|
HC Z G7 SCREW 6.5X30
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$147.70
|
| Rate for Payer: Aetna Medicare |
$57.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.52
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Centivo All Commercial |
$89.25
|
| Rate for Payer: Cigna All Commercial |
$151.02
|
| Rate for Payer: CORVEL All Commercial |
$162.75
|
| Rate for Payer: Coventry All Commercial |
$154.00
|
| Rate for Payer: Encore All Commercial |
$161.09
|
| Rate for Payer: Frontpath All Commercial |
$161.00
|
| Rate for Payer: Humana ChoiceCare |
$151.15
|
| Rate for Payer: Humana Medicare |
$89.25
|
| Rate for Payer: Lucent All Commercial |
$89.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$131.25
|
| Rate for Payer: PHP All Commercial |
$132.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.25
|
| Rate for Payer: Sagamore Health Network All Products |
$135.10
|
| Rate for Payer: Signature Care EPO |
$145.25
|
| Rate for Payer: Signature Care PPO |
$154.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$137.90
|
| Rate for Payer: United Healthcare Medicare |
$57.75
|
|
|
HC Z G7 SCREW 6.5X30
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna All Commercial |
$151.02
|
| Rate for Payer: CORVEL All Commercial |
$162.75
|
| Rate for Payer: Coventry All Commercial |
$154.00
|
| Rate for Payer: Encore All Commercial |
$161.09
|
| Rate for Payer: Frontpath All Commercial |
$161.00
|
| Rate for Payer: Humana ChoiceCare |
$151.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.50
|
| Rate for Payer: PHCS All Commercial |
$131.25
|
| Rate for Payer: PHP All Commercial |
$132.72
|
| Rate for Payer: Sagamore Health Network All Products |
$135.10
|
| Rate for Payer: Signature Care EPO |
$145.25
|
| Rate for Payer: Signature Care PPO |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$137.90
|
|
|
HC Z GAMMA-BSM KIT 5CC
|
Facility
IP
|
$9,568.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,176.60 |
| Max. Negotiated Rate |
$8,898.98 |
| Rate for Payer: Aetna Commercial |
$8,267.44
|
| Rate for Payer: Cash Price |
$5,932.66
|
| Rate for Payer: Cigna All Commercial |
$8,257.87
|
| Rate for Payer: CORVEL All Commercial |
$8,898.98
|
| Rate for Payer: Coventry All Commercial |
$8,420.54
|
| Rate for Payer: Encore All Commercial |
$8,808.08
|
| Rate for Payer: Frontpath All Commercial |
$8,803.30
|
| Rate for Payer: Humana ChoiceCare |
$8,264.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,611.92
|
| Rate for Payer: PHCS All Commercial |
$7,176.60
|
| Rate for Payer: PHP All Commercial |
$7,256.98
|
| Rate for Payer: Sagamore Health Network All Products |
$7,387.11
|
| Rate for Payer: Signature Care EPO |
$7,942.10
|
| Rate for Payer: Signature Care PPO |
$8,420.54
|
| Rate for Payer: United Healthcare Commercial |
$7,540.21
|
|
|
HC Z GAMMA-BSM KIT 5CC
|
Facility
OP
|
$9,568.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,898.98 |
| Rate for Payer: Aetna Commercial |
$8,076.07
|
| Rate for Payer: Aetna Medicare |
$3,157.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,157.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,495.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,981.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,631.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,473.47
|
| Rate for Payer: Cash Price |
$5,932.66
|
| Rate for Payer: Cash Price |
$5,932.66
|
| Rate for Payer: Centivo All Commercial |
$4,880.09
|
| Rate for Payer: Cigna All Commercial |
$8,257.87
|
| Rate for Payer: CORVEL All Commercial |
$8,898.98
|
| Rate for Payer: Coventry All Commercial |
$8,420.54
|
| Rate for Payer: Encore All Commercial |
$8,808.08
|
| Rate for Payer: Frontpath All Commercial |
$8,803.30
|
| Rate for Payer: Humana ChoiceCare |
$8,264.57
|
| Rate for Payer: Humana Medicare |
$4,880.09
|
| Rate for Payer: Lucent All Commercial |
$4,880.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,611.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,176.60
