|
HC Z ACETAB CUP 28X46MM
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606369
|
|
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 28X46MM
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606369
|
|
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
|
|
|
HC Z ACETAB CUP 28X48
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608034
|
|
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
|
|
|
HC Z ACETAB CUP 28X48
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608034
|
|
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 28X49
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606957
|
|
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 28X49
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606957
|
|
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
|
|
|
HC Z ACETAB CUP 28X50
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606505
|
|
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
|
|
|
HC Z ACETAB CUP 28X50
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606505
|
|
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 28X54
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607666
|
|
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
|
|
|
HC Z ACETAB CUP 28X54
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607666
|
|
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 28X56
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607520
|
|
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 28X56
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607520
|
|
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
|
|
|
HC Z ACETAB CUP 42X28
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606579
|
|
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 42X28
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606579
|
|
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
|
|
|
HC Z ACETAB CUP 43X28
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606569
|
|
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
|
|
|
HC Z ACETAB CUP 43X28
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606569
|
|
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 45X28
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607031
|
|
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 45X28
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607031
|
|
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
|
|
|
HC Z ACETAB LNR HW LONG 36D
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607430
|
|
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
|
|
|
HC Z ACETAB LNR HW LONG 36D
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607430
|
|
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 LNR NTL LONG 36D
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607004
|
|
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
|
|
|
HC Z ACETAB LNR NTL LONG 36D
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607004
|
|
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 LNR NTL LONG 36G
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607067
|
|
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 LNR NTL LONG 36G
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607067
|
|
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
|
|
|
HC Z ACETABULAR CUP 47X28
|
Facility
OP
|
$3,974.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606361
|
|
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
|
|
