|
HC W PLATE 77MM OFFSET LAT FIB R
|
Facility
IP
|
$5,529.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,147.20 |
| Max. Negotiated Rate |
$5,142.53 |
| Rate for Payer: Aetna Commercial |
$4,777.57
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Cigna All Commercial |
$4,772.04
|
| Rate for Payer: CORVEL All Commercial |
$5,142.53
|
| Rate for Payer: Coventry All Commercial |
$4,866.05
|
| Rate for Payer: Encore All Commercial |
$5,090.00
|
| Rate for Payer: Frontpath All Commercial |
$5,087.23
|
| Rate for Payer: Humana ChoiceCare |
$4,775.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,976.64
|
| Rate for Payer: PHCS All Commercial |
$4,147.20
|
| Rate for Payer: PHP All Commercial |
$4,193.65
|
| Rate for Payer: Sagamore Health Network All Products |
$4,268.85
|
| Rate for Payer: Signature Care EPO |
$4,589.57
|
| Rate for Payer: Signature Care PPO |
$4,866.05
|
| Rate for Payer: United Healthcare Commercial |
$4,357.32
|
|
|
HC W PLATE 77MM OFFSET LAT FIB R
|
Facility
OP
|
$5,529.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,142.53 |
| Rate for Payer: Aetna Commercial |
$4,666.98
|
| Rate for Payer: Aetna Medicare |
$1,824.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,824.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,175.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,456.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,098.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,007.24
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Cash Price |
$3,428.35
|
| Rate for Payer: Centivo All Commercial |
$2,820.10
|
| Rate for Payer: Cigna All Commercial |
$4,772.04
|
| Rate for Payer: CORVEL All Commercial |
$5,142.53
|
| Rate for Payer: Coventry All Commercial |
$4,866.05
|
| Rate for Payer: Encore All Commercial |
$5,090.00
|
| Rate for Payer: Frontpath All Commercial |
$5,087.23
|
| Rate for Payer: Humana ChoiceCare |
$4,775.92
|
| Rate for Payer: Humana Medicare |
$2,820.10
|
| Rate for Payer: Lucent All Commercial |
$2,820.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,976.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,147.20
|
| Rate for Payer: PHP All Commercial |
$4,193.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,156.54
|
| Rate for Payer: Sagamore Health Network All Products |
$4,268.85
|
| Rate for Payer: Signature Care EPO |
$4,589.57
|
| Rate for Payer: Signature Care PPO |
$4,866.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.16
|
| Rate for Payer: United Healthcare Commercial |
$4,357.32
|
| Rate for Payer: United Healthcare Medicare |
$1,824.77
|
|
|
HC W PLATE 7-H ST TUB
|
Facility
IP
|
$2,315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$2,152.95 |
| Rate for Payer: Aetna Commercial |
$2,000.16
|
| Rate for Payer: Cash Price |
$1,435.30
|
| Rate for Payer: Cigna All Commercial |
$1,997.84
|
| Rate for Payer: CORVEL All Commercial |
$2,152.95
|
| Rate for Payer: Coventry All Commercial |
$2,037.20
|
| Rate for Payer: Encore All Commercial |
$2,130.96
|
| Rate for Payer: Frontpath All Commercial |
$2,129.80
|
| Rate for Payer: Humana ChoiceCare |
$1,999.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,083.50
|
| Rate for Payer: PHCS All Commercial |
$1,736.25
|
| Rate for Payer: PHP All Commercial |
$1,755.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,787.18
|
| Rate for Payer: Signature Care EPO |
$1,921.45
|
| Rate for Payer: Signature Care PPO |
$2,037.20
|
| Rate for Payer: United Healthcare Commercial |
$1,824.22
|
|
|
HC W PLATE 7-H ST TUB
|
Facility
OP
|
$2,315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,152.95 |
| Rate for Payer: Aetna Commercial |
$1,953.86
|
| Rate for Payer: Aetna Medicare |
