|
HC W PLATE ANT LT TT FUSION LRG L
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| 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: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| 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: United Healthcare Commercial |
$7,092.00
|
|
|
HC W PLATE ANT LT TT FUSION LRG R
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| 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: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| 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: United Healthcare Commercial |
$7,092.00
|
|
|
HC W PLATE ANT LT TT FUSION LRG R
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605047
|
|
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
|
|
|
HC W PLATE ANT LT TT FUSION SM L
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| 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: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| 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: United Healthcare Commercial |
$7,092.00
|
|
|
HC W PLATE ANT LT TT FUSION SM L
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605044
|
|
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
|
|
|
HC W PLATE ANT LT TT FUSION SM R
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| 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: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| 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: United Healthcare Commercial |
$7,092.00
|
|
|
HC W PLATE ANT LT TT FUSION SM R
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605045
|
|
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
|
|
|
HC W PLATE ANT ST TT FUSION LRG L
|
Facility
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,456.60
|
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,782.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.95
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Centivo All Commercial |
$3,901.50
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Humana Medicare |
$3,901.50
|
| Rate for Payer: Lucent All Commercial |
$3,901.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.50
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
| Rate for Payer: United Healthcare Medicare |
$2,524.50
|
|
|
HC W PLATE ANT ST TT FUSION LRG L
|
Facility
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.50 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,609.60
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
|
|
HC W PLATE ANT ST TT FUSION LRG R
|
Facility
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,456.60
|
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,782.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.95
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Centivo All Commercial |
$3,901.50
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Humana Medicare |
$3,901.50
|
| Rate for Payer: Lucent All Commercial |
$3,901.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.50
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
| Rate for Payer: United Healthcare Medicare |
$2,524.50
|
|
|
HC W PLATE ANT ST TT FUSION LRG R
|
Facility
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.50 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,609.60
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
|
|
HC W PLATE ANT ST TT FUSION SM L
|
Facility
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,456.60
|
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,782.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.95
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Centivo All Commercial |
$3,901.50
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Humana Medicare |
$3,901.50
|
| Rate for Payer: Lucent All Commercial |
$3,901.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.50
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
| Rate for Payer: United Healthcare Medicare |
$2,524.50
|
|
|
HC W PLATE ANT ST TT FUSION SM L
|
Facility
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.50 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,609.60
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
|
|
HC W PLATE ANT ST TT FUSION SM R
|
Facility
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,737.50 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,609.60
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
|
|
HC W PLATE ANT ST TT FUSION SM R
|
Facility
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,114.50 |
| Rate for Payer: Aetna Commercial |
$6,456.60
|
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,524.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,393.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,782.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,903.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,776.95
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Cash Price |
$4,743.00
|
| Rate for Payer: Centivo All Commercial |
$3,901.50
|
| Rate for Payer: Cigna All Commercial |
$6,601.95
|
| Rate for Payer: CORVEL All Commercial |
$7,114.50
|
| Rate for Payer: Coventry All Commercial |
$6,732.00
|
| Rate for Payer: Encore All Commercial |
$7,041.82
|
| Rate for Payer: Frontpath All Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$6,607.30
|
| Rate for Payer: Humana Medicare |
$3,901.50
|
| Rate for Payer: Lucent All Commercial |
$3,901.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,885.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,737.50
|
| Rate for Payer: PHP All Commercial |