|
| Rate for Payer: PHP All Commercial |
$7,256.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,731.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7,387.11
|
| Rate for Payer: Signature Care EPO |
$7,942.10
|
| Rate for Payer: Signature Care PPO |
$8,420.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,133.48
|
| Rate for Payer: United Healthcare Commercial |
$7,540.21
|
| Rate for Payer: United Healthcare Medicare |
$3,157.70
|
|
|
HC Z GENEX BONE GRAFT 5CC
|
Facility
IP
|
$6,756.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,067.58 |
| Max. Negotiated Rate |
$6,283.80 |
| Rate for Payer: Aetna Commercial |
$5,837.85
|
| Rate for Payer: Cash Price |
$4,189.20
|
| Rate for Payer: Cigna All Commercial |
$5,831.09
|
| Rate for Payer: CORVEL All Commercial |
$6,283.80
|
| Rate for Payer: Coventry All Commercial |
$5,945.96
|
| Rate for Payer: Encore All Commercial |
$6,219.61
|
| Rate for Payer: Frontpath All Commercial |
$6,216.23
|
| Rate for Payer: Humana ChoiceCare |
$5,835.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,081.09
|
| Rate for Payer: PHCS All Commercial |
$5,067.58
|
| Rate for Payer: PHP All Commercial |
$5,124.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,216.23
|
| Rate for Payer: Signature Care EPO |
$5,608.12
|
| Rate for Payer: Signature Care PPO |
$5,945.96
|
| Rate for Payer: United Healthcare Commercial |
$5,324.33
|
|
|
HC Z GENEX BONE GRAFT 5CC
|
Facility
OP
|
$6,756.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,283.80 |
| Rate for Payer: Aetna Commercial |
$5,702.71
|
| Rate for Payer: Aetna Medicare |
$2,229.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,229.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,880.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,223.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,564.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,452.71
|
| Rate for Payer: Cash Price |
$4,189.20
|
| Rate for Payer: Cash Price |
$4,189.20
|
| Rate for Payer: Centivo All Commercial |
$3,445.95
|
| Rate for Payer: Cigna All Commercial |
$5,831.09
|
| Rate for Payer: CORVEL All Commercial |
$6,283.80
|
| Rate for Payer: Coventry All Commercial |
$5,945.96
|
| Rate for Payer: Encore All Commercial |
$6,219.61
|
| Rate for Payer: Frontpath All Commercial |
$6,216.23
|
| Rate for Payer: Humana ChoiceCare |
$5,835.82
|
| Rate for Payer: Humana Medicare |
$3,445.95
|
| Rate for Payer: Lucent All Commercial |
$3,445.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,081.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,067.58
|
| Rate for Payer: PHP All Commercial |
$5,124.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,635.14
|
| Rate for Payer: Sagamore Health Network All Products |
$5,216.23
|
| Rate for Payer: Signature Care EPO |
$5,608.12
|
| Rate for Payer: Signature Care PPO |
$5,945.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,743.25
|
| Rate for Payer: United Healthcare Commercial |
$5,324.33
|
| Rate for Payer: United Healthcare Medicare |
$2,229.73
|
|
|
HC Z GLED HYBRID POST REGENEREX
|
Facility
IP
|
$1,848.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.45 |
| Max. Negotiated Rate |
$1,719.20 |
| Rate for Payer: Aetna Commercial |
$1,597.19
|
| Rate for Payer: Cash Price |
$1,146.13
|
| Rate for Payer: Cigna All Commercial |
$1,595.34
|
| Rate for Payer: CORVEL All Commercial |
$1,719.20
|
| Rate for Payer: Coventry All Commercial |
$1,626.77
|
| Rate for Payer: Encore All Commercial |
$1,701.64
|
| Rate for Payer: Frontpath All Commercial |
$1,700.71
|
| Rate for Payer: Humana ChoiceCare |
$1,596.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,663.74
|
| Rate for Payer: PHCS All Commercial |
$1,386.45
|
| Rate for Payer: PHP All Commercial |
$1,401.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,427.12
|
| Rate for Payer: Signature Care EPO |
$1,534.34
|
| Rate for Payer: Signature Care PPO |
$1,626.77
|
| Rate for Payer: United Healthcare Commercial |