$763.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$763.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,329.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,447.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$878.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$840.34
|
| Rate for Payer: Cash Price |
$1,435.30
|
| Rate for Payer: Cash Price |
$1,435.30
|
| Rate for Payer: Centivo All Commercial |
$1,180.65
|
| Rate for Payer: Cigna All Commercial |
$1,997.84
|
| Rate for Payer: CORVEL All Commercial |
$2,152.95
|
| Rate for Payer: Coventry All Commercial |
$2,037.20
|
| Rate for Payer: Encore All Commercial |
$2,130.96
|
| Rate for Payer: Frontpath All Commercial |
$2,129.80
|
| Rate for Payer: Humana ChoiceCare |
$1,999.47
|
| Rate for Payer: Humana Medicare |
$1,180.65
|
| Rate for Payer: Lucent All Commercial |
$1,180.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,083.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,736.25
|
| Rate for Payer: PHP All Commercial |
$1,755.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$902.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,787.18
|
| Rate for Payer: Signature Care EPO |
$1,921.45
|
| Rate for Payer: Signature Care PPO |
$2,037.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,967.75
|
| Rate for Payer: United Healthcare Commercial |
$1,824.22
|
| Rate for Payer: United Healthcare Medicare |
$763.95
|
|
|
HC W PLATE 7-H ST TUB
|
Facility
OP
|
$2,320.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,157.60 |
| Rate for Payer: Aetna Commercial |
$1,958.08
|
| Rate for Payer: Aetna Medicare |
$765.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$765.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,332.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,450.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$880.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$842.16
|
| Rate for Payer: Cash Price |
$1,438.40
|
| Rate for Payer: Cash Price |
$1,438.40
|
| Rate for Payer: Centivo All Commercial |
$1,183.20
|
| Rate for Payer: Cigna All Commercial |
$2,002.16
|
| Rate for Payer: CORVEL All Commercial |
$2,157.60
|
| Rate for Payer: Coventry All Commercial |
$2,041.60
|
| Rate for Payer: Encore All Commercial |
$2,135.56
|
| Rate for Payer: Frontpath All Commercial |
$2,134.40
|
| Rate for Payer: Humana ChoiceCare |
$2,003.78
|
| Rate for Payer: Humana Medicare |
$1,183.20
|
| Rate for Payer: Lucent All Commercial |
$1,183.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,088.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,740.00
|
| Rate for Payer: PHP All Commercial |
$1,759.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$904.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,791.04
|
| Rate for Payer: Signature Care EPO |
$1,925.60
|
| Rate for Payer: Signature Care PPO |
$2,041.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,972.00
|
| Rate for Payer: United Healthcare Commercial |
$1,828.16
|
| Rate for Payer: United Healthcare Medicare |
$765.60
|
|
|
HC W PLATE 7-H ST TUB
|
Facility
IP
|
$2,320.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.00 |
| Max. Negotiated Rate |
$2,157.60 |
| Rate for Payer: Aetna Commercial |
$2,004.48
|
| Rate for Payer: Cash Price |
$1,438.40
|
| Rate for Payer: Cigna All Commercial |
$2,002.16
|
| Rate for Payer: CORVEL All Commercial |
$2,157.60
|
| Rate for Payer: Coventry All Commercial |
$2,041.60
|
| Rate for Payer: Encore All Commercial |
$2,135.56
|
| Rate for Payer: Frontpath All Commercial |
$2,134.40
|
| Rate for Payer: Humana ChoiceCare |
$2,003.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,088.00
|
| Rate for Payer: PHCS All Commercial |
$1,740.00
|
| Rate for Payer: PHP All Commercial |
$1,759.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,791.04
|
| Rate for Payer: Signature Care EPO |
$1,925.60
|
| Rate for Payer: Signature Care PPO |
$2,041.60
|
| Rate for Payer: United Healthcare Commercial |
$1,828.16
