|
HC Z 40X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,056.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Centivo All Commercial |
$938.40
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent All Commercial |
$938.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$717.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC Z 4-10 BONE CUBES 60CC
|
Facility
IP
|
$2,009.74
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.30 |
| Max. Negotiated Rate |
$1,869.06 |
| Rate for Payer: Aetna Commercial |
$1,736.42
|
| Rate for Payer: Cash Price |
$1,246.04
|
| Rate for Payer: Cigna All Commercial |
$1,734.41
|
| Rate for Payer: CORVEL All Commercial |
$1,869.06
|
| Rate for Payer: Coventry All Commercial |
$1,768.57
|
| Rate for Payer: Encore All Commercial |
$1,849.97
|
| Rate for Payer: Frontpath All Commercial |
$1,848.96
|
| Rate for Payer: Humana ChoiceCare |
$1,735.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,808.77
|
| Rate for Payer: PHCS All Commercial |
$1,507.30
|
| Rate for Payer: PHP All Commercial |
$1,524.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,551.52
|
| Rate for Payer: Signature Care EPO |
$1,668.08
|
| Rate for Payer: Signature Care PPO |
$1,768.57
|
| Rate for Payer: United Healthcare Commercial |
$1,583.68
|
|
|
HC Z 4-10 BONE CUBES 60CC
|
Facility
OP
|
$2,009.74
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,869.06 |
| Rate for Payer: Aetna Commercial |
$1,696.22
|
| Rate for Payer: Aetna Medicare |
$663.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$663.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,154.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,256.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$762.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$729.54
|
| Rate for Payer: Cash Price |
$1,246.04
|
| Rate for Payer: Cash Price |
$1,246.04
|
| Rate for Payer: Centivo All Commercial |
$1,024.97
|
| Rate for Payer: Cigna All Commercial |
$1,734.41
|
| Rate for Payer: CORVEL All Commercial |
$1,869.06
|
| Rate for Payer: Coventry All Commercial |
$1,768.57
|
| Rate for Payer: Encore All Commercial |
$1,849.97
|
| Rate for Payer: Frontpath All Commercial |
$1,848.96
|
| Rate for Payer: Humana ChoiceCare |
$1,735.81
|
| Rate for Payer: Humana Medicare |
$1,024.97
|
| Rate for Payer: Lucent All Commercial |
$1,024.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,808.77
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,507.30
|
| Rate for Payer: PHP All Commercial |
$1,524.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$783.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,551.52
|
| Rate for Payer: Signature Care EPO |
$1,668.08
|
| Rate for Payer: Signature Care PPO |
$1,768.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,708.28
|
| Rate for Payer: United Healthcare Commercial |
$1,583.68
|
| Rate for Payer: United Healthcare Medicare |
$663.21
|
|
|
HC Z 4-10 BONE GRAFT 30CC
|
Facility
IP
|
$1,704.65
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.49 |
| Max. Negotiated Rate |
$1,585.32 |
| Rate for Payer: Aetna Commercial |
$1,472.82
|
| Rate for Payer: Cash Price |
$1,056.88
|
| Rate for Payer: Cigna All Commercial |
$1,471.11
|
| Rate for Payer: CORVEL All Commercial |
$1,585.32
|
| Rate for Payer: Coventry All Commercial |
$1,500.09
|
| Rate for Payer: Encore All Commercial |
$1,569.13
|
| Rate for Payer: Frontpath All Commercial |
$1,568.28
|
| Rate for Payer: Humana ChoiceCare |
$1,472.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,534.18
|
| Rate for Payer: PHCS All Commercial |
$1,278.49
|
| Rate for Payer: PHP All Commercial |
$1,292.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1,315.99
|
| Rate for Payer: Signature Care EPO |
$1,414.86
|
| Rate for Payer: Signature Care PPO |
$1,500.09
|
| Rate for Payer: United Healthcare Commercial |
$1,343.26
|
|
|
HC Z 4-10 BONE GRAFT 30CC
|
Facility
OP
|
$1,704.65
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,585.32 |
| Rate for Payer: Aetna Commercial |
$1,438.72
|
| Rate for Payer: Aetna Medicare |
$562.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$562.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$978.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,065.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$646.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$618.79
|
| Rate for Payer: Cash Price |
$1,056.88
|
| Rate for Payer: Cash Price |
$1,056.88
|
| Rate for Payer: Centivo All Commercial |
$869.37
|
| Rate for Payer: Cigna All Commercial |
$1,471.11
|
| Rate for Payer: CORVEL All Commercial |
$1,585.32
|
| Rate for Payer: Coventry All Commercial |
$1,500.09
|
| Rate for Payer: Encore All Commercial |
$1,569.13
|
| Rate for Payer: Frontpath All Commercial |
$1,568.28
|
| Rate for Payer: Humana ChoiceCare |
$1,472.31
|
| Rate for Payer: Humana Medicare |
$869.37
|
| Rate for Payer: Lucent All Commercial |
$869.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,534.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,278.49
|
| Rate for Payer: PHP All Commercial |
$1,292.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$664.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1,315.99
|
| Rate for Payer: Signature Care EPO |
$1,414.86
|
| Rate for Payer: Signature Care PPO |
$1,500.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,448.95
|
| Rate for Payer: United Healthcare Commercial |
$1,343.26
|
| Rate for Payer: United Healthcare Medicare |
$562.53
|
|
|
HC Z 41MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,677.20
|
| Rate for Payer: Aetna Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,242.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$754.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$721.35
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Centivo All Commercial |
$1,013.47
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Humana Medicare |
$1,013.47
|
| Rate for Payer: Lucent All Commercial |
$1,013.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$775.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
| Rate for Payer: United Healthcare Medicare |
$655.78
|
|
|
HC Z 41MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.40 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,716.94
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
|
|