$1,456.70
|
|
|
HC Z GLED HYBRID POST REGENEREX
|
Facility
OP
|
$1,848.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,719.20 |
| Rate for Payer: Aetna Commercial |
$1,560.22
|
| Rate for Payer: Aetna Medicare |
$610.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$610.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,061.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,155.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$701.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$671.04
|
| Rate for Payer: Cash Price |
$1,146.13
|
| Rate for Payer: Cash Price |
$1,146.13
|
| Rate for Payer: Centivo All Commercial |
$942.79
|
| Rate for Payer: Cigna All Commercial |
$1,595.34
|
| Rate for Payer: CORVEL All Commercial |
$1,719.20
|
| Rate for Payer: Coventry All Commercial |
$1,626.77
|
| Rate for Payer: Encore All Commercial |
$1,701.64
|
| Rate for Payer: Frontpath All Commercial |
$1,700.71
|
| Rate for Payer: Humana ChoiceCare |
$1,596.64
|
| Rate for Payer: Humana Medicare |
$942.79
|
| Rate for Payer: Lucent All Commercial |
$942.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,663.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,386.45
|
| Rate for Payer: PHP All Commercial |
$1,401.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$720.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,427.12
|
| Rate for Payer: Signature Care EPO |
$1,534.34
|
| Rate for Payer: Signature Care PPO |
$1,626.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,571.31
|
| Rate for Payer: United Healthcare Commercial |
$1,456.70
|
| Rate for Payer: United Healthcare Medicare |
$610.04
|
|
|
HC Z GLEN 4 MM ALL POLY LRG
|
Facility
OP
|
$5,702.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,303.23 |
| Rate for Payer: Aetna Commercial |
$4,812.83
|
| Rate for Payer: Aetna Medicare |
$1,881.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,881.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,274.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,564.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,164.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,069.97
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Centivo All Commercial |
$2,908.22
|
| Rate for Payer: Cigna All Commercial |
$4,921.17
|
| Rate for Payer: CORVEL All Commercial |
$5,303.23
|
| Rate for Payer: Coventry All Commercial |
$5,018.11
|
| Rate for Payer: Encore All Commercial |
$5,249.06
|
| Rate for Payer: Frontpath All Commercial |
$5,246.21
|
| Rate for Payer: Humana ChoiceCare |
$4,925.16
|
| Rate for Payer: Humana Medicare |
$2,908.22
|
| Rate for Payer: Lucent All Commercial |
$2,908.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,132.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,276.80
|
| Rate for Payer: PHP All Commercial |
$4,324.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,223.94
|
| Rate for Payer: Sagamore Health Network All Products |
$4,402.25
|
| Rate for Payer: Signature Care EPO |
$4,732.99
|
| Rate for Payer: Signature Care PPO |
$5,018.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,847.04
|
| Rate for Payer: United Healthcare Commercial |
$4,493.49
|
| Rate for Payer: United Healthcare Medicare |
$1,881.79
|
|
|
HC Z GLEN 4 MM ALL POLY LRG
|
Facility
IP
|
$5,702.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,276.80 |
| Max. Negotiated Rate |
$5,303.23 |
| Rate for Payer: Aetna Commercial |
$4,926.87
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Cigna All Commercial |
$4,921.17
|
| Rate for Payer: CORVEL All Commercial |
$5,303.23
|
| Rate for Payer: Coventry All Commercial |
$5,018.11
|
| Rate for Payer: Encore All Commercial |
$5,249.06
|
| Rate for Payer: Frontpath All Commercial |
$5,246.21
|
| Rate for Payer: Humana ChoiceCare |
$4,925.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,132.16
|
| Rate for Payer: PHCS All Commercial |
$4,276.80
|
| Rate for Payer: PHP All Commercial |
$4,324.70
|