|
|
|
HC W PLATE 7-H T MET
|
Facility
OP
|
$2,347.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,182.90 |
| Rate for Payer: Aetna Commercial |
$1,981.04
|
| Rate for Payer: Aetna Medicare |
$774.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$774.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,348.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,467.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$890.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$852.03
|
| Rate for Payer: Cash Price |
$1,455.26
|
| Rate for Payer: Cash Price |
$1,455.26
|
| Rate for Payer: Centivo All Commercial |
$1,197.07
|
| Rate for Payer: Cigna All Commercial |
$2,025.63
|
| Rate for Payer: CORVEL All Commercial |
$2,182.90
|
| Rate for Payer: Coventry All Commercial |
$2,065.54
|
| Rate for Payer: Encore All Commercial |
$2,160.60
|
| Rate for Payer: Frontpath All Commercial |
$2,159.42
|
| Rate for Payer: Humana ChoiceCare |
$2,027.28
|
| Rate for Payer: Humana Medicare |
$1,197.07
|
| Rate for Payer: Lucent All Commercial |
$1,197.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,112.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,760.40
|
| Rate for Payer: PHP All Commercial |
$1,780.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$915.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,812.04
|
| Rate for Payer: Signature Care EPO |
$1,948.18
|
| Rate for Payer: Signature Care PPO |
$2,065.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,995.12
|
| Rate for Payer: United Healthcare Commercial |
$1,849.59
|
| Rate for Payer: United Healthcare Medicare |
$774.58
|
|
|
HC W PLATE 7-H T MET
|
Facility
IP
|
$2,347.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,760.40 |
| Max. Negotiated Rate |
$2,182.90 |
| Rate for Payer: Aetna Commercial |
$2,027.98
|
| Rate for Payer: Cash Price |
$1,455.26
|
| Rate for Payer: Cigna All Commercial |
$2,025.63
|
| Rate for Payer: CORVEL All Commercial |
$2,182.90
|
| Rate for Payer: Coventry All Commercial |
$2,065.54
|
| Rate for Payer: Encore All Commercial |
$2,160.60
|
| Rate for Payer: Frontpath All Commercial |
$2,159.42
|
| Rate for Payer: Humana ChoiceCare |
$2,027.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,112.48
|
| Rate for Payer: PHCS All Commercial |
$1,760.40
|
| Rate for Payer: PHP All Commercial |
$1,780.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,812.04
|
| Rate for Payer: Signature Care EPO |
$1,948.18
|
| Rate for Payer: Signature Care PPO |
$2,065.54
|
| Rate for Payer: United Healthcare Commercial |
$1,849.59
|
|
|
HC W PLATE 89MM LT FIB L
|
Facility
IP
|
$5,410.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,058.10 |
| Max. Negotiated Rate |
$5,032.04 |
| Rate for Payer: Aetna Commercial |
$4,674.93
|
| Rate for Payer: Cash Price |
$3,354.70
|
| Rate for Payer: Cigna All Commercial |
$4,669.52
|
| Rate for Payer: CORVEL All Commercial |
$5,032.04
|
| Rate for Payer: Coventry All Commercial |
$4,761.50
|
| Rate for Payer: Encore All Commercial |
$4,980.64
|
| Rate for Payer: Frontpath All Commercial |
$4,977.94
|
| Rate for Payer: Humana ChoiceCare |
$4,673.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,869.72
|
| Rate for Payer: PHCS All Commercial |
$4,058.10
|
| Rate for Payer: PHP All Commercial |
$4,103.55
|
| Rate for Payer: Sagamore Health Network All Products |
$4,177.14
|
| Rate for Payer: Signature Care EPO |
$4,490.96
|
| Rate for Payer: Signature Care PPO |
$4,761.50
|
| Rate for Payer: United Healthcare Commercial |
$4,263.71
|
|
|
HC W PLATE 89MM LT FIB L
|
Facility
OP
|
$5,410.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,032.04 |
| Rate for Payer: Aetna Commercial |
$4,566.72
|
| Rate for Payer: Aetna Medicare |
