|
HC Z ALL POLY PAT 26MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z ALL POLY PAT 26MM
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 26MM DIA
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 26MM DIA
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z ALL POLY PAT 29MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z ALL POLY PAT 29MM
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 29MM DIA
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z ALL POLY PAT 29MM DIA
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 32MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z ALL POLY PAT 32MM
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 32MM DIA
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z ALL POLY PAT 32MM DIA
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 35MM
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 35MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z ALL POLY PAT 35MM DIA
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 35MM DIA
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z ALL POLY PAT 38MM
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 38MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z ALL POLY PAT 38MM DIA
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z ALL POLY PAT 38MM DIA
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT 41MM
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z ALL POLY PAT 41MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z ALL POLY PAT 41MM DIA
|
Facility
OP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,795.33
|
| Rate for Payer: Aetna Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,092.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,902.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,070.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,256.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,202.26
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Centivo All Commercial |
$1,689.12
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Humana Medicare |
$1,689.12
|
| Rate for Payer: Lucent All Commercial |
$1,689.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,291.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
| Rate for Payer: United Healthcare Medicare |
$1,092.96
|
|
|
HC Z ALL POLY PAT 41MM DIA
|
Facility
IP
|
$3,312.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.00 |
| Max. Negotiated Rate |
$3,080.16 |
| Rate for Payer: Aetna Commercial |
$2,861.57
|
| Rate for Payer: Cash Price |
$2,053.44
|
| Rate for Payer: Cigna All Commercial |
$2,858.26
|
| Rate for Payer: CORVEL All Commercial |
$3,080.16
|
| Rate for Payer: Coventry All Commercial |
$2,914.56
|
| Rate for Payer: Encore All Commercial |
$3,048.70
|
| Rate for Payer: Frontpath All Commercial |
$3,047.04
|
| Rate for Payer: Humana ChoiceCare |
$2,860.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,980.80
|
| Rate for Payer: PHCS All Commercial |
$2,484.00
|
| Rate for Payer: PHP All Commercial |
$2,511.82
|
| Rate for Payer: Sagamore Health Network All Products |
$2,556.86
|
| Rate for Payer: Signature Care EPO |
$2,748.96
|
| Rate for Payer: Signature Care PPO |
$2,914.56
|
| Rate for Payer: United Healthcare Commercial |
$2,609.86
|
|
|
HC Z ALL POLY PAT PRLG 26MM
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
