
| Rate for Payer: Aetna Commercial |
$2,401.23
|
| Rate for Payer: Cash Price |
$1,723.10
|
| Rate for Payer: Cigna All Commercial |
$2,398.45
|
| Rate for Payer: CORVEL All Commercial |
$2,584.66
|
| Rate for Payer: Coventry All Commercial |
$2,445.70
|
| Rate for Payer: Encore All Commercial |
$2,558.25
|
| Rate for Payer: Frontpath All Commercial |
$2,556.86
|
| Rate for Payer: Humana ChoiceCare |
$2,400.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,501.28
|
| Rate for Payer: PHCS All Commercial |
$2,084.40
|
| Rate for Payer: PHP All Commercial |
$2,107.75
|
| Rate for Payer: Sagamore Health Network All Products |
$2,145.54
|
| Rate for Payer: Signature Care EPO |
$2,306.74
|
| Rate for Payer: Signature Care PPO |
$2,445.70
|
| Rate for Payer: United Healthcare Commercial |
$2,190.01
|
|
|
HC W PLATE 14-H ST TUB
|
Facility
|
OP
|
$2,779.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,584.66 |
| Rate for Payer: Aetna Commercial |
$2,345.64
|
| Rate for Payer: Aetna Medicare |
$917.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$917.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,596.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,737.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,054.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,008.85
|
| Rate for Payer: Cash Price |
$1,723.10
|
| Rate for Payer: Cash Price |
$1,723.10
|
| Rate for Payer: Centivo All Commercial |
$1,417.39
|
| Rate for Payer: Cigna All Commercial |
$2,398.45
|
| Rate for Payer: CORVEL All Commercial |
$2,584.66
|
| Rate for Payer: Coventry All Commercial |
$2,445.70
|
| Rate for Payer: Encore All Commercial |
$2,558.25
|
| Rate for Payer: Frontpath All Commercial |
$2,556.86
|
| Rate for Payer: Humana ChoiceCare |
$2,400.40
|
| Rate for Payer: Humana Medicare |
$1,417.39
|
| Rate for Payer: Lucent All Commercial |
$1,417.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,501.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,084.40
|
| Rate for Payer: PHP All Commercial |
$2,107.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,083.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,145.54
|
| Rate for Payer: Signature Care EPO |
$2,306.74
|
| Rate for Payer: Signature Care PPO |
$2,445.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,362.32
|
| Rate for Payer: United Healthcare Commercial |
$2,190.01
|
| Rate for Payer: United Healthcare Medicare |
$917.14
|
|
|
HC W PLATE 1 LAPIDUS
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605068
|
|
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 1 LAPIDUS
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605068
|
|
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 2 BOW
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605063
|
|
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 2 BOW
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605063
|
|
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 2-H ST
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC W PLATE 2-H ST
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC W PLATE 2 LAPIDUS
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605069
|
|
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 2 LAPIDUS
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605069
|
|
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 2 LAP L
|
Facility
|
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605119
|
|
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 2 LAP L
|
Facility
|
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605119
|
|
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 2 LAP R
|
Facility
|
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605120
|
|
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 2 LAP R
|
Facility
|
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605120
|
|
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 3-H AKIN
|
Facility
|
OP
|
$2,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,125.05 |
| Rate for Payer: Aetna Commercial |
$1,928.54
|
| Rate for Payer: Aetna Medicare |
$754.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$754.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,312.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,428.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$867.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$829.46
|
| Rate for Payer: Cash Price |
$1,416.70
|
| Rate for Payer: Cash Price |
$1,416.70
|
| Rate for Payer: Centivo All Commercial |