$1,785.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,785.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,107.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,382.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.12
|
| Rate for Payer: Cash Price |
$3,354.70
|
| Rate for Payer: Cash Price |
$3,354.70
|
| Rate for Payer: Centivo All Commercial |
$2,759.51
|
| Rate for Payer: Cigna All Commercial |
$4,669.52
|
| Rate for Payer: CORVEL All Commercial |
$5,032.04
|
| Rate for Payer: Coventry All Commercial |
$4,761.50
|
| Rate for Payer: Encore All Commercial |
$4,980.64
|
| Rate for Payer: Frontpath All Commercial |
$4,977.94
|
| Rate for Payer: Humana ChoiceCare |
$4,673.31
|
| Rate for Payer: Humana Medicare |
$2,759.51
|
| Rate for Payer: Lucent All Commercial |
$2,759.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,869.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,058.10
|
| Rate for Payer: PHP All Commercial |
$4,103.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,110.21
|
| Rate for Payer: Sagamore Health Network All Products |
$4,177.14
|
| Rate for Payer: Signature Care EPO |
$4,490.96
|
| Rate for Payer: Signature Care PPO |
$4,761.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,599.18
|
| Rate for Payer: United Healthcare Commercial |
$4,263.71
|
| Rate for Payer: United Healthcare Medicare |
$1,785.56
|
|
|
HC W PLATE 89MM LT FIB R
|
Facility
IP
|
$5,410.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,058.10 |
| Max. Negotiated Rate |
$5,032.04 |
| Rate for Payer: Aetna Commercial |
$4,674.93
|
| Rate for Payer: Cash Price |
$3,354.70
|
| Rate for Payer: Cigna All Commercial |
$4,669.52
|
| Rate for Payer: CORVEL All Commercial |
$5,032.04
|
| Rate for Payer: Coventry All Commercial |
$4,761.50
|
| Rate for Payer: Encore All Commercial |
$4,980.64
|
| Rate for Payer: Frontpath All Commercial |
$4,977.94
|
| Rate for Payer: Humana ChoiceCare |
$4,673.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,869.72
|
| Rate for Payer: PHCS All Commercial |
$4,058.10
|
| Rate for Payer: PHP All Commercial |
$4,103.55
|
| Rate for Payer: Sagamore Health Network All Products |
$4,177.14
|
| Rate for Payer: Signature Care EPO |
$4,490.96
|
| Rate for Payer: Signature Care PPO |
$4,761.50
|
| Rate for Payer: United Healthcare Commercial |
$4,263.71
|
|
|
HC W PLATE 89MM LT FIB R
|
Facility
OP
|
$5,410.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,032.04 |
| Rate for Payer: Aetna Commercial |
$4,566.72
|
| Rate for Payer: Aetna Medicare |
$1,785.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,785.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,107.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,382.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.12
|
| Rate for Payer: Cash Price |
$3,354.70
|
| Rate for Payer: Cash Price |
$3,354.70
|
| Rate for Payer: Centivo All Commercial |
$2,759.51
|
| Rate for Payer: Cigna All Commercial |
$4,669.52
|
| Rate for Payer: CORVEL All Commercial |
$5,032.04
|
| Rate for Payer: Coventry All Commercial |
$4,761.50
|
| Rate for Payer: Encore All Commercial |
$4,980.64
|
| Rate for Payer: Frontpath All Commercial |
$4,977.94
|
| Rate for Payer: Humana ChoiceCare |
$4,673.31
|
| Rate for Payer: Humana Medicare |
$2,759.51
|
| Rate for Payer: Lucent All Commercial |
$2,759.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,869.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,058.10
|
| Rate for Payer: PHP All Commercial |
$4,103.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,110.21
|
| Rate for Payer: Sagamore Health Network All Products |
$4,177.14
|
| Rate for Payer: Signature Care EPO |
$4,490.96
|
| Rate for Payer: Signature Care PPO |
$4,761.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,599.18
|
| Rate for Payer: United Healthcare Commercial |
$4,263.71
|
| Rate for Payer: United Healthcare Medicare |
$1,785.56
|
|
|
HC W PLATE 89MM OFFSET LAT FIB L