| Rate for Payer: Sagamore Health Network All Products |
$4,402.25
|
| Rate for Payer: Signature Care EPO |
$4,732.99
|
| Rate for Payer: Signature Care PPO |
$5,018.11
|
| Rate for Payer: United Healthcare Commercial |
$4,493.49
|
|
|
HC Z GLEN 4MM ALL POLY MD
|
Facility
IP
|
$5,702.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,276.80 |
| Max. Negotiated Rate |
$5,303.23 |
| Rate for Payer: Aetna Commercial |
$4,926.87
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Cigna All Commercial |
$4,921.17
|
| Rate for Payer: CORVEL All Commercial |
$5,303.23
|
| Rate for Payer: Coventry All Commercial |
$5,018.11
|
| Rate for Payer: Encore All Commercial |
$5,249.06
|
| Rate for Payer: Frontpath All Commercial |
$5,246.21
|
| Rate for Payer: Humana ChoiceCare |
$4,925.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,132.16
|
| Rate for Payer: PHCS All Commercial |
$4,276.80
|
| Rate for Payer: PHP All Commercial |
$4,324.70
|
| Rate for Payer: Sagamore Health Network All Products |
$4,402.25
|
| Rate for Payer: Signature Care EPO |
$4,732.99
|
| Rate for Payer: Signature Care PPO |
$5,018.11
|
| Rate for Payer: United Healthcare Commercial |
$4,493.49
|
|
|
HC Z GLEN 4MM ALL POLY MD
|
Facility
OP
|
$5,702.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,303.23 |
| Rate for Payer: Aetna Commercial |
$4,812.83
|
| Rate for Payer: Aetna Medicare |
$1,881.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,881.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,274.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,564.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,164.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,069.97
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Centivo All Commercial |
$2,908.22
|
| Rate for Payer: Cigna All Commercial |
$4,921.17
|
| Rate for Payer: CORVEL All Commercial |
$5,303.23
|
| Rate for Payer: Coventry All Commercial |
$5,018.11
|
| Rate for Payer: Encore All Commercial |
$5,249.06
|
| Rate for Payer: Frontpath All Commercial |
$5,246.21
|
| Rate for Payer: Humana ChoiceCare |
$4,925.16
|
| Rate for Payer: Humana Medicare |
$2,908.22
|
| Rate for Payer: Lucent All Commercial |
$2,908.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,132.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,276.80
|
| Rate for Payer: PHP All Commercial |
$4,324.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,223.94
|
| Rate for Payer: Sagamore Health Network All Products |
$4,402.25
|
| Rate for Payer: Signature Care EPO |
$4,732.99
|
| Rate for Payer: Signature Care PPO |
$5,018.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,847.04
|
| Rate for Payer: United Healthcare Commercial |
$4,493.49
|
| Rate for Payer: United Healthcare Medicare |
$1,881.79
|
|
|
HC Z GLEN 4MM ALL POLY SM
|
Facility
IP
|
$5,702.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,276.80 |
| Max. Negotiated Rate |
$5,303.23 |
| Rate for Payer: Aetna Commercial |
$4,926.87
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Cigna All Commercial |
$4,921.17
|
| Rate for Payer: CORVEL All Commercial |
$5,303.23
|
| Rate for Payer: Coventry All Commercial |
$5,018.11
|
| Rate for Payer: Encore All Commercial |
$5,249.06
|
| Rate for Payer: Frontpath All Commercial |
$5,246.21
|
| Rate for Payer: Humana ChoiceCare |
$4,925.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,132.16
|
| Rate for Payer: PHCS All Commercial |
$4,276.80
|
| Rate for Payer: PHP All Commercial |
$4,324.70
|
| Rate for Payer: Sagamore Health Network All Products |
$4,402.25
|
| Rate for Payer: Signature Care EPO |
$4,732.99
|
| Rate for Payer: Signature Care PPO |
$5,018.11
|
| Rate for Payer: United Healthcare Commercial |
$4,493.49
|
|
|
HC Z GLEN 4MM ALL POLY SM
|
Facility
OP
|
$5,702.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,303.23 |
| Rate for Payer: Aetna Commercial |
$4,812.83
|
| Rate for Payer: Aetna Medicare |
