|
HC Z NEXGEN 60MM TIP EXTENDER
|
Facility
OP
|
$2,335.00
|
|
| Hospital Charge Code |
41606105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$1,970.74
|
| Rate for Payer: Aetna Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,340.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,459.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$886.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$847.60
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Centivo All Commercial |
$1,190.85
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Humana Medicare |
$1,190.85
|
| Rate for Payer: Lucent All Commercial |
$1,190.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,984.75
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
| Rate for Payer: United Healthcare Medicare |
$770.55
|
|
|
HC Z NEXGEN 9.5 SHRT ULTRA-DRIVE
|
Facility
IP
|
$2,335.00
|
|
| Hospital Charge Code |
41606107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,751.25 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$2,017.44
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
|
|
HC Z NEXGEN 9.5 SHRT ULTRA-DRIVE
|
Facility
OP
|
$2,335.00
|
|
| Hospital Charge Code |
41606107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,171.55 |
| Rate for Payer: Aetna Commercial |
$1,970.74
|
| Rate for Payer: Aetna Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$770.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,340.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,459.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$886.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$847.60
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Cash Price |
$1,447.70
|
| Rate for Payer: Centivo All Commercial |
$1,190.85
|
| Rate for Payer: Cigna All Commercial |
$2,015.10
|
| Rate for Payer: CORVEL All Commercial |
$2,171.55
|
| Rate for Payer: Coventry All Commercial |
$2,054.80
|
| Rate for Payer: Encore All Commercial |
$2,149.37
|
| Rate for Payer: Frontpath All Commercial |
$2,148.20
|
| Rate for Payer: Humana ChoiceCare |
$2,016.74
|
| Rate for Payer: Humana Medicare |
$1,190.85
|
| Rate for Payer: Lucent All Commercial |
$1,190.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,101.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,751.25
|
| Rate for Payer: PHP All Commercial |
$1,770.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,802.62
|
| Rate for Payer: Signature Care EPO |
$1,938.05
|
| Rate for Payer: Signature Care PPO |
$2,054.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,984.75
|
| Rate for Payer: United Healthcare Commercial |
$1,839.98
|
| Rate for Payer: United Healthcare Medicare |
$770.55
|
|
|
HC Z NEXGEN ART SURF 17MM
|
Facility
OP
|
$4,275.00
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41606115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,975.75 |
| Rate for Payer: Aetna Commercial |
$3,608.10
|
| Rate for Payer: Aetna Medicare |
$1,410.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,410.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,455.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,672.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,622.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,551.82
|
| Rate for Payer: Cash Price |
$2,650.50
|
| Rate for Payer: Cash Price |
$2,650.50
|
| Rate for Payer: Centivo All Commercial |
$2,180.25
|
| Rate for Payer: Cigna All Commercial |
$3,689.32
|
| Rate for Payer: CORVEL All Commercial |
$3,975.75
|
| Rate for Payer: Coventry All Commercial |
$3,762.00
|
| Rate for Payer: Encore All Commercial |
$3,935.14
|
| Rate for Payer: Frontpath All Commercial |
$3,933.00
|
| Rate for Payer: Humana ChoiceCare |
$3,692.32
|
| Rate for Payer: Humana Medicare |
$2,180.25
|
| Rate for Payer: Lucent All Commercial |
$2,180.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,847.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,206.25
|
| Rate for Payer: PHP All Commercial |
$3,242.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,667.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,300.30
|
| Rate for Payer: Signature Care EPO |
$3,548.25
|
| Rate for Payer: Signature Care PPO |
$3,762.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,633.75
|
| Rate for Payer: United Healthcare Commercial |
$3,368.70
|
| Rate for Payer: United Healthcare Medicare |
$1,410.75
|
|
|
HC Z NEXGEN ART SURF 17MM
|
Facility
IP
|
$4,275.00
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41606115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,206.25 |
| Max. Negotiated Rate |
$3,975.75 |
| Rate for Payer: Aetna Commercial |
$3,693.60
|
| Rate for Payer: Cash Price |
$2,650.50
|
| Rate for Payer: Cigna All Commercial |
$3,689.32
|
| Rate for Payer: CORVEL All Commercial |
$3,975.75
|
| Rate for Payer: Coventry All Commercial |
