|
HC W PLATE 3 LAPIDUS
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605070
|
|
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 3 LAPIDUS
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605070
|
|
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 4-0 ST
|
Facility
|
OP
|
$2,206.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,052.32 |
| Rate for Payer: Aetna Commercial |
$1,862.54
|
| Rate for Payer: Aetna Medicare |
$728.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$728.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,267.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,379.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$837.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$801.07
|
| Rate for Payer: Cash Price |
$1,368.22
|
| Rate for Payer: Cash Price |
$1,368.22
|
| Rate for Payer: Centivo All Commercial |
$1,125.47
|
| Rate for Payer: Cigna All Commercial |
$1,904.47
|
| Rate for Payer: CORVEL All Commercial |
$2,052.32
|
| Rate for Payer: Coventry All Commercial |
$1,941.98
|
| Rate for Payer: Encore All Commercial |
$2,031.36
|
| Rate for Payer: Frontpath All Commercial |
$2,030.26
|
| Rate for Payer: Humana ChoiceCare |
$1,906.01
|
| Rate for Payer: Humana Medicare |
$1,125.47
|
| Rate for Payer: Lucent All Commercial |
$1,125.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,986.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,655.10
|
| Rate for Payer: PHP All Commercial |
$1,673.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$860.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,703.65
|
| Rate for Payer: Signature Care EPO |
$1,831.64
|
| Rate for Payer: Signature Care PPO |
$1,941.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,875.78
|
| Rate for Payer: United Healthcare Commercial |
$1,738.96
|
| Rate for Payer: United Healthcare Medicare |
$728.24
|
|
|
HC W PLATE 4-0 ST
|
Facility
|
IP
|
$2,206.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.10 |
| Max. Negotiated Rate |
$2,052.32 |
| Rate for Payer: Aetna Commercial |
$1,906.68
|
| Rate for Payer: Cash Price |
$1,368.22
|
| Rate for Payer: Cigna All Commercial |
$1,904.47
|
| Rate for Payer: CORVEL All Commercial |
$2,052.32
|
| Rate for Payer: Coventry All Commercial |
$1,941.98
|
| Rate for Payer: Encore All Commercial |
$2,031.36
|
| Rate for Payer: Frontpath All Commercial |
$2,030.26
|
| Rate for Payer: Humana ChoiceCare |
$1,906.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,986.12
|
| Rate for Payer: PHCS All Commercial |
$1,655.10
|
| Rate for Payer: PHP All Commercial |
$1,673.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,703.65
|
| Rate for Payer: Signature Care EPO |
$1,831.64
|
| Rate for Payer: Signature Care PPO |
$1,941.98
|
| Rate for Payer: United Healthcare Commercial |
$1,738.96
|
|
|
HC W PLATE 4.5 COTTON WEDGE
|
Facility
|
IP
|
$5,338.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,004.10 |
| Max. Negotiated Rate |
$4,965.08 |
| Rate for Payer: Aetna Commercial |
$4,612.72
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Cigna All Commercial |
$4,607.38
|
| Rate for Payer: CORVEL All Commercial |
$4,965.08
|
| Rate for Payer: Coventry All Commercial |
$4,698.14
|
| Rate for Payer: Encore All Commercial |
$4,914.37
|
| Rate for Payer: Frontpath All Commercial |
$4,911.70
|
| Rate for Payer: Humana ChoiceCare |
$4,611.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,804.92
|
| Rate for Payer: PHCS All Commercial |
$4,004.10
|
| Rate for Payer: PHP All Commercial |
$4,048.95
|
| Rate for Payer: Sagamore Health Network All Products |
$4,121.55
|
| Rate for Payer: Signature Care EPO |
$4,431.20
|
| Rate for Payer: Signature Care PPO |
$4,698.14
|
| Rate for Payer: United Healthcare Commercial |
$4,206.97
|
|
|
HC W PLATE 4.5 COTTON WEDGE
|
Facility
|
OP
|
$5,338.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,965.08 |
| Rate for Payer: Aetna Commercial |
$4,505.95
|
| Rate for Payer: Aetna Medicare |
$1,761.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,761.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,066.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,337.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,026.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,937.98
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Centivo All Commercial |
$2,722.79
|
| Rate for Payer: Cigna All Commercial |
$4,607.38
|
| Rate for Payer: CORVEL All Commercial |
$4,965.08
|
| Rate for Payer: Coventry All Commercial |
$4,698.14
|
| Rate for Payer: Encore All Commercial |
$4,914.37
|
| Rate for Payer: Frontpath All Commercial |
$4,911.70
|
| Rate for Payer: Humana ChoiceCare |
$4,611.12
|
| Rate for Payer: Humana Medicare |
$2,722.79
|
| Rate for Payer: Lucent All Commercial |
$2,722.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,804.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,004.10
|
| Rate for Payer: PHP All Commercial |
$4,048.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,082.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4,121.55
|
| Rate for Payer: Signature Care EPO |