$1,881.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,881.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,274.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,564.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,164.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,069.97
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Cash Price |
$3,535.49
|
| Rate for Payer: Centivo All Commercial |
$2,908.22
|
| Rate for Payer: Cigna All Commercial |
$4,921.17
|
| Rate for Payer: CORVEL All Commercial |
$5,303.23
|
| Rate for Payer: Coventry All Commercial |
$5,018.11
|
| Rate for Payer: Encore All Commercial |
$5,249.06
|
| Rate for Payer: Frontpath All Commercial |
$5,246.21
|
| Rate for Payer: Humana ChoiceCare |
$4,925.16
|
| Rate for Payer: Humana Medicare |
$2,908.22
|
| Rate for Payer: Lucent All Commercial |
$2,908.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,132.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,276.80
|
| Rate for Payer: PHP All Commercial |
$4,324.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,223.94
|
| Rate for Payer: Sagamore Health Network All Products |
$4,402.25
|
| Rate for Payer: Signature Care EPO |
$4,732.99
|
| Rate for Payer: Signature Care PPO |
$5,018.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,847.04
|
| Rate for Payer: United Healthcare Commercial |
$4,493.49
|
| Rate for Payer: United Healthcare Medicare |
$1,881.79
|
|
|
HC Z GLEN COMP 36MM TI
|
Facility
OP
|
$7,866.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,315.38 |
| Rate for Payer: Aetna Commercial |
$6,638.90
|
| Rate for Payer: Aetna Medicare |
$2,595.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,595.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,517.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,917.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,985.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,855.36
|
| Rate for Payer: Cash Price |
$4,876.92
|
| Rate for Payer: Cash Price |
$4,876.92
|
| Rate for Payer: Centivo All Commercial |
$4,011.66
|
| Rate for Payer: Cigna All Commercial |
$6,788.36
|
| Rate for Payer: CORVEL All Commercial |
$7,315.38
|
| Rate for Payer: Coventry All Commercial |
$6,922.08
|
| Rate for Payer: Encore All Commercial |
$7,240.65
|
| Rate for Payer: Frontpath All Commercial |
$7,236.72
|
| Rate for Payer: Humana ChoiceCare |
$6,793.86
|
| Rate for Payer: Humana Medicare |
$4,011.66
|
| Rate for Payer: Lucent All Commercial |
$4,011.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,079.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,899.50
|
| Rate for Payer: PHP All Commercial |
$5,965.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,067.74
|
| Rate for Payer: Sagamore Health Network All Products |
$6,072.55
|
| Rate for Payer: Signature Care EPO |
$6,528.78
|
| Rate for Payer: Signature Care PPO |
$6,922.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,686.10
|
| Rate for Payer: United Healthcare Commercial |
$6,198.41
|
| Rate for Payer: United Healthcare Medicare |
$2,595.78
|
|
|
HC Z GLEN COMP 36MM TI
|
Facility
IP
|
$7,866.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,899.50 |
| Max. Negotiated Rate |
$7,315.38 |
| Rate for Payer: Aetna Commercial |
$6,796.22
|
| Rate for Payer: Cash Price |
$4,876.92
|
| Rate for Payer: Cigna All Commercial |
$6,788.36
|
| Rate for Payer: CORVEL All Commercial |
$7,315.38
|
| Rate for Payer: Coventry All Commercial |
$6,922.08
|
| Rate for Payer: Encore All Commercial |
$7,240.65
|
| Rate for Payer: Frontpath All Commercial |
$7,236.72
|
| Rate for Payer: Humana ChoiceCare |
$6,793.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,079.40
|
| Rate for Payer: PHCS All Commercial |
$5,899.50
|
| Rate for Payer: PHP All Commercial |
$5,965.57
|
| Rate for Payer: Sagamore Health Network All Products |
$6,072.55
|
| Rate for Payer: Signature Care EPO |
$6,528.78
|
| Rate for Payer: Signature Care PPO |
$6,922.08
|
| Rate for Payer: United Healthcare Commercial |
$6,198.41
|
|
|
