|
HC Z AVENIR FEM STEM SO T7
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR FEM STEM SO T7
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM SO T7.5
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR FEM STEM SO T7.5
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR STEM STD CEM 1
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR STEM STD CEM 1
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR STEM STD CEM 2
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR STEM STD CEM 2
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR STEM STD CEM 3
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR STEM STD CEM 3
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR STEM STD CEM 5
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR STEM STD CEM 5
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR STEM STD CEM 6
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z AVENIR STEM STD CEM 6
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR STEM STD CM 4 L
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,210.00 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$7,153.92
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
|
|
HC Z AVENIR STEM STD CM 4 L
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,700.40 |
| Rate for Payer: Aetna Commercial |
$6,988.32
|
| Rate for Payer: Aetna Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,732.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,755.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,175.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,142.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,005.64
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Centivo All Commercial |
$4,222.80
|
| Rate for Payer: Cigna All Commercial |
$7,145.64
|
| Rate for Payer: CORVEL All Commercial |
$7,700.40
|
| Rate for Payer: Coventry All Commercial |
$7,286.40
|
| Rate for Payer: Encore All Commercial |
$7,621.74
|
| Rate for Payer: Frontpath All Commercial |
$7,617.60
|
| Rate for Payer: Humana ChoiceCare |
$7,151.44
|
| Rate for Payer: Humana Medicare |
$4,222.80
|
| Rate for Payer: Lucent All Commercial |
$4,222.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,452.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,210.00
|
| Rate for Payer: PHP All Commercial |
$6,279.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,229.20
|
| Rate for Payer: Sagamore Health Network All Products |
$6,392.16
|
| Rate for Payer: Signature Care EPO |
$6,872.40
|
| Rate for Payer: Signature Care PPO |
$7,286.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,038.00
|
| Rate for Payer: United Healthcare Commercial |
$6,524.64
|
| Rate for Payer: United Healthcare Medicare |
$2,732.40
|
|
|
HC Z BACTISURE WOUND LAVAGE
|
Facility
OP
|
$2,700.00
|
|
| Hospital Charge Code |
41603595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna Commercial |
$2,278.80
|
| Rate for Payer: Aetna Medicare |
$891.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$891.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,550.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,687.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,024.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$980.10
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Centivo All Commercial |
$1,377.00
|
| Rate for Payer: Cigna All Commercial |
$2,330.10
|
| Rate for Payer: CORVEL All Commercial |
$2,511.00
|
| Rate for Payer: Coventry All Commercial |
$2,376.00
|
| Rate for Payer: Encore All Commercial |
$2,485.35
|
| Rate for Payer: Frontpath All Commercial |
$2,484.00
|
| Rate for Payer: Humana ChoiceCare |
$2,331.99
|
| Rate for Payer: Humana Medicare |
$1,377.00
|
| Rate for Payer: Lucent All Commercial |
$1,377.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,430.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,025.00
|
| Rate for Payer: PHP All Commercial |
$2,047.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,053.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,084.40
|
| Rate for Payer: Signature Care EPO |
$2,241.00
|
| Rate for Payer: Signature Care PPO |
$2,376.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,295.00
|
| Rate for Payer: United Healthcare Commercial |
$2,127.60
|
| Rate for Payer: United Healthcare Medicare |
$891.00
|
|
|
HC Z BACTISURE WOUND LAVAGE
|
Facility
IP
|
$2,700.00
|
|
| Hospital Charge Code |
41603595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna Commercial |
$2,332.80
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna All Commercial |