$5,801.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,983.50
|
| Rate for Payer: Sagamore Health Network All Products |
$5,905.80
|
| Rate for Payer: Signature Care EPO |
$6,349.50
|
| Rate for Payer: Signature Care PPO |
$6,732.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare Commercial |
$6,028.20
|
| Rate for Payer: United Healthcare Medicare |
$2,524.50
|
|
|
HC W PLATE BOW 3MM
|
Facility
OP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603572
|
|
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 BOW 3MM
|
Facility
IP
|
$4,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603572
|
|
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 FIRST RAY MED
|
Facility
IP
|
$4,219.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.40 |
| Max. Negotiated Rate |
$3,923.86 |
| Rate for Payer: Aetna Commercial |
$3,645.39
|
| Rate for Payer: Cash Price |
$2,615.90
|
| Rate for Payer: Cigna All Commercial |
$3,641.17
|
| Rate for Payer: CORVEL All Commercial |
$3,923.86
|
| Rate for Payer: Coventry All Commercial |
$3,712.90
|
| Rate for Payer: Encore All Commercial |
$3,883.77
|
| Rate for Payer: Frontpath All Commercial |
$3,881.66
|
| Rate for Payer: Humana ChoiceCare |
$3,644.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,797.28
|
| Rate for Payer: PHCS All Commercial |
$3,164.40
|
| Rate for Payer: PHP All Commercial |
$3,199.84
|
| Rate for Payer: Sagamore Health Network All Products |
$3,257.22
|
| Rate for Payer: Signature Care EPO |
$3,501.94
|
| Rate for Payer: Signature Care PPO |
$3,712.90
|
| Rate for Payer: United Healthcare Commercial |
$3,324.73
|
|
|
HC W PLATE FIRST RAY MED
|
Facility
OP
|
$4,219.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,923.86 |
| Rate for Payer: Aetna Commercial |
$3,561.00
|
| Rate for Payer: Aetna Medicare |
$1,392.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,392.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,423.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,637.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,601.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,531.57
|
| Rate for Payer: Cash Price |
$2,615.90
|
| Rate for Payer: Cash Price |
$2,615.90
|
| Rate for Payer: Centivo All Commercial |
$2,151.79
|
| Rate for Payer: Cigna All Commercial |
$3,641.17
|
| Rate for Payer: CORVEL All Commercial |
$3,923.86
|
| Rate for Payer: Coventry All Commercial |
$3,712.90
|
| Rate for Payer: Encore All Commercial |
$3,883.77
|
| Rate for Payer: Frontpath All Commercial |
$3,881.66
|
| Rate for Payer: Humana ChoiceCare |
$3,644.12
|
| Rate for Payer: Humana Medicare |
$2,151.79
|
| Rate for Payer: Lucent All Commercial |
$2,151.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,797.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,164.40
|
| Rate for Payer: PHP All Commercial |
$3,199.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,645.49
|
| Rate for Payer: Sagamore Health Network All Products |
$3,257.22
|
| Rate for Payer: Signature Care EPO |
$3,501.94
|
| Rate for Payer: Signature Care PPO |
$3,712.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,586.32
|
| Rate for Payer: United Healthcare Commercial |
$3,324.73
|
| Rate for Payer: United Healthcare Medicare |
$1,392.34
|
|
|
HC W PLATE FIRST RAY SM
|
Facility
IP
|
$4,219.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.40 |
| Max. Negotiated Rate |
$3,923.86 |
| Rate for Payer: Aetna Commercial |
$3,645.39
|
| Rate for Payer: Cash Price |
$2,615.90
|
| Rate for Payer: Cigna All Commercial |
$3,641.17
|
| Rate for Payer: CORVEL All Commercial |
$3,923.86
|
| Rate for Payer: Coventry All Commercial |
$3,712.90
|
| Rate for Payer: Encore All Commercial |
$3,883.77
|
| Rate for Payer: Frontpath All Commercial |
$3,881.66
|
| Rate for Payer: Humana ChoiceCare |
$3,644.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,797.28
|
| Rate for Payer: PHCS All Commercial |
$3,164.40
|
| Rate for Payer: PHP All Commercial |
$3,199.84
|
| Rate for Payer: Sagamore Health Network All Products |
$3,257.22
|
| Rate for Payer: Signature Care EPO |
$3,501.94
|
| Rate for Payer: Signature Care PPO |
$3,712.90
|
| Rate for Payer: United Healthcare Commercial |
$3,324.73
|
|
|
HC W PLATE FIRST RAY SM
|
Facility
OP
|
$4,219.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,923.86 |
| Rate for Payer: Aetna Commercial |
$3,561.00
|
| Rate for Payer: Aetna Medicare |
$1,392.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,392.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,423.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,637.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,601.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,531.57
|
| Rate for Payer: Cash Price |
$2,615.90
|
| Rate for Payer: Cash Price |
$2,615.90
|
| Rate for Payer: Centivo All Commercial |
$2,151.79
|
| Rate for Payer: Cigna All Commercial |
$3,641.17
|
| Rate for Payer: CORVEL All Commercial |
$3,923.86
|
| Rate for Payer: Coventry All Commercial |
$3,712.90
|
| Rate for Payer: Encore All Commercial |
$3,883.77
|
| Rate for Payer: Frontpath All Commercial |
$3,881.66
|
| Rate for Payer: Humana ChoiceCare |
$3,644.12
|
| Rate for Payer: Humana Medicare |
$2,151.79
|
| Rate for Payer: Lucent All Commercial |
$2,151.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,797.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,164.40
|
| Rate for Payer: PHP All Commercial |
$3,199.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,645.49
|