HC Z GLEN HYBRID POLY
|
Facility
OP
|
$1,575.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.75 |
| Max. Negotiated Rate |
$1,464.75 |
| Rate for Payer: Aetna Commercial |
$1,329.30
|
| Rate for Payer: Aetna Medicare |
$519.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$519.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$904.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$984.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$597.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$571.72
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Centivo All Commercial |
$803.25
|
| Rate for Payer: Cigna All Commercial |
$1,359.22
|
| Rate for Payer: CORVEL All Commercial |
$1,464.75
|
| Rate for Payer: Coventry All Commercial |
$1,386.00
|
| Rate for Payer: Encore All Commercial |
$1,449.79
|
| Rate for Payer: Frontpath All Commercial |
$1,449.00
|
| Rate for Payer: Humana ChoiceCare |
$1,360.33
|
| Rate for Payer: Humana Medicare |
$803.25
|
| Rate for Payer: Lucent All Commercial |
$803.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,417.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,181.25
|
| Rate for Payer: PHP All Commercial |
$1,194.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$614.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,215.90
|
| Rate for Payer: Signature Care EPO |
$1,307.25
|
| Rate for Payer: Signature Care PPO |
$1,386.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,338.75
|
| Rate for Payer: United Healthcare Commercial |
$1,241.10
|
| Rate for Payer: United Healthcare Medicare |
$519.75
|
|
|
HC Z GLEN HYBRID POLY
|
Facility
IP
|
$1,575.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$1,464.75 |
| Rate for Payer: Aetna Commercial |
$1,360.80
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cigna All Commercial |
$1,359.22
|
| Rate for Payer: CORVEL All Commercial |
$1,464.75
|
| Rate for Payer: Coventry All Commercial |
$1,386.00
|
| Rate for Payer: Encore All Commercial |
$1,449.79
|
| Rate for Payer: Frontpath All Commercial |
$1,449.00
|
| Rate for Payer: Humana ChoiceCare |
$1,360.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,417.50
|
| Rate for Payer: PHCS All Commercial |
$1,181.25
|
| Rate for Payer: PHP All Commercial |
$1,194.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,215.90
|
| Rate for Payer: Signature Care EPO |
$1,307.25
|
| Rate for Payer: Signature Care PPO |
$1,386.00
|
| Rate for Payer: United Healthcare Commercial |
$1,241.10
|
|
|
HC Z GLEN MOD 4 PEG SZ 2 L
|
Facility
OP
|
$7,312.90
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,801.00 |
| Rate for Payer: Aetna Commercial |
$6,172.09
|
| Rate for Payer: Aetna Medicare |
$2,413.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,413.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,199.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,571.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,775.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,654.58
|
| Rate for Payer: Cash Price |
$4,534.00
|
| Rate for Payer: Cash Price |
$4,534.00
|
| Rate for Payer: Centivo All Commercial |
$3,729.58
|
| Rate for Payer: Cigna All Commercial |
$6,311.03
|
| Rate for Payer: CORVEL All Commercial |
$6,801.00
|
| Rate for Payer: Coventry All Commercial |
$6,435.35
|
| Rate for Payer: Encore All Commercial |
$6,731.52
|
| Rate for Payer: Frontpath All Commercial |
$6,727.87
|
| Rate for Payer: Humana ChoiceCare |
$6,316.15
|
| Rate for Payer: Humana Medicare |
$3,729.58
|
| Rate for Payer: Lucent All Commercial |
$3,729.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,581.61
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,484.68
|
| Rate for Payer: PHP All Commercial |
$5,546.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,852.03
|
| Rate for Payer: Sagamore Health Network All Products |
$5,645.56
|
| Rate for Payer: Signature Care EPO |
$6,069.71
|
| Rate for Payer: Signature Care PPO |
$6,435.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,215.96