$2,330.10
|
| Rate for Payer: CORVEL All Commercial |
$2,511.00
|
| Rate for Payer: Coventry All Commercial |
$2,376.00
|
| Rate for Payer: Encore All Commercial |
$2,485.35
|
| Rate for Payer: Frontpath All Commercial |
$2,484.00
|
| Rate for Payer: Humana ChoiceCare |
$2,331.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,430.00
|
| Rate for Payer: PHCS All Commercial |
$2,025.00
|
| Rate for Payer: PHP All Commercial |
$2,047.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,084.40
|
| Rate for Payer: Signature Care EPO |
$2,241.00
|
| Rate for Payer: Signature Care PPO |
$2,376.00
|
| Rate for Payer: United Healthcare Commercial |
$2,127.60
|
|
|
HC Z BAR 11X200
|
Facility
OP
|
$948.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.10 |
| Max. Negotiated Rate |
$882.38 |
| Rate for Payer: Aetna Commercial |
$800.79
|
| Rate for Payer: Aetna Medicare |
$313.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$544.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$593.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.41
|
| Rate for Payer: Cash Price |
$588.26
|
| Rate for Payer: Cash Price |
$588.26
|
| Rate for Payer: Centivo All Commercial |
$483.89
|
| Rate for Payer: Cigna All Commercial |
$818.81
|
| Rate for Payer: CORVEL All Commercial |
$882.38
|
| Rate for Payer: Coventry All Commercial |
$834.94
|
| Rate for Payer: Encore All Commercial |
$873.37
|
| Rate for Payer: Frontpath All Commercial |
$872.90
|
| Rate for Payer: Humana ChoiceCare |
$819.48
|
| Rate for Payer: Humana Medicare |
$483.89
|
| Rate for Payer: Lucent All Commercial |
$483.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$853.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$711.60
|
| Rate for Payer: PHP All Commercial |
$719.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$370.03
|
| Rate for Payer: Sagamore Health Network All Products |
$732.47
|
| Rate for Payer: Signature Care EPO |
$787.50
|
| Rate for Payer: Signature Care PPO |
$834.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$806.48
|
| Rate for Payer: United Healthcare Commercial |
$747.65
|
| Rate for Payer: United Healthcare Medicare |
$313.10
|
|
|
HC Z BAR 11X200
|
Facility
IP
|
$948.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.60 |
| Max. Negotiated Rate |
$882.38 |
| Rate for Payer: Aetna Commercial |
$819.76
|
| Rate for Payer: Cash Price |
$588.26
|
| Rate for Payer: Cigna All Commercial |
$818.81
|
| Rate for Payer: CORVEL All Commercial |
$882.38
|
| Rate for Payer: Coventry All Commercial |
$834.94
|
| Rate for Payer: Encore All Commercial |
$873.37
|
| Rate for Payer: Frontpath All Commercial |
$872.90
|
| Rate for Payer: Humana ChoiceCare |
$819.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$853.92
|
| Rate for Payer: PHCS All Commercial |
$711.60
|
| Rate for Payer: PHP All Commercial |
$719.57
|
| Rate for Payer: Sagamore Health Network All Products |
$732.47
|
| Rate for Payer: Signature Care EPO |
$787.50
|
| Rate for Payer: Signature Care PPO |
$834.94
|
| Rate for Payer: United Healthcare Commercial |
$747.65
|
|
|
HC Z BAR 11X400
|
Facility
OP
|
$1,215.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,130.04 |
| Rate for Payer: Aetna Commercial |
$1,025.54
|
| Rate for Payer: Aetna Medicare |
$400.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$400.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$697.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$759.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.08
|
| Rate for Payer: Cash Price |
$753.36
|
| Rate for Payer: Cash Price |
$753.36
|
| Rate for Payer: Centivo All Commercial |
$619.70
|
| Rate for Payer: Cigna All Commercial |
$1,048.63
|
| Rate for Payer: CORVEL All Commercial |
$1,130.04
|
| Rate for Payer: Coventry All Commercial |
$1,069.29
|
| Rate for Payer: Encore All Commercial |
$1,118.50
|
| Rate for Payer: Frontpath All Commercial |
$1,117.89
|
| Rate for Payer: Humana ChoiceCare |
$1,049.48
|
| Rate for Payer: Humana Medicare |
$619.70
|
| Rate for Payer: Lucent All Commercial |
$619.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,093.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$911.32
|
| Rate for Payer: PHP All Commercial |
$921.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$473.89
|
| Rate for Payer: Sagamore Health Network All Products |
$938.06
|
| Rate for Payer: Signature Care EPO |
$1,008.53
|
| Rate for Payer: Signature Care PPO |
$1,069.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,032.84
|
