|
HC Z 20X160 STD BODY STD NK
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605295
|
|
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 Z 20X160 XEXT
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605299
|
|
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 Z 20X160 XEXT
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605299
|
|
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 Z 23MM LPS-FLEX PRLG 1-2 CD
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 23MM LPS-FLEX PRLG 1-2 CD
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 23MM LPS-FLEX PRLG 3-4 CD
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 23MM LPS-FLEX PRLG 3-4 CD
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 23MM LPS-FLEX PRLG 3-4 EF
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 23MM LPS-FLEX PRLG 3-4 EF
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 2.7 PLATE 6H 72MM
|
Facility
IP
|
$1,348.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.19 |
| Max. Negotiated Rate |
$1,253.87 |
| Rate for Payer: Aetna Commercial |
$1,164.89
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cigna All Commercial |
$1,163.54
|
| Rate for Payer: CORVEL All Commercial |
$1,253.87
|
| Rate for Payer: Coventry All Commercial |
$1,186.46
|
| Rate for Payer: Encore All Commercial |
$1,241.06
|
| Rate for Payer: Frontpath All Commercial |
$1,240.39
|
| Rate for Payer: Humana ChoiceCare |
$1,164.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,213.42
|
| Rate for Payer: PHCS All Commercial |
$1,011.19
|
| Rate for Payer: PHP All Commercial |
$1,022.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,040.85
|
| Rate for Payer: Signature Care EPO |
$1,119.05
|
| Rate for Payer: Signature Care PPO |
$1,186.46
|
| Rate for Payer: United Healthcare Commercial |
$1,062.42
|
|
|
HC Z 2.7 PLATE 6H 72MM
|
Facility
OP
|
$1,348.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.92 |
| Max. Negotiated Rate |
$1,253.87 |
| Rate for Payer: Aetna Commercial |
$1,137.92
|
| Rate for Payer: Aetna Medicare |
$444.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$444.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$774.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$842.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$511.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$489.41
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Cash Price |
$835.92
|
| Rate for Payer: Centivo All Commercial |
$687.61
|
| Rate for Payer: Cigna All Commercial |
$1,163.54
|
| Rate for Payer: CORVEL All Commercial |
$1,253.87
|
| Rate for Payer: Coventry All Commercial |
$1,186.46
|
| Rate for Payer: Encore All Commercial |
$1,241.06
|
| Rate for Payer: Frontpath All Commercial |
$1,240.39
|
| Rate for Payer: Humana ChoiceCare |
$1,164.48
|
| Rate for Payer: Humana Medicare |
$687.61
|
| Rate for Payer: Lucent All Commercial |
$687.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,213.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,011.19
|
| Rate for Payer: PHP All Commercial |
$1,022.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$525.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,040.85
|
| Rate for Payer: Signature Care EPO |
$1,119.05
|
| Rate for Payer: Signature Care PPO |
$1,186.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,146.01
|
| Rate for Payer: United Healthcare Commercial |
$1,062.42
|
| Rate for Payer: United Healthcare Medicare |
$444.92
|
|
|
HC Z 2.7 THREADED BENDER
|
Facility
OP
|
$1,235.00
|
|
| Hospital Charge Code |
41606489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Aetna Commercial |
$1,042.34
|
| Rate for Payer: Aetna Medicare |
$407.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$407.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$709.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$772.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$468.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.30