|
| Rate for Payer: United Healthcare Commercial |
$5,762.57
|
| Rate for Payer: United Healthcare Medicare |
$2,413.26
|
|
|
HC Z GLEN MOD 4 PEG SZ 2 L
|
Facility
IP
|
$7,312.90
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,484.68 |
| Max. Negotiated Rate |
$6,801.00 |
| Rate for Payer: Aetna Commercial |
$6,318.35
|
| Rate for Payer: Cash Price |
$4,534.00
|
| Rate for Payer: Cigna All Commercial |
$6,311.03
|
| Rate for Payer: CORVEL All Commercial |
$6,801.00
|
| Rate for Payer: Coventry All Commercial |
$6,435.35
|
| Rate for Payer: Encore All Commercial |
$6,731.52
|
| Rate for Payer: Frontpath All Commercial |
$6,727.87
|
| Rate for Payer: Humana ChoiceCare |
$6,316.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,581.61
|
| Rate for Payer: PHCS All Commercial |
$5,484.68
|
| Rate for Payer: PHP All Commercial |
$5,546.10
|
| Rate for Payer: Sagamore Health Network All Products |
$5,645.56
|
| Rate for Payer: Signature Care EPO |
$6,069.71
|
| Rate for Payer: Signature Care PPO |
$6,435.35
|
| Rate for Payer: United Healthcare Commercial |
$5,762.57
|
|
|
HC Z GLEN MOD 4 PEG SZ 3
|
Facility
OP
|
$5,325.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,952.90 |
| Rate for Payer: Aetna Commercial |
$4,494.89
|
| Rate for Payer: Aetna Medicare |
$1,757.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,757.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,058.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,329.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,021.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,933.23
|
| Rate for Payer: Cash Price |
$3,301.93
|
| Rate for Payer: Cash Price |
$3,301.93
|
| Rate for Payer: Centivo All Commercial |
$2,716.11
|
| Rate for Payer: Cigna All Commercial |
$4,596.08
|
| Rate for Payer: CORVEL All Commercial |
$4,952.90
|
| Rate for Payer: Coventry All Commercial |
$4,686.62
|
| Rate for Payer: Encore All Commercial |
$4,902.31
|
| Rate for Payer: Frontpath All Commercial |
$4,899.64
|
| Rate for Payer: Humana ChoiceCare |
$4,599.81
|
| Rate for Payer: Humana Medicare |
$2,716.11
|
| Rate for Payer: Lucent All Commercial |
$2,716.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,793.13
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,994.28
|
| Rate for Payer: PHP All Commercial |
$4,039.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,077.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,111.44
|
| Rate for Payer: Signature Care EPO |
$4,420.33
|
| Rate for Payer: Signature Care PPO |
$4,686.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,526.84
|
| Rate for Payer: United Healthcare Commercial |
$4,196.65
|
| Rate for Payer: United Healthcare Medicare |
$1,757.48
|
|
|
HC Z GLEN MOD 4 PEG SZ 3
|
Facility
IP
|
$5,325.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,994.28 |
| Max. Negotiated Rate |
$4,952.90 |
| Rate for Payer: Aetna Commercial |
$4,601.40
|
| Rate for Payer: Cash Price |
$3,301.93
|
| Rate for Payer: Cigna All Commercial |
$4,596.08
|
| Rate for Payer: CORVEL All Commercial |
$4,952.90
|
| Rate for Payer: Coventry All Commercial |
$4,686.62
|
| Rate for Payer: Encore All Commercial |
$4,902.31
|
| Rate for Payer: Frontpath All Commercial |
$4,899.64
|
| Rate for Payer: Humana ChoiceCare |
$4,599.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,793.13
|
| Rate for Payer: PHCS All Commercial |
$3,994.28
|
| Rate for Payer: PHP All Commercial |
$4,039.01
|
| Rate for Payer: Sagamore Health Network All Products |
$4,111.44
|
| Rate for Payer: Signature Care EPO |
$4,420.33
|
| Rate for Payer: Signature Care PPO |
$4,686.62
|
| Rate for Payer: United Healthcare Commercial |
$4,196.65
|
|
|
HC Z GLEN MOD 4 PEG SZ 4
|
Facility
OP
|
$5,325.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,952.90 |
| Rate for Payer: Aetna Commercial |
$4,494.89
|
| Rate for Payer: Aetna Medicare |
