|
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
|
|
|
HC Z 66MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605440
|
|
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 66MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605440
|
|
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 68/70X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605476
|
|
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 68/70X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605476
|
|
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 68MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605441
|
|
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 68MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605441
|
|
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 68X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605475
|
|
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 68X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605475
|
|
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 68X32 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605477
|
|
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 68X32 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605477
|
|
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 70MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605442
|
|
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 70MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605442
|
|
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 72MM SHELL OD
|
Facility
IP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605443
|
|
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 72MM SHELL OD
|
Facility
OP
|
$1,987.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605443
|
|
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 72X26 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605478
|
|
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 72X26 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605478
|
|
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 72X28 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605479
|
|
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 72X28 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605479
|
|
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 72X32 OD LINER
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605480
|
|
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 72X32 OD LINER
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605480
|
|
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 9.5X175 STND BRCH BODY
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z 9.5X175 STND BRCH BODY
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z ACETAB CUP 28X44
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,354.39
|
| Rate for Payer: Aetna Medicare |
$1,311.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,311.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,282.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,508.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,442.71
|
| Rate for Payer: Cash Price |
$2,464.13
|
| Rate for Payer: Cash Price |
$2,464.13
|
| Rate for Payer: Centivo All Commercial |
$2,026.94
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Humana Medicare |
$2,026.94
|
| Rate for Payer: Lucent All Commercial |
$2,026.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
| Rate for Payer: United Healthcare Medicare |
$1,311.55
|
|
|
HC Z ACETAB CUP 28X44
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.80 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,433.88
|
| Rate for Payer: Cash Price |
$2,464.13
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