HC Z 42/43X22 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,056.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Centivo All Commercial |
$938.40
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent All Commercial |
$938.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$717.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC Z 42/43X22 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC Z 42MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.40 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,716.94
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
|
|
HC Z 42MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,677.20
|
| Rate for Payer: Aetna Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,242.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$754.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$721.35
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Centivo All Commercial |
$1,013.47
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Humana Medicare |
$1,013.47
|
| Rate for Payer: Lucent All Commercial |
$1,013.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$775.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
| Rate for Payer: United Healthcare Medicare |
$655.78
|
|
|
HC Z 42X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC Z 42X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,056.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Centivo All Commercial |
$938.40
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent All Commercial |
$938.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$717.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC Z 43MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.40 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,716.94
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
|
|
HC Z 43MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,677.20
|
| Rate for Payer: Aetna Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,242.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$754.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$721.35
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Centivo All Commercial |
$1,013.47
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Humana Medicare |
$1,013.47
|
| Rate for Payer: Lucent All Commercial |
$1,013.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$775.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
| Rate for Payer: United Healthcare Medicare |
$655.78
|
|
|
HC Z 44/45/46X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,056.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Centivo All Commercial |
$938.40
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent All Commercial |
$938.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$717.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC Z 44/45/46X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC Z 44MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.40 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,716.94
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
|
|
HC Z 44MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,677.20
|
| Rate for Payer: Aetna Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,242.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$754.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$721.35
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Centivo All Commercial |
$1,013.47
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Humana Medicare |
$1,013.47
|
| Rate for Payer: Lucent All Commercial |
$1,013.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$775.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
| Rate for Payer: United Healthcare Medicare |
$655.78
|
|
|
HC Z 44X22 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,056.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Centivo All Commercial |
$938.40
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent All Commercial |
$938.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$717.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC Z 44X22 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC Z 44X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,589.76
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
|
|
HC Z 44X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,711.20 |
| Rate for Payer: Aetna Commercial |
$1,552.96
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,056.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.92
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Centivo All Commercial |
$938.40
|
| Rate for Payer: Cigna All Commercial |
$1,587.92
|
| Rate for Payer: CORVEL All Commercial |
$1,711.20
|
| Rate for Payer: Coventry All Commercial |
$1,619.20
|
| Rate for Payer: Encore All Commercial |
$1,693.72
|
| Rate for Payer: Frontpath All Commercial |
$1,692.80
|
| Rate for Payer: Humana ChoiceCare |
$1,589.21
|
| Rate for Payer: Humana Medicare |
$938.40
|
| Rate for Payer: Lucent All Commercial |
$938.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,656.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,380.00
|
| Rate for Payer: PHP All Commercial |
$1,395.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$717.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,420.48
|
| Rate for Payer: Signature Care EPO |
$1,527.20
|
| Rate for Payer: Signature Care PPO |
$1,619.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Commercial |
$1,449.92
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
|
|
HC Z 45MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.40 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,716.94
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
|
|
HC Z 45MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,677.20
|
| Rate for Payer: Aetna Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$655.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,242.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$754.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$721.35
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Centivo All Commercial |
$1,013.47
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Humana Medicare |
$1,013.47
|
| Rate for Payer: Lucent All Commercial |
$1,013.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$775.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
| Rate for Payer: United Healthcare Medicare |
$655.78
|
|