|
| Rate for Payer: Cash Price |
$765.70
|
| Rate for Payer: Cash Price |
$765.70
|
| Rate for Payer: Centivo All Commercial |
$629.85
|
| Rate for Payer: Cigna All Commercial |
$1,065.80
|
| Rate for Payer: CORVEL All Commercial |
$1,148.55
|
| Rate for Payer: Coventry All Commercial |
$1,086.80
|
| Rate for Payer: Encore All Commercial |
$1,136.82
|
| Rate for Payer: Frontpath All Commercial |
$1,136.20
|
| Rate for Payer: Humana ChoiceCare |
$1,066.67
|
| Rate for Payer: Humana Medicare |
$629.85
|
| Rate for Payer: Lucent All Commercial |
$629.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,111.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$926.25
|
| Rate for Payer: PHP All Commercial |
$936.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$481.65
|
| Rate for Payer: Sagamore Health Network All Products |
$953.42
|
| Rate for Payer: Signature Care EPO |
$1,025.05
|
| Rate for Payer: Signature Care PPO |
$1,086.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,049.75
|
| Rate for Payer: United Healthcare Commercial |
$973.18
|
| Rate for Payer: United Healthcare Medicare |
$407.55
|
|
|
HC Z 2.7 THREADED BENDER
|
Facility
IP
|
$1,235.00
|
|
| Hospital Charge Code |
41606489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Aetna Commercial |
$1,067.04
|
| Rate for Payer: Cash Price |
$765.70
|
| Rate for Payer: Cigna All Commercial |
$1,065.80
|
| Rate for Payer: CORVEL All Commercial |
$1,148.55
|
| Rate for Payer: Coventry All Commercial |
$1,086.80
|
| Rate for Payer: Encore All Commercial |
$1,136.82
|
| Rate for Payer: Frontpath All Commercial |
$1,136.20
|
| Rate for Payer: Humana ChoiceCare |
$1,066.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,111.50
|
| Rate for Payer: PHCS All Commercial |
$926.25
|
| Rate for Payer: PHP All Commercial |
$936.62
|
| Rate for Payer: Sagamore Health Network All Products |
$953.42
|
| Rate for Payer: Signature Care EPO |
$1,025.05
|
| Rate for Payer: Signature Care PPO |
$1,086.80
|
| Rate for Payer: United Healthcare Commercial |
$973.18
|
|
|
HC Z 28 MOD HD STD NECK TP1 TAPE
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC Z 28 MOD HD STD NECK TP1 TAPE
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC Z 3.2X30 RNGLC+ACET DRL BIT
|
Facility
OP
|
$627.90
|
|
| Hospital Charge Code |
41603409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$583.95 |
| Rate for Payer: Aetna Commercial |
$529.95
|
| Rate for Payer: Aetna Medicare |
$207.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$360.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$392.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$238.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.93
|
| Rate for Payer: Cash Price |
$389.30
|
| Rate for Payer: Cash Price |
$389.30
|
| Rate for Payer: Centivo All Commercial |
$320.23
|
| Rate for Payer: Cigna All Commercial |
$541.88
|
| Rate for Payer: CORVEL All Commercial |
$583.95
|
| Rate for Payer: Coventry All Commercial |
$552.55
|
| Rate for Payer: Encore All Commercial |
$577.98
|
| Rate for Payer: Frontpath All Commercial |
$577.67
|
| Rate for Payer: Humana ChoiceCare |
$542.32
|
| Rate for Payer: Humana Medicare |
$320.23
|
| Rate for Payer: Lucent All Commercial |
$320.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$565.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$470.92
|
| Rate for Payer: PHP All Commercial |
$476.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.88
|
| Rate for Payer: Sagamore Health Network All Products |
$484.74
|
| Rate for Payer: Signature Care EPO |
$521.16
|
| Rate for Payer: Signature Care PPO |
$552.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$533.72
|
