|
HC W SCREW 7X55 CANN
|
Facility
OP
|
$1,635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,520.55 |
| Rate for Payer: Aetna Commercial |
$1,379.94
|
| Rate for Payer: Aetna Medicare |
$539.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$539.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$938.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,022.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$620.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$593.50
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Centivo All Commercial |
$833.85
|
| Rate for Payer: Cigna All Commercial |
$1,411.00
|
| Rate for Payer: CORVEL All Commercial |
$1,520.55
|
| Rate for Payer: Coventry All Commercial |
$1,438.80
|
| Rate for Payer: Encore All Commercial |
$1,505.02
|
| Rate for Payer: Frontpath All Commercial |
$1,504.20
|
| Rate for Payer: Humana ChoiceCare |
$1,412.15
|
| Rate for Payer: Humana Medicare |
$833.85
|
| Rate for Payer: Lucent All Commercial |
$833.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,471.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,226.25
|
| Rate for Payer: PHP All Commercial |
$1,239.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$637.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,262.22
|
| Rate for Payer: Signature Care EPO |
$1,357.05
|
| Rate for Payer: Signature Care PPO |
$1,438.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,389.75
|
| Rate for Payer: United Healthcare Commercial |
$1,288.38
|
| Rate for Payer: United Healthcare Medicare |
$539.55
|
|
|
HC W SCREW 7X55 CANN
|
Facility
IP
|
$1,635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$1,520.55 |
| Rate for Payer: Aetna Commercial |
$1,412.64
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna All Commercial |
$1,411.00
|
| Rate for Payer: CORVEL All Commercial |
$1,520.55
|
| Rate for Payer: Coventry All Commercial |
$1,438.80
|
| Rate for Payer: Encore All Commercial |
$1,505.02
|
| Rate for Payer: Frontpath All Commercial |
$1,504.20
|
| Rate for Payer: Humana ChoiceCare |
$1,412.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,471.50
|
| Rate for Payer: PHCS All Commercial |
$1,226.25
|
| Rate for Payer: PHP All Commercial |
$1,239.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,262.22
|
| Rate for Payer: Signature Care EPO |
$1,357.05
|
| Rate for Payer: Signature Care PPO |
$1,438.80
|
| Rate for Payer: United Healthcare Commercial |
$1,288.38
|
|
|
HC W STAPLE FUSEFORCE 10X10
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE FUSEFORCE 10X10
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE FUSEFORCE 8X8
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE FUSEFORCE 8X8
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE NITINOL 10X10
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE NITINOL 10X10
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE NITINOL 10X12
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE NITINOL 10X12
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE NITINOL 10X15X13
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE NITINOL 10X15X13
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE NITINOL 12X12
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE NITINOL 12X12
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE NITINOL 15X15
|
Facility
OP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,530.25
|
| Rate for Payer: Aetna Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,082.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,355.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,037.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,948.44
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Centivo All Commercial |
$2,737.48
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Humana Medicare |
$2,737.48
|
| Rate for Payer: Lucent All Commercial |
$2,737.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,093.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,562.46
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
| Rate for Payer: United Healthcare Medicare |
$1,771.31
|
|
|
HC W STAPLE NITINOL 15X15
|
Facility
IP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,025.70 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,637.61
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
|
|
HC W STAPLE NITINOL 18X16
|
Facility
OP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,530.25
|
| Rate for Payer: Aetna Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,082.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,355.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,037.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,948.44
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Centivo All Commercial |
$2,737.48
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Humana Medicare |
$2,737.48
|
| Rate for Payer: Lucent All Commercial |
$2,737.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,093.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,562.46
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
| Rate for Payer: United Healthcare Medicare |
$1,771.31
|
|
|
HC W STAPLE NITINOL 18X16
|
Facility
IP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,025.70 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,637.61
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
|
|
HC W STAPLE NITINOL 20X20
|
Facility
OP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,530.25
|
| Rate for Payer: Aetna Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,082.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,355.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,037.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,948.44
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Centivo All Commercial |
