|
HC Z CONT 74 TT CLT-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605333
|
|
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 CONT 74 TT UNI-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605332
|
|
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 CONT 74 TT UNI-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605332
|
|
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 CONT 76 UU CLT-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605335
|
|
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 CONT 76 UU CLT-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605335
|
|
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 CONT 76 UU UNI-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605334
|
|
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 CONT 76 UU UNI-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605334
|
|
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 CONT 78 VV CLT-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605337
|
|
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 CONT 78 VV CLT-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605337
|
|
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 CONT 78 VV UNI-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605336
|
|
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 CONT 78 VV UNI-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605336
|
|
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 CONT 80 VV CLT-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605339
|
|
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 CONT 80 VV CLT-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605339
|
|
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 CONT 80 VV UNI-HOLE SHELL
|
Facility
OP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605338
|
|
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 CONT 80 VV UNI-HOLE SHELL
|
Facility
IP
|
$8,280.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605338
|
|
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 COUNTERSINK 1.3/1.5
|
Facility
OP
|
$657.51
|
|
| Hospital Charge Code |
41608225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z COUNTERSINK 1.3/1.5
|
Facility
IP
|
$657.51
|
|
| Hospital Charge Code |
41608225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z CR 10MM PLY 1-2 CD L
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 10MM PLY 1-2 CD L
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 10MM PLY 1-2 CD R
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 10MM PLY 1-2 CD R
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 10MM PLY 3-11 EF L
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
|
HC Z CR 10MM PLY 3-11 EF L
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 10MM PLY 3-11 EF R
|
Facility
IP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,229.20 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,720.04
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
|
|
HC Z CR 10MM PLY 3-11 EF R
|
Facility
OP
|
$4,305.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,004.21 |
| Rate for Payer: Aetna Commercial |
$3,633.93
|
| Rate for Payer: Aetna Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,420.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,472.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,691.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,633.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,562.93
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Cash Price |
$2,669.47
|
| Rate for Payer: Centivo All Commercial |
$2,195.86
|
| Rate for Payer: Cigna All Commercial |
$3,715.73
|
| Rate for Payer: CORVEL All Commercial |
$4,004.21
|
| Rate for Payer: Coventry All Commercial |
$3,788.93
|
| Rate for Payer: Encore All Commercial |
$3,963.30
|
| Rate for Payer: Frontpath All Commercial |
$3,961.15
|
| Rate for Payer: Humana ChoiceCare |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$2,195.86
|
| Rate for Payer: Lucent All Commercial |
$2,195.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,875.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,229.20
|
| Rate for Payer: PHP All Commercial |
$3,265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,323.92
|
| Rate for Payer: Signature Care EPO |
$3,573.65
|
| Rate for Payer: Signature Care PPO |
$3,788.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,659.76
|
| Rate for Payer: United Healthcare Commercial |
$3,392.81
|
| Rate for Payer: United Healthcare Medicare |
$1,420.85
|
|
