|
HC Z 50X32 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605460
|
|
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 51MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605430
|
|
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 51MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605430
|
|
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 52MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605431
|
|
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 52MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605431
|
|
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 53/54/55X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605463
|
|
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 53/54/55X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605463
|
|
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 53MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605432
|
|
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 53MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605432
|
|
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 53X22 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605461
|
|
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 53X22 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605461
|
|
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 53X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605462
|
|
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 53X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605462
|
|
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 53X32 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605464
|
|
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 53X32 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605464
|
|
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 54MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605433
|
|
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 54MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605433
|
|
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 55MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605434
|
|
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 55MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605434
|
|
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 57/58X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605467
|
|
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 57/58X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605467
|
|
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 57MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605435
|
|
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 57MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605435
|
|
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 57X22 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605465
|
|
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 57X22 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605465
|
|
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
|
|
