|
HC Z ACETABULAR CUP 47X28
|
Facility
IP
|
$3,974.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606361
|
|
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 ACROM XL 44-36 RTNV+3
|
Facility
OP
|
$3,745.87
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,483.66 |
| Rate for Payer: Aetna Commercial |
$3,161.51
|
| Rate for Payer: Aetna Medicare |
$1,236.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,236.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,151.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,341.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,421.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,359.75
|
| Rate for Payer: Cash Price |
$2,322.44
|
| Rate for Payer: Cash Price |
$2,322.44
|
| Rate for Payer: Centivo All Commercial |
$1,910.39
|
| Rate for Payer: Cigna All Commercial |
$3,232.69
|
| Rate for Payer: CORVEL All Commercial |
$3,483.66
|
| Rate for Payer: Coventry All Commercial |
$3,296.37
|
| Rate for Payer: Encore All Commercial |
$3,448.07
|
| Rate for Payer: Frontpath All Commercial |
$3,446.20
|
| Rate for Payer: Humana ChoiceCare |
$3,235.31
|
| Rate for Payer: Humana Medicare |
$1,910.39
|
| Rate for Payer: Lucent All Commercial |
$1,910.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,371.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,809.40
|
| Rate for Payer: PHP All Commercial |
$2,840.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,460.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,891.81
|
| Rate for Payer: Signature Care EPO |
$3,109.07
|
| Rate for Payer: Signature Care PPO |
$3,296.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,183.99
|
| Rate for Payer: United Healthcare Commercial |
$2,951.75
|
| Rate for Payer: United Healthcare Medicare |
$1,236.14
|
|
|
HC Z ACROM XL 44-36 RTNV+3
|
Facility
IP
|
$3,745.87
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,809.40 |
| Max. Negotiated Rate |
$3,483.66 |
| Rate for Payer: Aetna Commercial |
$3,236.43
|
| Rate for Payer: Cash Price |
$2,322.44
|
| Rate for Payer: Cigna All Commercial |
$3,232.69
|
| Rate for Payer: CORVEL All Commercial |
$3,483.66
|
| Rate for Payer: Coventry All Commercial |
$3,296.37
|
| Rate for Payer: Encore All Commercial |
$3,448.07
|
| Rate for Payer: Frontpath All Commercial |
$3,446.20
|
| Rate for Payer: Humana ChoiceCare |
$3,235.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,371.28
|
| Rate for Payer: PHCS All Commercial |
$2,809.40
|
| Rate for Payer: PHP All Commercial |
$2,840.87
|
| Rate for Payer: Sagamore Health Network All Products |
$2,891.81
|
| Rate for Payer: Signature Care EPO |
$3,109.07
|
| Rate for Payer: Signature Care PPO |
$3,296.37
|
| Rate for Payer: United Healthcare Commercial |
$2,951.75
|
|
|
HC Z ACROM XL 44-36 STD +3
|
Facility
OP
|
$3,745.87
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,483.66 |
| Rate for Payer: Aetna Commercial |
$3,161.51
|
| Rate for Payer: Aetna Medicare |
$1,236.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,236.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,151.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,341.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,421.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,359.75
|
| Rate for Payer: Cash Price |
$2,322.44
|
| Rate for Payer: Cash Price |
$2,322.44
|
| Rate for Payer: Centivo All Commercial |
$1,910.39
|
| Rate for Payer: Cigna All Commercial |
$3,232.69
|
| Rate for Payer: CORVEL All Commercial |
$3,483.66
|
| Rate for Payer: Coventry All Commercial |
$3,296.37
|
| Rate for Payer: Encore All Commercial |
$3,448.07
|
| Rate for Payer: Frontpath All Commercial |
$3,446.20
|
| Rate for Payer: Humana ChoiceCare |
$3,235.31
|
| Rate for Payer: Humana Medicare |
$1,910.39
|
| Rate for Payer: Lucent All Commercial |
$1,910.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,371.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,809.40
|
| Rate for Payer: PHP All Commercial |
$2,840.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,460.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,891.81
|
| Rate for Payer: Signature Care EPO |
$3,109.07
|
| Rate for Payer: Signature Care PPO |
$3,296.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,183.99
|
| Rate for Payer: United Healthcare Commercial |
$2,951.75
|
| Rate for Payer: United Healthcare Medicare |
$1,236.14
|
|
|
HC Z ACROM XL 44-36 STD +3
|
Facility
IP
|
$3,745.87
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,809.40 |
| Max. Negotiated Rate |
$3,483.66 |
| Rate for Payer: Aetna Commercial |
$3,236.43
|
| Rate for Payer: Cash Price |
$2,322.44
|
| Rate for Payer: Cigna All Commercial |
$3,232.69
|
| Rate for Payer: CORVEL All Commercial |
$3,483.66
|
| Rate for Payer: Coventry All Commercial |
$3,296.37
|
| Rate for Payer: Encore All Commercial |
$3,448.07
|
| Rate for Payer: Frontpath All Commercial |
$3,446.20
|
| Rate for Payer: Humana ChoiceCare |
$3,235.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,371.28
|
| Rate for Payer: PHCS All Commercial |
$2,809.40
|
| Rate for Payer: PHP All Commercial |
$2,840.87
|
| Rate for Payer: Sagamore Health Network All Products |
$2,891.81
|
| Rate for Payer: Signature Care EPO |
$3,109.07
|
| Rate for Payer: Signature Care PPO |
$3,296.37
|
| Rate for Payer: United Healthcare Commercial |
$2,951.75
|
|
|
HC Z ACT ARTC HD ARCOM XL 28X44 F
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,494.16
|
| Rate for Payer: Aetna Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,377.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,587.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,571.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,502.82