$2,737.48
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Humana Medicare |
$2,737.48
|
| Rate for Payer: Lucent All Commercial |
$2,737.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,093.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,562.46
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
| Rate for Payer: United Healthcare Medicare |
$1,771.31
|
|
|
HC W STAPLE NITINOL 20X20
|
Facility
IP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,025.70 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,637.61
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
|
|
HC W STAPLE NITINOL 25X22
|
Facility
OP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,530.25
|
| Rate for Payer: Aetna Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,771.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,082.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,355.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,037.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,948.44
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Centivo All Commercial |
$2,737.48
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Humana Medicare |
$2,737.48
|
| Rate for Payer: Lucent All Commercial |
$2,737.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,093.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,562.46
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
| Rate for Payer: United Healthcare Medicare |
$1,771.31
|
|
|
HC W STAPLE NITINOL 25X22
|
Facility
IP
|
$5,367.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,025.70 |
| Max. Negotiated Rate |
$4,991.87 |
| Rate for Payer: Aetna Commercial |
$4,637.61
|
| Rate for Payer: Cash Price |
$3,327.91
|
| Rate for Payer: Cigna All Commercial |
$4,632.24
|
| Rate for Payer: CORVEL All Commercial |
$4,991.87
|
| Rate for Payer: Coventry All Commercial |
$4,723.49
|
| Rate for Payer: Encore All Commercial |
$4,940.88
|
| Rate for Payer: Frontpath All Commercial |
$4,938.19
|
| Rate for Payer: Humana ChoiceCare |
$4,636.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,830.84
|
| Rate for Payer: PHCS All Commercial |
$4,025.70
|
| Rate for Payer: PHP All Commercial |
$4,070.79
|
| Rate for Payer: Sagamore Health Network All Products |
$4,143.79
|
| Rate for Payer: Signature Care EPO |
$4,455.11
|
| Rate for Payer: Signature Care PPO |
$4,723.49
|
| Rate for Payer: United Healthcare Commercial |
$4,229.67
|
|
|
HC W STAPLE NITINOL 8X8
|
Facility
OP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,260.20
|
| Rate for Payer: Aetna Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,274.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,218.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,414.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,465.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.20
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Centivo All Commercial |
$1,970.03
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Humana Medicare |
$1,970.03
|
| Rate for Payer: Lucent All Commercial |
$1,970.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,506.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
| Rate for Payer: United Healthcare Medicare |
$1,274.72
|
|
|
HC W STAPLE NITINOL 8X8
|
Facility
IP
|
$3,862.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.10 |
| Max. Negotiated Rate |
$3,592.40 |
| Rate for Payer: Aetna Commercial |
$3,337.46
|
| Rate for Payer: Cash Price |
$2,394.94
|
| Rate for Payer: Cigna All Commercial |
$3,333.60
|
| Rate for Payer: CORVEL All Commercial |
$3,592.40
|
| Rate for Payer: Coventry All Commercial |
$3,399.26
|
| Rate for Payer: Encore All Commercial |
$3,555.71
|
| Rate for Payer: Frontpath All Commercial |
$3,553.78
|
| Rate for Payer: Humana ChoiceCare |
$3,336.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,476.52
|
| Rate for Payer: PHCS All Commercial |
$2,897.10
|
| Rate for Payer: PHP All Commercial |
$2,929.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,982.08
|
| Rate for Payer: Signature Care EPO |
$3,206.12
|
| Rate for Payer: Signature Care PPO |
$3,399.26
|
| Rate for Payer: United Healthcare Commercial |
$3,043.89
|
|
|
HC W STAPLE SIZER
|
Facility
OP
|
$812.00
|
|
| Hospital Charge Code |
41606928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$755.16 |
| Rate for Payer: Aetna Commercial |
$685.33
|
| Rate for Payer: Aetna Medicare |
$267.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$267.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$466.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$507.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$308.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$294.76
|
| Rate for Payer: Cash Price |
$503.44
|
| Rate for Payer: Cash Price |
$503.44
|
| Rate for Payer: Centivo All Commercial |
$414.12
|
| Rate for Payer: Cigna All Commercial |
$700.76
|
| Rate for Payer: CORVEL All Commercial |
$755.16
|
| Rate for Payer: Coventry All Commercial |
$714.56
|
| Rate for Payer: Encore All Commercial |
$747.45
|
| Rate for Payer: Frontpath All Commercial |
$747.04
|
| Rate for Payer: Humana ChoiceCare |
$701.32
|
| Rate for Payer: Humana Medicare |
$414.12
|
| Rate for Payer: Lucent All Commercial |
$414.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$730.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$609.00
|
| Rate for Payer: PHP All Commercial |
$615.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$316.68
|
| Rate for Payer: Sagamore Health Network All Products |
$626.86
|
| Rate for Payer: Signature Care EPO |
$673.96
|
| Rate for Payer: Signature Care PPO |
$714.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$690.20
|
| Rate for Payer: United Healthcare Commercial |
$639.86
|
| Rate for Payer: United Healthcare Medicare |
$267.96
|
|