$4,431.20
|
| Rate for Payer: Signature Care PPO |
$4,698.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,537.98
|
| Rate for Payer: United Healthcare Commercial |
$4,206.97
|
| Rate for Payer: United Healthcare Medicare |
$1,761.80
|
|
|
HC W PLATE 4 BOW
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605064
|
|
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 4 BOW
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605064
|
|
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 4-H RAY
|
Facility
|
OP
|
$2,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605097
|
|
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 4-H RAY
|
Facility
|
IP
|
$2,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605097
|
|
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 4-H ST MET
|
Facility
|
IP
|
$2,005.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605101
|
|
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 4-H ST MET
|
Facility
|
OP
|
$2,005.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605101
|
|
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
|
|
|
HC W PLATE 4 LAPIDUS
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605071
|
|
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 4 LAPIDUS
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605071
|
|
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 5.5 COTTON WEDGE
|
Facility
|
OP
|
$5,338.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,965.08 |
| Rate for Payer: Aetna Commercial |
$4,505.95
|
| Rate for Payer: Aetna Medicare |
$1,761.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,761.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,066.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,337.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,026.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,937.98
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Centivo All Commercial |
$2,722.79
|
| Rate for Payer: Cigna All Commercial |
$4,607.38
|
| Rate for Payer: CORVEL All Commercial |
$4,965.08
|
| Rate for Payer: Coventry All Commercial |
$4,698.14
|
| Rate for Payer: Encore All Commercial |
$4,914.37
|
| Rate for Payer: Frontpath All Commercial |
$4,911.70
|
| Rate for Payer: Humana ChoiceCare |
$4,611.12
|
| Rate for Payer: Humana Medicare |
$2,722.79
|
| Rate for Payer: Lucent All Commercial |
$2,722.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,804.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,004.10
|
| Rate for Payer: PHP All Commercial |
$4,048.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,082.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4,121.55
|
| Rate for Payer: Signature Care EPO |
$4,431.20
|
| Rate for Payer: Signature Care PPO |
$4,698.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,537.98
|
| Rate for Payer: United Healthcare Commercial |
$4,206.97
|
| Rate for Payer: United Healthcare Medicare |
$1,761.80
|
|
|
HC W PLATE 5.5 COTTON WEDGE
|
Facility
|
IP
|
$5,338.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,004.10 |
| Max. Negotiated Rate |
$4,965.08 |
| Rate for Payer: Aetna Commercial |
$4,612.72
|
| Rate for Payer: Cash Price |
$3,310.06
|
| Rate for Payer: Cigna All Commercial |
$4,607.38
|
| Rate for Payer: CORVEL All Commercial |
$4,965.08
|
| Rate for Payer: Coventry All Commercial |
$4,698.14
|
| Rate for Payer: Encore All Commercial |
$4,914.37
|
| Rate for Payer: Frontpath All Commercial |
$4,911.70
|
| Rate for Payer: Humana ChoiceCare |
$4,611.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,804.92
|
| Rate for Payer: PHCS All Commercial |
$4,004.10
|
| Rate for Payer: PHP All Commercial |
$4,048.95
|
| Rate for Payer: Sagamore Health Network All Products |
$4,121.55
|
| Rate for Payer: Signature Care EPO |
$4,431.20
|
| Rate for Payer: Signature Care PPO |
$4,698.14
|
| Rate for Payer: United Healthcare Commercial |
$4,206.97
|
|
|
HC W PLATE 5 BOW
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605065
|
|
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 5 BOW
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605065
|
|
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 5DG MTP MED L
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604970
|
|
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 5DG MTP MED L
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604970
|
|
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 5DG MTP MED R
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604971
|
|
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 5DG MTP MED R
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604971
|
|
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 5DG MTP SM L
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605129
|
|
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 5DG MTP SM L
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605129
|
|
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 5DG MTP SM R
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605130
|
|
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
|
|