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Centivo All Commercial |
$2,111.40
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Humana Medicare |
$2,111.40
|
| Rate for Payer: Lucent All Commercial |
$2,111.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,614.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,519.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
|
|
HC Z ACT ARTC HD ARCOM XL 28X44 F
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.00 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
|
|
HC Z ACT ARTC HD ARCOM XL 28X54 I
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.00 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
|
|
HC Z ACT ARTC HD ARCOM XL 28X54 I
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,494.16
|
| Rate for Payer: Aetna Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,377.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,587.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,571.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,502.82
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Centivo All Commercial |
$2,111.40
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Humana Medicare |
$2,111.40
|
| Rate for Payer: Lucent All Commercial |
$2,111.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,614.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,519.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X38 C
|
Facility
OP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,289.49
|
| Rate for Payer: Aetna Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,279.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,658.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,828.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,705.08
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Centivo All Commercial |
$3,800.52
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Humana Medicare |
$3,800.52
|
| Rate for Payer: Lucent All Commercial |
$3,800.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,906.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,334.20
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
| Rate for Payer: United Healthcare Medicare |
$2,459.16
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X38 C
|
Facility
IP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,589.00 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,438.53
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X42 E
|
Facility
OP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,289.49
|
| Rate for Payer: Aetna Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,279.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,658.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,828.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,705.08
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Centivo All Commercial |
$3,800.52
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Humana Medicare |
$3,800.52
|
| Rate for Payer: Lucent All Commercial |
$3,800.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,906.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,334.20
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
| Rate for Payer: United Healthcare Medicare |
$2,459.16
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X42 E
|
Facility
IP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,589.00 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,438.53
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X44 F
|
Facility
OP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,289.49
|
| Rate for Payer: Aetna Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,279.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,658.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,828.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,705.08
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Centivo All Commercial |
$3,800.52
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Humana Medicare |
$3,800.52
|
| Rate for Payer: Lucent All Commercial |
$3,800.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,906.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,334.20
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
| Rate for Payer: United Healthcare Medicare |
$2,459.16
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X44 F
|
Facility
IP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,589.00 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,438.53
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X46 G
|
Facility
OP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,289.49
|
| Rate for Payer: Aetna Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,459.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,279.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,658.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,828.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,705.08
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Centivo All Commercial |
$3,800.52
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Humana Medicare |
$3,800.52
|
| Rate for Payer: Lucent All Commercial |
$3,800.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,906.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,334.20
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
| Rate for Payer: United Healthcare Medicare |
$2,459.16
|
|
|
HC Z ACT ARTIC E1 HIP BRG 28X46 G
|
Facility
IP
|
$7,452.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,589.00 |
| Max. Negotiated Rate |
$6,930.36 |
| Rate for Payer: Aetna Commercial |