|
Facility
IP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605021
|
|
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 89MM OFFSET LAT FIB L
|
Facility
OP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605021
|
|
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 89MM OFFSET LAT FIB R
|
Facility
OP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605022
|
|
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 89MM OFFSET LAT FIB R
|
Facility
IP
|
$5,652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605022
|
|
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 8 EVANS OPN WEDGE
|
Facility
IP
|
$5,695.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605082
|
|
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 8 EVANS OPN WEDGE
|
Facility
OP
|
$5,695.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605082
|
|
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 8-H ST TUB
|
Facility
IP
|
$2,224.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605001
|
|
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 8-H ST TUB
|
Facility
OP
|
$2,224.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605001
|
|
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 8-H ST TUB
|
Facility
OP
|
$2,485.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,311.05 |
| Rate for Payer: Aetna Commercial |
$2,097.34
|
| Rate for Payer: Aetna Medicare |
$820.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$820.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,427.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,553.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$943.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$902.06
|
| Rate for Payer: Cash Price |
$1,540.70
|
| Rate for Payer: Cash Price |
$1,540.70
|
| Rate for Payer: Centivo All Commercial |
$1,267.35
|
| Rate for Payer: Cigna All Commercial |
$2,144.56
|
| Rate for Payer: CORVEL All Commercial |
$2,311.05
|
| Rate for Payer: Coventry All Commercial |
$2,186.80
|
| Rate for Payer: Encore All Commercial |
$2,287.44
|
| Rate for Payer: Frontpath All Commercial |
$2,286.20
|
| Rate for Payer: Humana ChoiceCare |
$2,146.29
|
| Rate for Payer: Humana Medicare |
$1,267.35
|
| Rate for Payer: Lucent All Commercial |
$1,267.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,236.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,863.75
|
| Rate for Payer: PHP All Commercial |
$1,884.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$969.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,918.42
|
| Rate for Payer: Signature Care EPO |
$2,062.55
|
| Rate for Payer: Signature Care PPO |
$2,186.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,112.25
|
| Rate for Payer: United Healthcare Commercial |
$1,958.18
|
| Rate for Payer: United Healthcare Medicare |
$820.05
|
|
|
HC W PLATE 8-H ST TUB
|
Facility
IP
|
$2,485.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,863.75 |
| Max. Negotiated Rate |
$2,311.05 |
| Rate for Payer: Aetna Commercial |
$2,147.04
|
| Rate for Payer: Cash Price |
$1,540.70
|
| Rate for Payer: Cigna All Commercial |
$2,144.56
|
| Rate for Payer: CORVEL All Commercial |
$2,311.05
|
| Rate for Payer: Coventry All Commercial |
$2,186.80
|
| Rate for Payer: Encore All Commercial |
$2,287.44
|
| Rate for Payer: Frontpath All Commercial |
$2,286.20
|
| Rate for Payer: Humana ChoiceCare |
$2,146.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,236.50
|
| Rate for Payer: PHCS All Commercial |
$1,863.75
|
| Rate for Payer: PHP All Commercial |
$1,884.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,918.42
|
| Rate for Payer: Signature Care EPO |
$2,062.55
|
| Rate for Payer: Signature Care PPO |
$2,186.80
|
| Rate for Payer: United Healthcare Commercial |
$1,958.18
|
|
|
HC W PLATE 8-H UNIV
|
Facility
OP
|