| Rate for Payer: United Healthcare Commercial |
$494.79
|
| Rate for Payer: United Healthcare Medicare |
$207.21
|
|
|
HC Z 3.2X30 RNGLC+ACET DRL BIT
|
Facility
IP
|
$627.90
|
|
| Hospital Charge Code |
41603409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.92 |
| Max. Negotiated Rate |
$583.95 |
| Rate for Payer: Aetna Commercial |
$542.51
|
| Rate for Payer: Cash Price |
$389.30
|
| Rate for Payer: Cigna All Commercial |
$541.88
|
| Rate for Payer: CORVEL All Commercial |
$583.95
|
| Rate for Payer: Coventry All Commercial |
$552.55
|
| Rate for Payer: Encore All Commercial |
$577.98
|
| Rate for Payer: Frontpath All Commercial |
$577.67
|
| Rate for Payer: Humana ChoiceCare |
$542.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$565.11
|
| Rate for Payer: PHCS All Commercial |
$470.92
|
| Rate for Payer: PHP All Commercial |
$476.20
|
| Rate for Payer: Sagamore Health Network All Products |
$484.74
|
| Rate for Payer: Signature Care EPO |
$521.16
|
| Rate for Payer: Signature Care PPO |
$552.55
|
| Rate for Payer: United Healthcare Commercial |
$494.79
|
|
|
HC Z 3.5 LOCK PLATE LAT TIB 6H LT
|
Facility
IP
|
$4,434.19
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,325.64 |
| Max. Negotiated Rate |
$4,123.80 |
| Rate for Payer: Aetna Commercial |
$3,831.14
|
| Rate for Payer: Cash Price |
$2,749.20
|
| Rate for Payer: Cigna All Commercial |
$3,826.71
|
| Rate for Payer: CORVEL All Commercial |
$4,123.80
|
| Rate for Payer: Coventry All Commercial |
$3,902.09
|
| Rate for Payer: Encore All Commercial |
$4,081.67
|
| Rate for Payer: Frontpath All Commercial |
$4,079.45
|
| Rate for Payer: Humana ChoiceCare |
$3,829.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,990.77
|
| Rate for Payer: PHCS All Commercial |
$3,325.64
|
| Rate for Payer: PHP All Commercial |
$3,362.89
|
| Rate for Payer: Sagamore Health Network All Products |
$3,423.19
|
| Rate for Payer: Signature Care EPO |
$3,680.38
|
| Rate for Payer: Signature Care PPO |
$3,902.09
|
| Rate for Payer: United Healthcare Commercial |
$3,494.14
|
|
|
HC Z 3.5 LOCK PLATE LAT TIB 6H LT
|
Facility
OP
|
$4,434.19
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,123.80 |
| Rate for Payer: Aetna Commercial |
$3,742.46
|
| Rate for Payer: Aetna Medicare |
$1,463.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,463.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,546.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,771.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,682.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,609.61
|
| Rate for Payer: Cash Price |
$2,749.20
|
| Rate for Payer: Cash Price |
$2,749.20
|
| Rate for Payer: Centivo All Commercial |
$2,261.44
|
| Rate for Payer: Cigna All Commercial |
$3,826.71
|
| Rate for Payer: CORVEL All Commercial |
$4,123.80
|
| Rate for Payer: Coventry All Commercial |
$3,902.09
|
| Rate for Payer: Encore All Commercial |
$4,081.67
|
| Rate for Payer: Frontpath All Commercial |
$4,079.45
|
| Rate for Payer: Humana ChoiceCare |
$3,829.81
|
| Rate for Payer: Humana Medicare |
$2,261.44
|
| Rate for Payer: Lucent All Commercial |
$2,261.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,990.77
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,325.64
|
| Rate for Payer: PHP All Commercial |
$3,362.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,729.33
|
| Rate for Payer: Sagamore Health Network All Products |
$3,423.19
|
| Rate for Payer: Signature Care EPO |
$3,680.38
|
| Rate for Payer: Signature Care PPO |
$3,902.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,769.06
|
| Rate for Payer: United Healthcare Commercial |
$3,494.14
|
| Rate for Payer: United Healthcare Medicare |
$1,463.28
|
|
|
HC Z 3.5 PLATE 10-H
|
Facility
IP
|
$1,247.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.51 |
| Max. Negotiated Rate |