$6,438.53
|
| Rate for Payer: Cash Price |
$4,620.24
|
| Rate for Payer: Cigna All Commercial |
$6,431.08
|
| Rate for Payer: CORVEL All Commercial |
$6,930.36
|
| Rate for Payer: Coventry All Commercial |
$6,557.76
|
| Rate for Payer: Encore All Commercial |
$6,859.57
|
| Rate for Payer: Frontpath All Commercial |
$6,855.84
|
| Rate for Payer: Humana ChoiceCare |
$6,436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,706.80
|
| Rate for Payer: PHCS All Commercial |
$5,589.00
|
| Rate for Payer: PHP All Commercial |
$5,651.60
|
| Rate for Payer: Sagamore Health Network All Products |
$5,752.94
|
| Rate for Payer: Signature Care EPO |
$6,185.16
|
| Rate for Payer: Signature Care PPO |
$6,557.76
|
| Rate for Payer: United Healthcare Commercial |
$5,872.18
|
|
|
HC Z ACT ARTIC HD ARCOM XL 28X42
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,494.16
|
| Rate for Payer: Aetna Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,377.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,587.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,571.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,502.82
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Centivo All Commercial |
$2,111.40
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Humana Medicare |
$2,111.40
|
| Rate for Payer: Lucent All Commercial |
$2,111.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,614.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,519.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
|
|
HC Z ACT ARTIC HD ARCOM XL 28X42
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.00 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
|
|
HC Z ACT ARTIC HD ARCOM XL 28X46
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.00 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
|
|
HC Z ACT ARTIC HD ARCOM XL 28X46
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,494.16
|
| Rate for Payer: Aetna Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,377.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,587.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,571.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,502.82
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Centivo All Commercial |
$2,111.40
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Humana Medicare |
$2,111.40
|
| Rate for Payer: Lucent All Commercial |
$2,111.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,614.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,519.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
|
|
HC Z ALL GLEN GUIDE/BONE LT
|
Facility
OP
|
$4,809.02
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,058.81
|
| Rate for Payer: Aetna Medicare |
$1,586.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,586.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,761.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,006.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,825.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,745.67
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Centivo All Commercial |
$2,452.60
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Humana Medicare |
$2,452.60
|
| Rate for Payer: Lucent All Commercial |
$2,452.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,875.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,087.67
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
| Rate for Payer: United Healthcare Medicare |
$1,586.98
|
|
|
HC Z ALL GLEN GUIDE/BONE LT
|
Facility
IP
|
$4,809.02
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,606.76 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,154.99
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
|
|
HC Z ALL GLEN GUIDE/BONE R
|
Facility
OP
|
$4,809.02
|
|
| Hospital Charge Code |
41607781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,058.81
|
| Rate for Payer: Aetna Medicare |
$1,586.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,586.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,761.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,006.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,825.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,745.67
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Centivo All Commercial |
$2,452.60
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Humana Medicare |
$2,452.60
|
| Rate for Payer: Lucent All Commercial |
$2,452.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,875.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,087.67
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
| Rate for Payer: United Healthcare Medicare |
$1,586.98
|
|
|
HC Z ALL GLEN GUIDE/BONE R
|
Facility
IP
|
$4,809.02
|
|
| Hospital Charge Code |
41607781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,606.76 |
| Max. Negotiated Rate |
$4,472.39 |
| Rate for Payer: Aetna Commercial |
$4,154.99
|
| Rate for Payer: Cash Price |
$2,981.59
|
| Rate for Payer: Cigna All Commercial |
$4,150.18
|
| Rate for Payer: CORVEL All Commercial |
$4,472.39
|
| Rate for Payer: Coventry All Commercial |
$4,231.94
|
| Rate for Payer: Encore All Commercial |
$4,426.70
|
| Rate for Payer: Frontpath All Commercial |
$4,424.30
|
| Rate for Payer: Humana ChoiceCare |
$4,153.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,328.12
|
| Rate for Payer: PHCS All Commercial |
$3,606.76
|
| Rate for Payer: PHP All Commercial |
$3,647.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,712.56
|
| Rate for Payer: Signature Care EPO |
$3,991.49
|
| Rate for Payer: Signature Care PPO |
$4,231.94
|
| Rate for Payer: United Healthcare Commercial |
$3,789.51
|
|