$1,165.35
|
| Rate for Payer: Cigna All Commercial |
$1,971.96
|
| Rate for Payer: CORVEL All Commercial |
$2,125.05
|
| Rate for Payer: Coventry All Commercial |
$2,010.80
|
| Rate for Payer: Encore All Commercial |
$2,103.34
|
| Rate for Payer: Frontpath All Commercial |
$2,102.20
|
| Rate for Payer: Humana ChoiceCare |
$1,973.55
|
| Rate for Payer: Humana Medicare |
$1,165.35
|
| Rate for Payer: Lucent All Commercial |
$1,165.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,056.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,713.75
|
| Rate for Payer: PHP All Commercial |
$1,732.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$891.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,764.02
|
| Rate for Payer: Signature Care EPO |
$1,896.55
|
| Rate for Payer: Signature Care PPO |
$2,010.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,942.25
|
| Rate for Payer: United Healthcare Commercial |
$1,800.58
|
| Rate for Payer: United Healthcare Medicare |
$754.05
|
|
|
HC W PLATE 3-H AKIN
|
Facility
|
IP
|
$2,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,713.75 |
| Max. Negotiated Rate |
$2,125.05 |
| Rate for Payer: Aetna Commercial |
$1,974.24
|
| Rate for Payer: Cash Price |
$1,416.70
|
| Rate for Payer: Cigna All Commercial |
$1,971.96
|
| Rate for Payer: CORVEL All Commercial |
$2,125.05
|
| Rate for Payer: Coventry All Commercial |
$2,010.80
|
| Rate for Payer: Encore All Commercial |
$2,103.34
|
| Rate for Payer: Frontpath All Commercial |
$2,102.20
|
| Rate for Payer: Humana ChoiceCare |
$1,973.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,056.50
|
| Rate for Payer: PHCS All Commercial |
$1,713.75
|
| Rate for Payer: PHP All Commercial |
$1,732.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,764.02
|
| Rate for Payer: Signature Care EPO |
$1,896.55
|
| Rate for Payer: Signature Care PPO |
$2,010.80
|
| Rate for Payer: United Healthcare Commercial |
$1,800.58
|
|
|
HC W PLATE 3-H ST MET
|
Facility
|
IP
|
$2,005.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.90 |
| Max. Negotiated Rate |
$1,864.84 |
| Rate for Payer: Aetna Commercial |
$1,732.49
|
| Rate for Payer: Cash Price |
$1,243.22
|
| Rate for Payer: Cigna All Commercial |
$1,730.49
|
| Rate for Payer: CORVEL All Commercial |
$1,864.84
|
| Rate for Payer: Coventry All Commercial |
$1,764.58
|
| Rate for Payer: Encore All Commercial |
$1,845.79
|
| Rate for Payer: Frontpath All Commercial |
$1,844.78
|
| Rate for Payer: Humana ChoiceCare |
$1,731.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,804.68
|
| Rate for Payer: PHCS All Commercial |
$1,503.90
|
| Rate for Payer: PHP All Commercial |
$1,520.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,548.01
|
| Rate for Payer: Signature Care EPO |
$1,664.32
|
| Rate for Payer: Signature Care PPO |
$1,764.58
|
| Rate for Payer: United Healthcare Commercial |
$1,580.10
|
|
|
HC W PLATE 3-H ST MET
|
Facility
|
OP
|
$2,005.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,864.84 |
| Rate for Payer: Aetna Commercial |
$1,692.39
|
| Rate for Payer: Aetna Medicare |
$661.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$661.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,151.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,253.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$760.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$727.89
|
| Rate for Payer: Cash Price |
$1,243.22
|
| Rate for Payer: Cash Price |
$1,243.22
|
| Rate for Payer: Centivo All Commercial |
$1,022.65
|
| Rate for Payer: Cigna All Commercial |
$1,730.49
|
| Rate for Payer: CORVEL All Commercial |
$1,864.84
|
| Rate for Payer: Coventry All Commercial |
$1,764.58
|
| Rate for Payer: Encore All Commercial |
$1,845.79
|
| Rate for Payer: Frontpath All Commercial |
$1,844.78
|
| Rate for Payer: Humana ChoiceCare |
$1,731.89
|
| Rate for Payer: Humana Medicare |
$1,022.65
|
| Rate for Payer: Lucent All Commercial |
$1,022.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,804.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,503.90
|
| Rate for Payer: PHP All Commercial |
$1,520.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$782.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,548.01
|
| Rate for Payer: Signature Care EPO |
$1,664.32
|
| Rate for Payer: Signature Care PPO |
$1,764.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,704.42
|
| Rate for Payer: United Healthcare Commercial |
$1,580.10
|
| Rate for Payer: United Healthcare Medicare |
$661.72
|
|
