|
HC Z HUMERAL HD 58X24X64
|
Facility
OP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,216.08
|
| Rate for Payer: Aetna Medicare |
$2,039.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,039.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,549.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,863.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,345.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,243.41
|
| Rate for Payer: Cash Price |
$3,831.72
|
| Rate for Payer: Cash Price |
$3,831.72
|
| Rate for Payer: Centivo All Commercial |
$3,151.90
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Humana Medicare |
$3,151.90
|
| Rate for Payer: Lucent All Commercial |
$3,151.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,410.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,253.16
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
| Rate for Payer: United Healthcare Medicare |
$2,039.46
|
|
|
HC Z HUMERAL HD 58X27X61
|
Facility
IP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,635.14 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,339.68
|
| Rate for Payer: Cash Price |
$3,831.72
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
|
|
HC Z HUMERAL HD 58X27X61
|
Facility
OP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,216.08
|
| Rate for Payer: Aetna Medicare |
$2,039.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,039.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,549.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,863.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,345.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,243.41
|
| Rate for Payer: Cash Price |
$3,831.72
|
| Rate for Payer: Cash Price |
$3,831.72
|
| Rate for Payer: Centivo All Commercial |
$3,151.90
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Humana Medicare |
$3,151.90
|
| Rate for Payer: Lucent All Commercial |
$3,151.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,410.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,253.16
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
| Rate for Payer: United Healthcare Medicare |
$2,039.46
|
|
|
HC Z HUMERAL NAIL 7X220
|
Facility
IP
|
$5,377.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,033.23 |
| Max. Negotiated Rate |
$5,001.21 |
| Rate for Payer: Aetna Commercial |
$4,646.28
|
| Rate for Payer: Cash Price |
$3,334.14
|
| Rate for Payer: Cigna All Commercial |
$4,640.90
|
| Rate for Payer: CORVEL All Commercial |
$5,001.21
|
| Rate for Payer: Coventry All Commercial |
$4,732.32
|
| Rate for Payer: Encore All Commercial |
$4,950.12
|
| Rate for Payer: Frontpath All Commercial |
$4,947.43
|
| Rate for Payer: Humana ChoiceCare |
$4,644.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,839.88
|
| Rate for Payer: PHCS All Commercial |
$4,033.23
|
| Rate for Payer: PHP All Commercial |
$4,078.40
|
| Rate for Payer: Sagamore Health Network All Products |
$4,151.54
|
| Rate for Payer: Signature Care EPO |
$4,463.44
|
| Rate for Payer: Signature Care PPO |
$4,732.32
|
| Rate for Payer: United Healthcare Commercial |
$4,237.58
|
|
|
HC Z HUMERAL NAIL 7X220
|
Facility
OP
|
$5,377.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,001.21 |
| Rate for Payer: Aetna Commercial |
$4,538.73
|
| Rate for Payer: Aetna Medicare |
$1,774.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,774.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,088.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,361.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,040.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,952.08
|
| Rate for Payer: Cash Price |
$3,334.14
|
| Rate for Payer: Cash Price |
$3,334.14
|
| Rate for Payer: Centivo All Commercial |
$2,742.60
|
| Rate for Payer: Cigna All Commercial |
$4,640.90
|
| Rate for Payer: CORVEL All Commercial |
$5,001.21
|
| Rate for Payer: Coventry All Commercial |
$4,732.32
|
| Rate for Payer: Encore All Commercial |
$4,950.12
|
| Rate for Payer: Frontpath All Commercial |
$4,947.43
|
| Rate for Payer: Humana ChoiceCare |
$4,644.67
|
| Rate for Payer: Humana Medicare |
$2,742.60
|
| Rate for Payer: Lucent All Commercial |
$2,742.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,839.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,033.23
|
| Rate for Payer: PHP All Commercial |
$4,078.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,097.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,151.54
|
| Rate for Payer: Signature Care EPO |
$4,463.44
|
| Rate for Payer: Signature Care PPO |
$4,732.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,570.99
|
| Rate for Payer: United Healthcare Commercial |
$4,237.58
|
| Rate for Payer: United Healthcare Medicare |
$1,774.62
|
|
|
HC Z HUMERAL NAIL 7X240
|
Facility
IP
|
$5,377.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,033.23 |
| Max. Negotiated Rate |
$5,001.21 |
| Rate for Payer: Aetna Commercial |
$4,646.28
|
| Rate for Payer: Cash Price |
$3,334.14
|
| Rate for Payer: Cigna All Commercial |
$4,640.90
|
| Rate for Payer: CORVEL All Commercial |
$5,001.21
|
| Rate for Payer: Coventry All Commercial |
$4,732.32
|
| Rate for Payer: Encore All Commercial |
$4,950.12
|
| Rate for Payer: Frontpath All Commercial |
$4,947.43
|
| Rate for Payer: Humana ChoiceCare |
$4,644.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,839.88
|
| Rate for Payer: PHCS All Commercial |
$4,033.23
|
| Rate for Payer: PHP All Commercial |