$1,160.04 |
| Rate for Payer: Aetna Commercial |
$1,077.71
|
| Rate for Payer: Cash Price |
$773.36
|
| Rate for Payer: Cigna All Commercial |
$1,076.46
|
| Rate for Payer: CORVEL All Commercial |
$1,160.04
|
| Rate for Payer: Coventry All Commercial |
$1,097.67
|
| Rate for Payer: Encore All Commercial |
$1,148.19
|
| Rate for Payer: Frontpath All Commercial |
$1,147.56
|
| Rate for Payer: Humana ChoiceCare |
$1,077.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,122.62
|
| Rate for Payer: PHCS All Commercial |
$935.51
|
| Rate for Payer: PHP All Commercial |
$945.99
|
| Rate for Payer: Sagamore Health Network All Products |
$962.95
|
| Rate for Payer: Signature Care EPO |
$1,035.30
|
| Rate for Payer: Signature Care PPO |
$1,097.67
|
| Rate for Payer: United Healthcare Commercial |
$982.91
|
|
|
HC Z 3.5 PLATE 10-H
|
Facility
OP
|
$1,247.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.63 |
| Max. Negotiated Rate |
$1,160.04 |
| Rate for Payer: Aetna Commercial |
$1,052.76
|
| Rate for Payer: Aetna Medicare |
$411.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$411.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$716.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$779.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$473.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$452.79
|
| Rate for Payer: Cash Price |
$773.36
|
| Rate for Payer: Cash Price |
$773.36
|
| Rate for Payer: Centivo All Commercial |
$636.15
|
| Rate for Payer: Cigna All Commercial |
$1,076.46
|
| Rate for Payer: CORVEL All Commercial |
$1,160.04
|
| Rate for Payer: Coventry All Commercial |
$1,097.67
|
| Rate for Payer: Encore All Commercial |
$1,148.19
|
| Rate for Payer: Frontpath All Commercial |
$1,147.56
|
| Rate for Payer: Humana ChoiceCare |
$1,077.34
|
| Rate for Payer: Humana Medicare |
$636.15
|
| Rate for Payer: Lucent All Commercial |
$636.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,122.62
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$935.51
|
| Rate for Payer: PHP All Commercial |
$945.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$486.47
|
| Rate for Payer: Sagamore Health Network All Products |
$962.95
|
| Rate for Payer: Signature Care EPO |
$1,035.30
|
| Rate for Payer: Signature Care PPO |
$1,097.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,060.25
|
| Rate for Payer: United Healthcare Commercial |
$982.91
|
| Rate for Payer: United Healthcare Medicare |
$411.63
|
|
|
HC Z 3.5 PLATE 12-H
|
Facility
OP
|
$1,388.75
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.29 |
| Max. Negotiated Rate |
$1,291.54 |
| Rate for Payer: Aetna Commercial |
$1,172.10
|
| Rate for Payer: Aetna Medicare |
$458.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$458.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$797.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$868.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$527.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$504.12
|
| Rate for Payer: Cash Price |
$861.03
|
| Rate for Payer: Cash Price |
$861.03
|
| Rate for Payer: Centivo All Commercial |
$708.26
|
| Rate for Payer: Cigna All Commercial |
$1,198.49
|
| Rate for Payer: CORVEL All Commercial |
$1,291.54
|
| Rate for Payer: Coventry All Commercial |
$1,222.10
|
| Rate for Payer: Encore All Commercial |
$1,278.34
|
| Rate for Payer: Frontpath All Commercial |
$1,277.65
|
| Rate for Payer: Humana ChoiceCare |
$1,199.46
|
| Rate for Payer: Humana Medicare |
$708.26
|
| Rate for Payer: Lucent All Commercial |
$708.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,249.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,041.56
|
| Rate for Payer: PHP All Commercial |
$1,053.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$541.61
|
| Rate for Payer: Sagamore Health Network All Products |