$3,762.00
|
| Rate for Payer: Encore All Commercial |
$3,935.14
|
| Rate for Payer: Frontpath All Commercial |
$3,933.00
|
| Rate for Payer: Humana ChoiceCare |
$3,692.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,847.50
|
| Rate for Payer: PHCS All Commercial |
$3,206.25
|
| Rate for Payer: PHP All Commercial |
$3,242.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,300.30
|
| Rate for Payer: Signature Care EPO |
$3,548.25
|
| Rate for Payer: Signature Care PPO |
$3,762.00
|
| Rate for Payer: United Healthcare Commercial |
$3,368.70
|
|
|
HC Z NEXGEN FEM AUG BLOCK F-5MM
|
Facility
OP
|
$3,762.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,499.43 |
| Rate for Payer: Aetna Commercial |
$3,175.83
|
| Rate for Payer: Aetna Medicare |
$1,241.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,241.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,160.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,352.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,427.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,365.91
|
| Rate for Payer: Cash Price |
$2,332.96
|
| Rate for Payer: Cash Price |
$2,332.96
|
| Rate for Payer: Centivo All Commercial |
$1,919.04
|
| Rate for Payer: Cigna All Commercial |
$3,247.32
|
| Rate for Payer: CORVEL All Commercial |
$3,499.43
|
| Rate for Payer: Coventry All Commercial |
$3,311.29
|
| Rate for Payer: Encore All Commercial |
$3,463.69
|
| Rate for Payer: Frontpath All Commercial |
$3,461.80
|
| Rate for Payer: Humana ChoiceCare |
$3,249.96
|
| Rate for Payer: Humana Medicare |
$1,919.04
|
| Rate for Payer: Lucent All Commercial |
$1,919.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,386.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,822.12
|
| Rate for Payer: PHP All Commercial |
$2,853.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,467.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,904.90
|
| Rate for Payer: Signature Care EPO |
$3,123.15
|
| Rate for Payer: Signature Care PPO |
$3,311.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,198.41
|
| Rate for Payer: United Healthcare Commercial |
$2,965.11
|
| Rate for Payer: United Healthcare Medicare |
$1,241.73
|
|
|
HC Z NEXGEN FEM AUG BLOCK F-5MM
|
Facility
IP
|
$3,762.83
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.12 |
| Max. Negotiated Rate |
$3,499.43 |
| Rate for Payer: Aetna Commercial |
$3,251.09
|
| Rate for Payer: Cash Price |
$2,332.96
|
| Rate for Payer: Cigna All Commercial |
$3,247.32
|
| Rate for Payer: CORVEL All Commercial |
$3,499.43
|
| Rate for Payer: Coventry All Commercial |
$3,311.29
|
| Rate for Payer: Encore All Commercial |
$3,463.69
|
| Rate for Payer: Frontpath All Commercial |
$3,461.80
|
| Rate for Payer: Humana ChoiceCare |
$3,249.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,386.55
|
| Rate for Payer: PHCS All Commercial |
$2,822.12
|
| Rate for Payer: PHP All Commercial |
$2,853.73
|
| Rate for Payer: Sagamore Health Network All Products |
$2,904.90
|
| Rate for Payer: Signature Care EPO |
$3,123.15
|
| Rate for Payer: Signature Care PPO |
$3,311.29
|
| Rate for Payer: United Healthcare Commercial |
$2,965.11
|
|
|
HC Z NEXGEN FEM F-LT
|
Facility
IP
|
$24,717.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,538.10 |
| Max. Negotiated Rate |
$22,987.24 |
| Rate for Payer: Aetna Commercial |
$21,355.89
|
| Rate for Payer: Cash Price |
$15,324.83
|
| Rate for Payer: Cigna All Commercial |
$21,331.17
|
| Rate for Payer: CORVEL All Commercial |
$22,987.24
|
| Rate for Payer: Coventry All Commercial |
$21,751.36
|
| Rate for Payer: Encore All Commercial |
$22,752.42
|
| Rate for Payer: Frontpath All Commercial |
$22,740.06
|
| Rate for Payer: Humana ChoiceCare |
$21,348.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,245.71
|
| Rate for Payer: PHCS All Commercial |
$18,538.10
|
| Rate for Payer: PHP All Commercial |
$18,745.72
|
| Rate for Payer: Sagamore Health Network All Products |
$19,081.88
|
| Rate for Payer: Signature Care EPO |
$20,515.49
|
| Rate for Payer: Signature Care PPO |
$21,751.36
|
| Rate for Payer: United Healthcare Commercial |
$19,477.36
|
|
|
HC Z NEXGEN FEM F-LT
|
Facility
OP
|
$24,717.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$22,987.24 |
| Rate for Payer: Aetna Commercial |
$20,861.54
|
| Rate for Payer: Aetna Medicare |
$8,156.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,156.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,195.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,450.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,380.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8,972.44
|
| Rate for Payer: Cash Price |
$15,324.83
|
| Rate for Payer: Cash Price |
$15,324.83
|
| Rate for Payer: Centivo All Commercial |
$12,605.90
|
| Rate for Payer: Cigna All Commercial |