$4,078.40
|
| Rate for Payer: Sagamore Health Network All Products |
$4,151.54
|
| Rate for Payer: Signature Care EPO |
$4,463.44
|
| Rate for Payer: Signature Care PPO |
$4,732.32
|
| Rate for Payer: United Healthcare Commercial |
$4,237.58
|
|
|
HC Z HUMERAL NAIL 7X240
|
Facility
OP
|
$5,377.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,001.21 |
| Rate for Payer: Aetna Commercial |
$4,538.73
|
| Rate for Payer: Aetna Medicare |
$1,774.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,774.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,088.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,361.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,040.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,952.08
|
| Rate for Payer: Cash Price |
$3,334.14
|
| Rate for Payer: Cash Price |
$3,334.14
|
| Rate for Payer: Centivo All Commercial |
$2,742.60
|
| Rate for Payer: Cigna All Commercial |
$4,640.90
|
| Rate for Payer: CORVEL All Commercial |
$5,001.21
|
| Rate for Payer: Coventry All Commercial |
$4,732.32
|
| Rate for Payer: Encore All Commercial |
$4,950.12
|
| Rate for Payer: Frontpath All Commercial |
$4,947.43
|
| Rate for Payer: Humana ChoiceCare |
$4,644.67
|
| Rate for Payer: Humana Medicare |
$2,742.60
|
| Rate for Payer: Lucent All Commercial |
$2,742.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,839.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,033.23
|
| Rate for Payer: PHP All Commercial |
$4,078.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,097.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4,151.54
|
| Rate for Payer: Signature Care EPO |
$4,463.44
|
| Rate for Payer: Signature Care PPO |
$4,732.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,570.99
|
| Rate for Payer: United Healthcare Commercial |
$4,237.58
|
| Rate for Payer: United Healthcare Medicare |
$1,774.62
|
|
|
HC Z HUM FRACT 10MM STEM
|
Facility
OP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$11,757.15
|
| Rate for Payer: Aetna Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,000.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,707.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,286.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,056.69
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Centivo All Commercial |
$7,104.44
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Humana Medicare |
$7,104.44
|
| Rate for Payer: Lucent All Commercial |
$7,104.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,432.81
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,840.73
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
| Rate for Payer: United Healthcare Medicare |
$4,596.99
|
|
|
HC Z HUM FRACT 10MM STEM
|
Facility
IP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,447.70 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$12,035.75
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
|
|
HC Z HUM FRACT 12MM STEM
|
Facility
IP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,447.70 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$12,035.75
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
|
|
HC Z HUM FRACT 12MM STEM
|
Facility
OP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$11,757.15
|
| Rate for Payer: Aetna Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,000.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,707.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,286.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,056.69
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Centivo All Commercial |
$7,104.44
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Humana Medicare |
$7,104.44
|
| Rate for Payer: Lucent All Commercial |
$7,104.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,432.81
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,840.73
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
| Rate for Payer: United Healthcare Medicare |
$4,596.99
|
|
|
HC Z HUM FRACT 14MM STEM
|
Facility
IP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,447.70 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$12,035.75
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
|
|
HC Z HUM FRACT 14MM STEM
|
Facility
OP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$11,757.15
|
| Rate for Payer: Aetna Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,000.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,707.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,286.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,056.69
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Centivo All Commercial |
$7,104.44
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Humana Medicare |
$7,104.44
|
| Rate for Payer: Lucent All Commercial |
$7,104.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,432.81
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,840.73
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
| Rate for Payer: United Healthcare Medicare |
$4,596.99
|
|
|
HC Z HUM FRACT 4MM STEM
|
Facility
OP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$11,757.15
|
| Rate for Payer: Aetna Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,000.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,707.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,286.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,056.69
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Centivo All Commercial |