| Rate for Payer: Sagamore Health Network All Products |
$3,257.22
|
| Rate for Payer: Signature Care EPO |
$3,501.94
|
| Rate for Payer: Signature Care PPO |
$3,712.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,586.32
|
| Rate for Payer: United Healthcare Commercial |
$3,324.73
|
| Rate for Payer: United Healthcare Medicare |
$1,392.34
|
|
|
HC W PLATE FRAC PERM LRG
|
Facility
OP
|
$5,104.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,747.46 |
| Rate for Payer: Aetna Commercial |
$4,308.45
|
| Rate for Payer: Aetna Medicare |
$1,684.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,684.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,931.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,191.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,937.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,853.04
|
| Rate for Payer: Cash Price |
$3,164.98
|
| Rate for Payer: Cash Price |
$3,164.98
|
| Rate for Payer: Centivo All Commercial |
$2,603.45
|
| Rate for Payer: Cigna All Commercial |
$4,405.44
|
| Rate for Payer: CORVEL All Commercial |
$4,747.46
|
| Rate for Payer: Coventry All Commercial |
$4,492.22
|
| Rate for Payer: Encore All Commercial |
$4,698.97
|
| Rate for Payer: Frontpath All Commercial |
$4,696.42
|
| Rate for Payer: Humana ChoiceCare |
$4,409.02
|
| Rate for Payer: Humana Medicare |
$2,603.45
|
| Rate for Payer: Lucent All Commercial |
$2,603.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,594.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,828.60
|
| Rate for Payer: PHP All Commercial |
$3,871.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,990.87
|
| Rate for Payer: Sagamore Health Network All Products |
$3,940.91
|
| Rate for Payer: Signature Care EPO |
$4,236.98
|
| Rate for Payer: Signature Care PPO |
$4,492.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,339.08
|
| Rate for Payer: United Healthcare Commercial |
$4,022.58
|
| Rate for Payer: United Healthcare Medicare |
$1,684.58
|
|
|
HC W PLATE FRAC PERM LRG
|
Facility
IP
|
$5,104.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,828.60 |
| Max. Negotiated Rate |
$4,747.46 |
| Rate for Payer: Aetna Commercial |
$4,410.55
|
| Rate for Payer: Cash Price |
$3,164.98
|
| Rate for Payer: Cigna All Commercial |
$4,405.44
|
| Rate for Payer: CORVEL All Commercial |
$4,747.46
|
| Rate for Payer: Coventry All Commercial |
$4,492.22
|
| Rate for Payer: Encore All Commercial |
$4,698.97
|
| Rate for Payer: Frontpath All Commercial |
$4,696.42
|
| Rate for Payer: Humana ChoiceCare |
$4,409.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,594.32
|
| Rate for Payer: PHCS All Commercial |
$3,828.60
|
| Rate for Payer: PHP All Commercial |
$3,871.48
|
| Rate for Payer: Sagamore Health Network All Products |
$3,940.91
|
| Rate for Payer: Signature Care EPO |
$4,236.98
|
| Rate for Payer: Signature Care PPO |
$4,492.22
|
| Rate for Payer: United Healthcare Commercial |
$4,022.58
|
|
|
HC W PLATE FRAC PERM SM
|
Facility
OP
|
$5,104.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,747.46 |
| Rate for Payer: Aetna Commercial |
$4,308.45
|
| Rate for Payer: Aetna Medicare |
$1,684.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,684.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,931.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,191.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,937.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,853.04
|
| Rate for Payer: Cash Price |
$3,164.98
|
| Rate for Payer: Cash Price |
$3,164.98
|
| Rate for Payer: Centivo All Commercial |
$2,603.45
|
| Rate for Payer: Cigna All Commercial |
$4,405.44
|
| Rate for Payer: CORVEL All Commercial |
$4,747.46
|
| Rate for Payer: Coventry All Commercial |
$4,492.22
|
| Rate for Payer: Encore All Commercial |
$4,698.97
|
| Rate for Payer: Frontpath All Commercial |
$4,696.42
|
| Rate for Payer: Humana ChoiceCare |
$4,409.02
|
| Rate for Payer: Humana Medicare |
$2,603.45
|
| Rate for Payer: Lucent All Commercial |
$2,603.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,594.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,828.60
|
| Rate for Payer: PHP All Commercial |
$3,871.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,990.87
|
| Rate for Payer: Sagamore Health Network All Products |
$3,940.91
|
| Rate for Payer: Signature Care EPO |
$4,236.98
|
| Rate for Payer: Signature Care PPO |
$4,492.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,339.08
|
| Rate for Payer: United Healthcare Commercial |
$4,022.58
|
| Rate for Payer: United Healthcare Medicare |
$1,684.58
|
|
|
HC W PLATE FRAC PERM SM
|
Facility
IP
|
$5,104.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,828.60 |
| Max. Negotiated Rate |
$4,747.46 |
| Rate for Payer: Aetna Commercial |
$4,410.55
|
| Rate for Payer: Cash Price |
$3,164.98
|
| Rate for Payer: Cigna All Commercial |
$4,405.44
|
| Rate for Payer: CORVEL All Commercial |
$4,747.46
|
| Rate for Payer: Coventry All Commercial |
$4,492.22
|
| Rate for Payer: Encore All Commercial |
$4,698.97
|
| Rate for Payer: Frontpath All Commercial |
$4,696.42
|
| Rate for Payer: Humana ChoiceCare |
$4,409.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,594.32
|
| Rate for Payer: PHCS All Commercial |
$3,828.60
|
| Rate for Payer: PHP All Commercial |
$3,871.48
|
| Rate for Payer: Sagamore Health Network All Products |
$3,940.91
|
| Rate for Payer: Signature Care EPO |
$4,236.98
|
| Rate for Payer: Signature Care PPO |
$4,492.22
|
| Rate for Payer: United Healthcare Commercial |
$4,022.58
|
|