$2,862.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,661.66 |
| Rate for Payer: Aetna Commercial |
$2,415.53
|
| Rate for Payer: Aetna Medicare |
$944.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$944.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,643.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,789.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,086.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,038.91
|
| Rate for Payer: Cash Price |
$1,774.44
|
| Rate for Payer: Cash Price |
$1,774.44
|
| Rate for Payer: Centivo All Commercial |
$1,459.62
|
| Rate for Payer: Cigna All Commercial |
$2,469.91
|
| Rate for Payer: CORVEL All Commercial |
$2,661.66
|
| Rate for Payer: Coventry All Commercial |
$2,518.56
|
| Rate for Payer: Encore All Commercial |
$2,634.47
|
| Rate for Payer: Frontpath All Commercial |
$2,633.04
|
| Rate for Payer: Humana ChoiceCare |
$2,471.91
|
| Rate for Payer: Humana Medicare |
$1,459.62
|
| Rate for Payer: Lucent All Commercial |
$1,459.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,575.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,146.50
|
| Rate for Payer: PHP All Commercial |
$2,170.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,116.18
|
| Rate for Payer: Sagamore Health Network All Products |
$2,209.46
|
| Rate for Payer: Signature Care EPO |
$2,375.46
|
| Rate for Payer: Signature Care PPO |
$2,518.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,432.70
|
| Rate for Payer: United Healthcare Commercial |
$2,255.26
|
| Rate for Payer: United Healthcare Medicare |
$944.46
|
|
|
HC W PLATE 8-H UNIV
|
Facility
IP
|
$2,862.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.50 |
| Max. Negotiated Rate |
$2,661.66 |
| Rate for Payer: Aetna Commercial |
$2,472.77
|
| Rate for Payer: Cash Price |
$1,774.44
|
| Rate for Payer: Cigna All Commercial |
$2,469.91
|
| Rate for Payer: CORVEL All Commercial |
$2,661.66
|
| Rate for Payer: Coventry All Commercial |
$2,518.56
|
| Rate for Payer: Encore All Commercial |
$2,634.47
|
| Rate for Payer: Frontpath All Commercial |
$2,633.04
|
| Rate for Payer: Humana ChoiceCare |
$2,471.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,575.80
|
| Rate for Payer: PHCS All Commercial |
$2,146.50
|
| Rate for Payer: PHP All Commercial |
$2,170.54
|
| Rate for Payer: Sagamore Health Network All Products |
$2,209.46
|
| Rate for Payer: Signature Care EPO |
$2,375.46
|
| Rate for Payer: Signature Care PPO |
$2,518.56
|
| Rate for Payer: United Healthcare Commercial |
$2,255.26
|
|
|
HC W PLATE ANT LT TT FUSION LRG L
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Medicare |
$2,970.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,970.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,168.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,625.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,415.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,267.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Centivo All Commercial |
$4,590.00
|
| Rate for Payer: Cigna All Commercial |
$7,767.00
|
| Rate for Payer: CORVEL All Commercial |
$8,370.00
|
| Rate for Payer: Coventry All Commercial |
$7,920.00
|
| Rate for Payer: Encore All Commercial |
$8,284.50
|
| Rate for Payer: Frontpath All Commercial |
$8,280.00
|
| Rate for Payer: Humana ChoiceCare |
$7,773.30
|
| Rate for Payer: Humana Medicare |
$4,590.00
|
| Rate for Payer: Lucent All Commercial |
$4,590.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,510.00
|
| Rate for Payer: Sagamore Health Network All Products |
$6,948.00
|
| Rate for Payer: Signature Care EPO |
$7,470.00
|
| Rate for Payer: Signature Care PPO |
$7,920.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,650.00
|
| Rate for Payer: United Healthcare Commercial |
$7,092.00
|
| Rate for Payer: United Healthcare Medicare |
$2,970.00
|
|