$7,104.44
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Humana Medicare |
$7,104.44
|
| Rate for Payer: Lucent All Commercial |
$7,104.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,432.81
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,840.73
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
| Rate for Payer: United Healthcare Medicare |
$4,596.99
|
|
|
HC Z HUM FRACT 4MM STEM
|
Facility
IP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,447.70 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$12,035.75
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
|
|
HC Z HUM FRACT 6MM STEM
|
Facility
OP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$11,757.15
|
| Rate for Payer: Aetna Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,000.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,707.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,286.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,056.69
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Centivo All Commercial |
$7,104.44
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Humana Medicare |
$7,104.44
|
| Rate for Payer: Lucent All Commercial |
$7,104.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,432.81
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,840.73
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
| Rate for Payer: United Healthcare Medicare |
$4,596.99
|
|
|
HC Z HUM FRACT 6MM STEM
|
Facility
IP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,447.70 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$12,035.75
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
|
|
HC Z HUM FRACT 8MM STEM
|
Facility
OP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$11,757.15
|
| Rate for Payer: Aetna Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,596.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,000.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,707.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,286.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,056.69
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Centivo All Commercial |
$7,104.44
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Humana Medicare |
$7,104.44
|
| Rate for Payer: Lucent All Commercial |
$7,104.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,432.81
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,840.73
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
| Rate for Payer: United Healthcare Medicare |
$4,596.99
|
|
|
HC Z HUM FRACT 8MM STEM
|
Facility
IP
|
$13,930.27
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,447.70 |
| Max. Negotiated Rate |
$12,955.15 |
| Rate for Payer: Aetna Commercial |
$12,035.75
|
| Rate for Payer: Cash Price |
$8,636.77
|
| Rate for Payer: Cigna All Commercial |
$12,021.82
|
| Rate for Payer: CORVEL All Commercial |
$12,955.15
|
| Rate for Payer: Coventry All Commercial |
$12,258.64
|
| Rate for Payer: Encore All Commercial |
$12,822.81
|
| Rate for Payer: Frontpath All Commercial |
$12,815.85
|
| Rate for Payer: Humana ChoiceCare |
$12,031.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,537.24
|
| Rate for Payer: PHCS All Commercial |
$10,447.70
|
| Rate for Payer: PHP All Commercial |
$10,564.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10,754.17
|
| Rate for Payer: Signature Care EPO |
$11,562.12
|
| Rate for Payer: Signature Care PPO |
$12,258.64
|
| Rate for Payer: United Healthcare Commercial |
$10,977.05
|
|
|
HC Z HUM SLEEVE 10MM
|
Facility
OP
|
$1,214.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$1,129.39 |
| Rate for Payer: Aetna Commercial |
$1,024.95
|
| Rate for Payer: Aetna Medicare |
$400.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$400.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$697.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$759.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$460.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$440.83
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Centivo All Commercial |
$619.34
|
| Rate for Payer: Cigna All Commercial |
$1,048.03
|
| Rate for Payer: CORVEL All Commercial |
$1,129.39
|
| Rate for Payer: Coventry All Commercial |
$1,068.67
|
| Rate for Payer: Encore All Commercial |
$1,117.86
|
| Rate for Payer: Frontpath All Commercial |
$1,117.25
|
| Rate for Payer: Humana ChoiceCare |
$1,048.88
|
| Rate for Payer: Humana Medicare |
$619.34
|
| Rate for Payer: Lucent All Commercial |
$619.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$910.80
|
| Rate for Payer: PHP All Commercial |
$921.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$473.62
|
| Rate for Payer: Sagamore Health Network All Products |
$937.52
|
| Rate for Payer: Signature Care EPO |
$1,007.95
|
| Rate for Payer: Signature Care PPO |
$1,068.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,032.24
|
| Rate for Payer: United Healthcare Commercial |
$956.95
|
| Rate for Payer: United Healthcare Medicare |
$400.75
|
|
|
HC Z HUM SLEEVE 10MM
|
Facility
IP
|
$1,214.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.80 |
| Max. Negotiated Rate |
$1,129.39 |
| Rate for Payer: Aetna Commercial |
$1,049.24
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Cigna All Commercial |
$1,048.03
|
| Rate for Payer: CORVEL All Commercial |
$1,129.39
|
| Rate for Payer: Coventry All Commercial |
$1,068.67
|
| Rate for Payer: Encore All Commercial |
