|
HC Z 57X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605466
|
|
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 57X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605466
|
|
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 57X32 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605468
|
|
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 57X32 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605468
|
|
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 58MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605436
|
|
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 58MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605436
|
|
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 5CC BETA-BSM KIT
|
Facility
OP
|
$9,568.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,898.98 |
| Rate for Payer: Aetna Commercial |
$8,076.07
|
| Rate for Payer: Aetna Medicare |
$3,157.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,157.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,495.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,981.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,631.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,473.47
|
| Rate for Payer: Cash Price |
$5,932.66
|
| Rate for Payer: Cash Price |
$5,932.66
|
| Rate for Payer: Centivo All Commercial |
$4,880.09
|
| Rate for Payer: Cigna All Commercial |
$8,257.87
|
| Rate for Payer: CORVEL All Commercial |
$8,898.98
|
| Rate for Payer: Coventry All Commercial |
$8,420.54
|
| Rate for Payer: Encore All Commercial |
$8,808.08
|
| Rate for Payer: Frontpath All Commercial |
$8,803.30
|
| Rate for Payer: Humana ChoiceCare |
$8,264.57
|
| Rate for Payer: Humana Medicare |
$4,880.09
|
| Rate for Payer: Lucent All Commercial |
$4,880.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,611.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,176.60
|
| Rate for Payer: PHP All Commercial |
$7,256.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,731.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7,387.11
|
| Rate for Payer: Signature Care EPO |
$7,942.10
|
| Rate for Payer: Signature Care PPO |
$8,420.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,133.48
|
| Rate for Payer: United Healthcare Commercial |
$7,540.21
|
| Rate for Payer: United Healthcare Medicare |
$3,157.70
|
|
|
HC Z 5CC BETA-BSM KIT
|
Facility
IP
|
$9,568.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,176.60 |
| Max. Negotiated Rate |
$8,898.98 |
| Rate for Payer: Aetna Commercial |
$8,267.44
|
| Rate for Payer: Cash Price |
$5,932.66
|
| Rate for Payer: Cigna All Commercial |
$8,257.87
|
| Rate for Payer: CORVEL All Commercial |
$8,898.98
|
| Rate for Payer: Coventry All Commercial |
$8,420.54
|
| Rate for Payer: Encore All Commercial |
$8,808.08
|
| Rate for Payer: Frontpath All Commercial |
$8,803.30
|
| Rate for Payer: Humana ChoiceCare |
$8,264.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,611.92
|
| Rate for Payer: PHCS All Commercial |
$7,176.60
|
| Rate for Payer: PHP All Commercial |
$7,256.98
|
| Rate for Payer: Sagamore Health Network All Products |
$7,387.11
|
| Rate for Payer: Signature Care EPO |
$7,942.10
|
| Rate for Payer: Signature Care PPO |
$8,420.54
|
| Rate for Payer: United Healthcare Commercial |
$7,540.21
|
|
|
HC Z 60/62X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605471
|
|
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 60/62X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605471
|
|
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 60MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605437
|
|
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 60MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605437
|
|
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 60X22 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605469
|
|
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 60X22 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605469
|
|
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 60X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605470
|
|
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 60X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605470
|
|
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 62MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605438
|
|
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 62MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605438
|
|
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 64/66X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605473
|
|
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 64/66X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605473
|
|
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 64MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605439
|
|
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 64MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605439
|
|
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 64X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605472
|
|
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 64X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605472
|
|
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 64X32 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605474
|
|
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
|
|