$1,072.12
|
| Rate for Payer: Signature Care EPO |
$1,152.66
|
| Rate for Payer: Signature Care PPO |
$1,222.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,180.44
|
| Rate for Payer: United Healthcare Commercial |
$1,094.34
|
| Rate for Payer: United Healthcare Medicare |
$458.29
|
|
|
HC Z 3.5 PLATE 12-H
|
Facility
IP
|
$1,388.75
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.56 |
| Max. Negotiated Rate |
$1,291.54 |
| Rate for Payer: Aetna Commercial |
$1,199.88
|
| Rate for Payer: Cash Price |
$861.03
|
| Rate for Payer: Cigna All Commercial |
$1,198.49
|
| Rate for Payer: CORVEL All Commercial |
$1,291.54
|
| Rate for Payer: Coventry All Commercial |
$1,222.10
|
| Rate for Payer: Encore All Commercial |
$1,278.34
|
| Rate for Payer: Frontpath All Commercial |
$1,277.65
|
| Rate for Payer: Humana ChoiceCare |
$1,199.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,249.88
|
| Rate for Payer: PHCS All Commercial |
$1,041.56
|
| Rate for Payer: PHP All Commercial |
$1,053.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,072.12
|
| Rate for Payer: Signature Care EPO |
$1,152.66
|
| Rate for Payer: Signature Care PPO |
$1,222.10
|
| Rate for Payer: United Healthcare Commercial |
$1,094.34
|
|
|
HC Z 3.5 PLATE 14-H
|
Facility
OP
|
$1,469.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.95 |
| Max. Negotiated Rate |
$1,366.68 |
| Rate for Payer: Aetna Commercial |
$1,240.30
|
| Rate for Payer: Aetna Medicare |
$484.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$484.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$843.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$918.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$557.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$533.45
|
| Rate for Payer: Cash Price |
$911.12
|
| Rate for Payer: Cash Price |
$911.12
|
| Rate for Payer: Centivo All Commercial |
$749.47
|
| Rate for Payer: Cigna All Commercial |
$1,268.22
|
| Rate for Payer: CORVEL All Commercial |
$1,366.68
|
| Rate for Payer: Coventry All Commercial |
$1,293.20
|
| Rate for Payer: Encore All Commercial |
$1,352.72
|
| Rate for Payer: Frontpath All Commercial |
$1,351.99
|
| Rate for Payer: Humana ChoiceCare |
$1,269.25
|
| Rate for Payer: Humana Medicare |
$749.47
|
| Rate for Payer: Lucent All Commercial |
$749.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,322.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,102.16
|
| Rate for Payer: PHP All Commercial |
$1,114.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$573.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,134.49
|
| Rate for Payer: Signature Care EPO |
$1,219.73
|
| Rate for Payer: Signature Care PPO |
$1,293.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,249.12
|
| Rate for Payer: United Healthcare Commercial |
$1,158.01
|
| Rate for Payer: United Healthcare Medicare |
$484.95
|
|
|
HC Z 3.5 PLATE 14-H
|
Facility
IP
|
$1,469.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.16 |
| Max. Negotiated Rate |
$1,366.68 |
| Rate for Payer: Aetna Commercial |
$1,269.69
|
| Rate for Payer: Cash Price |
$911.12
|
| Rate for Payer: Cigna All Commercial |
$1,268.22
|
| Rate for Payer: CORVEL All Commercial |
$1,366.68
|
| Rate for Payer: Coventry All Commercial |
$1,293.20
|
| Rate for Payer: Encore All Commercial |
$1,352.72
|
| Rate for Payer: Frontpath All Commercial |
$1,351.99
|
| Rate for Payer: Humana ChoiceCare |
$1,269.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,322.60
|
| Rate for Payer: PHCS All Commercial |
$1,102.16
|
| Rate for Payer: PHP All Commercial |
$1,114.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,134.49
|
| Rate for Payer: Signature Care EPO |
$1,219.73
|
| Rate for Payer: Signature Care PPO |
$1,293.20
|
| Rate for Payer: United Healthcare Commercial |
$1,158.01
|
|