| Rate for Payer: United Healthcare Commercial |
$957.50
|
| Rate for Payer: United Healthcare Medicare |
$400.98
|
|
|
HC Z BAR 11X400
|
Facility
IP
|
$1,215.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$911.32 |
| Max. Negotiated Rate |
$1,130.04 |
| Rate for Payer: Aetna Commercial |
$1,049.85
|
| Rate for Payer: Cash Price |
$753.36
|
| Rate for Payer: Cigna All Commercial |
$1,048.63
|
| Rate for Payer: CORVEL All Commercial |
$1,130.04
|
| Rate for Payer: Coventry All Commercial |
$1,069.29
|
| Rate for Payer: Encore All Commercial |
$1,118.50
|
| Rate for Payer: Frontpath All Commercial |
$1,117.89
|
| Rate for Payer: Humana ChoiceCare |
$1,049.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,093.59
|
| Rate for Payer: PHCS All Commercial |
$911.32
|
| Rate for Payer: PHP All Commercial |
$921.53
|
| Rate for Payer: Sagamore Health Network All Products |
$938.06
|
| Rate for Payer: Signature Care EPO |
$1,008.53
|
| Rate for Payer: Signature Care PPO |
$1,069.29
|
| Rate for Payer: United Healthcare Commercial |
$957.50
|
|
|
HC Z BAR 11X500
|
Facility
IP
|
$1,314.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$986.21 |
| Max. Negotiated Rate |
$1,222.90 |
| Rate for Payer: Aetna Commercial |
$1,136.12
|
| Rate for Payer: Cash Price |
$815.27
|
| Rate for Payer: Cigna All Commercial |
$1,134.80
|
| Rate for Payer: CORVEL All Commercial |
$1,222.90
|
| Rate for Payer: Coventry All Commercial |
$1,157.16
|
| Rate for Payer: Encore All Commercial |
$1,210.41
|
| Rate for Payer: Frontpath All Commercial |
$1,209.75
|
| Rate for Payer: Humana ChoiceCare |
$1,135.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,183.46
|
| Rate for Payer: PHCS All Commercial |
$986.21
|
| Rate for Payer: PHP All Commercial |
$997.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,015.14
|
| Rate for Payer: Signature Care EPO |
$1,091.41
|
| Rate for Payer: Signature Care PPO |
$1,157.16
|
| Rate for Payer: United Healthcare Commercial |
$1,036.18
|
|
|
HC Z BAR 11X500
|
Facility
OP
|
$1,314.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.93 |
| Max. Negotiated Rate |
$1,222.90 |
| Rate for Payer: Aetna Commercial |
$1,109.82
|
| Rate for Payer: Aetna Medicare |
$433.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$433.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$755.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$821.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$499.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.33
|
| Rate for Payer: Cash Price |
$815.27
|
| Rate for Payer: Cash Price |
$815.27
|
| Rate for Payer: Centivo All Commercial |
$670.62
|
| Rate for Payer: Cigna All Commercial |
$1,134.80
|
| Rate for Payer: CORVEL All Commercial |
$1,222.90
|
| Rate for Payer: Coventry All Commercial |
$1,157.16
|
| Rate for Payer: Encore All Commercial |
$1,210.41
|
| Rate for Payer: Frontpath All Commercial |
$1,209.75
|
| Rate for Payer: Humana ChoiceCare |
$1,135.72
|
| Rate for Payer: Humana Medicare |
$670.62
|
| Rate for Payer: Lucent All Commercial |
$670.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,183.46
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$986.21
|
| Rate for Payer: PHP All Commercial |
$997.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$512.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,015.14
|
| Rate for Payer: Signature Care EPO |
$1,091.41
|
| Rate for Payer: Signature Care PPO |
$1,157.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,117.71
|
| Rate for Payer: United Healthcare Commercial |
$1,036.18
|
| Rate for Payer: United Healthcare Medicare |
$433.93
|
|
|
HC Z BAR CLAMP LG
|
Facility
IP
|
$2,025.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,519.02 |
| Max. Negotiated Rate |
$1,883.58 |
| Rate for Payer: Aetna Commercial |
$1,749.91
|
| Rate for Payer: Cash Price |
$1,255.72
|
| Rate for Payer: Cigna All Commercial |
$1,747.89
|
| Rate for Payer: CORVEL All Commercial |
$1,883.58
|
| Rate for Payer: Coventry All Commercial |
$1,782.32
|
| Rate for Payer: Encore All Commercial |
$1,864.34
|
| Rate for Payer: Frontpath All Commercial |
$1,863.33
|
| Rate for Payer: Humana ChoiceCare |
$1,749.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,822.82
|
| Rate for Payer: PHCS All Commercial |
$1,519.02
|
| Rate for Payer: PHP All Commercial |
$1,536.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,563.58
|
| Rate for Payer: Signature Care EPO |
$1,681.05
|
| Rate for Payer: Signature Care PPO |
$1,782.32
|
| Rate for Payer: United Healthcare Commercial |
$1,595.98
|
|