$1,117.86
|
| Rate for Payer: Frontpath All Commercial |
$1,117.25
|
| Rate for Payer: Humana ChoiceCare |
$1,048.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.96
|
| Rate for Payer: PHCS All Commercial |
$910.80
|
| Rate for Payer: PHP All Commercial |
$921.00
|
| Rate for Payer: Sagamore Health Network All Products |
$937.52
|
| Rate for Payer: Signature Care EPO |
$1,007.95
|
| Rate for Payer: Signature Care PPO |
$1,068.67
|
| Rate for Payer: United Healthcare Commercial |
$956.95
|
|
|
HC Z HUM SLEEVE 11MM
|
Facility
IP
|
$1,214.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.80 |
| Max. Negotiated Rate |
$1,129.39 |
| Rate for Payer: Aetna Commercial |
$1,049.24
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Cigna All Commercial |
$1,048.03
|
| Rate for Payer: CORVEL All Commercial |
$1,129.39
|
| Rate for Payer: Coventry All Commercial |
$1,068.67
|
| Rate for Payer: Encore All Commercial |
$1,117.86
|
| Rate for Payer: Frontpath All Commercial |
$1,117.25
|
| Rate for Payer: Humana ChoiceCare |
$1,048.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.96
|
| Rate for Payer: PHCS All Commercial |
$910.80
|
| Rate for Payer: PHP All Commercial |
$921.00
|
| Rate for Payer: Sagamore Health Network All Products |
$937.52
|
| Rate for Payer: Signature Care EPO |
$1,007.95
|
| Rate for Payer: Signature Care PPO |
$1,068.67
|
| Rate for Payer: United Healthcare Commercial |
$956.95
|
|
|
HC Z HUM SLEEVE 11MM
|
Facility
OP
|
$1,214.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$1,129.39 |
| Rate for Payer: Aetna Commercial |
$1,024.95
|
| Rate for Payer: Aetna Medicare |
$400.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$400.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$697.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$759.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$460.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$440.83
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Centivo All Commercial |
$619.34
|
| Rate for Payer: Cigna All Commercial |
$1,048.03
|
| Rate for Payer: CORVEL All Commercial |
$1,129.39
|
| Rate for Payer: Coventry All Commercial |
$1,068.67
|
| Rate for Payer: Encore All Commercial |
$1,117.86
|
| Rate for Payer: Frontpath All Commercial |
$1,117.25
|
| Rate for Payer: Humana ChoiceCare |
$1,048.88
|
| Rate for Payer: Humana Medicare |
$619.34
|
| Rate for Payer: Lucent All Commercial |
$619.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$910.80
|
| Rate for Payer: PHP All Commercial |
$921.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$473.62
|
| Rate for Payer: Sagamore Health Network All Products |
$937.52
|
| Rate for Payer: Signature Care EPO |
$1,007.95
|
| Rate for Payer: Signature Care PPO |
$1,068.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,032.24
|
| Rate for Payer: United Healthcare Commercial |
$956.95
|
| Rate for Payer: United Healthcare Medicare |
$400.75
|
|
|
HC Z HUM SLEEVE 12MM
|
Facility
IP
|
$1,214.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.80 |
| Max. Negotiated Rate |
$1,129.39 |
| Rate for Payer: Aetna Commercial |
$1,049.24
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Cigna All Commercial |
$1,048.03
|
| Rate for Payer: CORVEL All Commercial |
$1,129.39
|
| Rate for Payer: Coventry All Commercial |
$1,068.67
|
| Rate for Payer: Encore All Commercial |
$1,117.86
|
| Rate for Payer: Frontpath All Commercial |
$1,117.25
|
| Rate for Payer: Humana ChoiceCare |
$1,048.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.96
|
| Rate for Payer: PHCS All Commercial |
$910.80
|
| Rate for Payer: PHP All Commercial |
$921.00
|
| Rate for Payer: Sagamore Health Network All Products |
$937.52
|
| Rate for Payer: Signature Care EPO |
$1,007.95
|
| Rate for Payer: Signature Care PPO |
$1,068.67
|
| Rate for Payer: United Healthcare Commercial |
$956.95
|
|
|
HC Z HUM SLEEVE 12MM
|
Facility
OP
|
$1,214.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$1,129.39 |
| Rate for Payer: Aetna Commercial |
$1,024.95
|
| Rate for Payer: Aetna Medicare |
$400.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$400.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$697.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$759.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$460.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$440.83
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Cash Price |
$752.93
|
| Rate for Payer: Centivo All Commercial |
$619.34
|
| Rate for Payer: Cigna All Commercial |
$1,048.03
|
| Rate for Payer: CORVEL All Commercial |
$1,129.39
|
| Rate for Payer: Coventry All Commercial |
$1,068.67
|
| Rate for Payer: Encore All Commercial |
$1,117.86
|
| Rate for Payer: Frontpath All Commercial |
$1,117.25
|
| Rate for Payer: Humana ChoiceCare |
$1,048.88
|
| Rate for Payer: Humana Medicare |
$619.34
|
| Rate for Payer: Lucent All Commercial |
$619.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$910.80
|
| Rate for Payer: PHP All Commercial |
$921.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$473.62
|
| Rate for Payer: Sagamore Health Network All Products |
$937.52
|
| Rate for Payer: Signature Care EPO |
$1,007.95
|
| Rate for Payer: Signature Care PPO |
$1,068.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,032.24
|
| Rate for Payer: United Healthcare Commercial |
$956.95
|
| Rate for Payer: United Healthcare Medicare |
$400.75
|
|