$1,757.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,757.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,058.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,329.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,021.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,933.23
|
| Rate for Payer: Cash Price |
$3,301.93
|
| Rate for Payer: Cash Price |
$3,301.93
|
| Rate for Payer: Centivo All Commercial |
$2,716.11
|
| Rate for Payer: Cigna All Commercial |
$4,596.08
|
| Rate for Payer: CORVEL All Commercial |
$4,952.90
|
| Rate for Payer: Coventry All Commercial |
$4,686.62
|
| Rate for Payer: Encore All Commercial |
$4,902.31
|
| Rate for Payer: Frontpath All Commercial |
$4,899.64
|
| Rate for Payer: Humana ChoiceCare |
$4,599.81
|
| Rate for Payer: Humana Medicare |
$2,716.11
|
| Rate for Payer: Lucent All Commercial |
$2,716.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,793.13
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,994.28
|
| Rate for Payer: PHP All Commercial |
$4,039.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,077.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,111.44
|
| Rate for Payer: Signature Care EPO |
$4,420.33
|
| Rate for Payer: Signature Care PPO |
$4,686.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,526.84
|
| Rate for Payer: United Healthcare Commercial |
$4,196.65
|
| Rate for Payer: United Healthcare Medicare |
$1,757.48
|
|
|
HC Z GLEN MOD 4 PEG SZ 4
|
Facility
IP
|
$5,325.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,994.28 |
| Max. Negotiated Rate |
$4,952.90 |
| Rate for Payer: Aetna Commercial |
$4,601.40
|
| Rate for Payer: Cash Price |
$3,301.93
|
| Rate for Payer: Cigna All Commercial |
$4,596.08
|
| Rate for Payer: CORVEL All Commercial |
$4,952.90
|
| Rate for Payer: Coventry All Commercial |
$4,686.62
|
| Rate for Payer: Encore All Commercial |
$4,902.31
|
| Rate for Payer: Frontpath All Commercial |
$4,899.64
|
| Rate for Payer: Humana ChoiceCare |
$4,599.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,793.13
|
| Rate for Payer: PHCS All Commercial |
$3,994.28
|
| Rate for Payer: PHP All Commercial |
$4,039.01
|
| Rate for Payer: Sagamore Health Network All Products |
$4,111.44
|
| Rate for Payer: Signature Care EPO |
$4,420.33
|
| Rate for Payer: Signature Care PPO |
$4,686.62
|
| Rate for Payer: United Healthcare Commercial |
$4,196.65
|
|
|
HC Z GLEN MOD 4 PEG SZ4 LT
|
Facility
OP
|
$7,312.90
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,801.00 |
| Rate for Payer: Aetna Commercial |
$6,172.09
|
| Rate for Payer: Aetna Medicare |
$2,413.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,413.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,199.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,571.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,775.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,654.58
|
| Rate for Payer: Cash Price |
$4,534.00
|
| Rate for Payer: Cash Price |
$4,534.00
|
| Rate for Payer: Centivo All Commercial |
$3,729.58
|
| Rate for Payer: Cigna All Commercial |
$6,311.03
|
| Rate for Payer: CORVEL All Commercial |
$6,801.00
|
| Rate for Payer: Coventry All Commercial |
$6,435.35
|
| Rate for Payer: Encore All Commercial |
$6,731.52
|
| Rate for Payer: Frontpath All Commercial |
$6,727.87
|
| Rate for Payer: Humana ChoiceCare |
$6,316.15
|
| Rate for Payer: Humana Medicare |
$3,729.58
|
| Rate for Payer: Lucent All Commercial |
$3,729.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,581.61
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,484.68
|
| Rate for Payer: PHP All Commercial |
$5,546.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,852.03
|
| Rate for Payer: Sagamore Health Network All Products |
$5,645.56
|
| Rate for Payer: Signature Care EPO |
$6,069.71
|
| Rate for Payer: Signature Care PPO |
$6,435.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,215.96
|
| Rate for Payer: United Healthcare Commercial |
$5,762.57
|
| Rate for Payer: United Healthcare Medicare |
$2,413.26
|
|