$21,331.17
|
| Rate for Payer: CORVEL All Commercial |
$22,987.24
|
| Rate for Payer: Coventry All Commercial |
$21,751.36
|
| Rate for Payer: Encore All Commercial |
$22,752.42
|
| Rate for Payer: Frontpath All Commercial |
$22,740.06
|
| Rate for Payer: Humana ChoiceCare |
$21,348.47
|
| Rate for Payer: Humana Medicare |
$12,605.90
|
| Rate for Payer: Lucent All Commercial |
$12,605.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22,245.71
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$18,538.10
|
| Rate for Payer: PHP All Commercial |
$18,745.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,639.81
|
| Rate for Payer: Sagamore Health Network All Products |
$19,081.88
|
| Rate for Payer: Signature Care EPO |
$20,515.49
|
| Rate for Payer: Signature Care PPO |
$21,751.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,009.84
|
| Rate for Payer: United Healthcare Commercial |
$19,477.36
|
| Rate for Payer: United Healthcare Medicare |
$8,156.76
|
|
|
HC Z NEXGEN PATELLA 35
|
Facility
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.00 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,488.32
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cigna All Commercial |
$2,485.44
|
| Rate for Payer: CORVEL All Commercial |
$2,678.40
|
| Rate for Payer: Coventry All Commercial |
$2,534.40
|
| Rate for Payer: Encore All Commercial |
$2,651.04
|
| Rate for Payer: Frontpath All Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,487.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,592.00
|
| Rate for Payer: PHCS All Commercial |
$2,160.00
|
| Rate for Payer: PHP All Commercial |
$2,184.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,223.36
|
| Rate for Payer: Signature Care EPO |
$2,390.40
|
| Rate for Payer: Signature Care PPO |
$2,534.40
|
| Rate for Payer: United Healthcare Commercial |
$2,269.44
|
|
|
HC Z NEXGEN PATELLA 35
|
Facility
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,430.72
|
| Rate for Payer: Aetna Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,653.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,800.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,092.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,045.44
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Centivo All Commercial |
$1,468.80
|
| Rate for Payer: Cigna All Commercial |
$2,485.44
|
| Rate for Payer: CORVEL All Commercial |
$2,678.40
|
| Rate for Payer: Coventry All Commercial |
$2,534.40
|
| Rate for Payer: Encore All Commercial |
$2,651.04
|
| Rate for Payer: Frontpath All Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,487.46
|
| Rate for Payer: Humana Medicare |
$1,468.80
|
| Rate for Payer: Lucent All Commercial |
$1,468.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,592.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,160.00
|
| Rate for Payer: PHP All Commercial |
$2,184.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,123.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,223.36
|
| Rate for Payer: Signature Care EPO |
$2,390.40
|
| Rate for Payer: Signature Care PPO |
$2,534.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare Commercial |
$2,269.44
|
| Rate for Payer: United Healthcare Medicare |
$950.40
|
|
|
HC Z NEXGEN STEM 12X100
|
Facility
OP
|
$5,646.96
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,251.67 |
| Rate for Payer: Aetna Commercial |
$4,766.03
|
| Rate for Payer: Aetna Medicare |
$1,863.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,863.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,243.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,529.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,143.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,049.85
|
| Rate for Payer: Cash Price |
$3,501.12
|
| Rate for Payer: Cash Price |
$3,501.12
|
| Rate for Payer: Centivo All Commercial |
$2,879.95
|
| Rate for Payer: Cigna All Commercial |
$4,873.33
|
| Rate for Payer: CORVEL All Commercial |
$5,251.67
|
| Rate for Payer: Coventry All Commercial |
$4,969.32
|
| Rate for Payer: Encore All Commercial |
$5,198.03
|
| Rate for Payer: Frontpath All Commercial |
$5,195.20
|
| Rate for Payer: Humana ChoiceCare |
$4,877.28
|
| Rate for Payer: Humana Medicare |
$2,879.95
|
| Rate for Payer: Lucent All Commercial |
$2,879.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,082.26
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,235.22
|
| Rate for Payer: PHP All Commercial |
$4,282.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,202.31
|
| Rate for Payer: Sagamore Health Network All Products |
$4,359.45
|
| Rate for Payer: Signature Care EPO |
$4,686.98
|
| Rate for Payer: Signature Care PPO |
$4,969.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,799.92
|
| Rate for Payer: United Healthcare Commercial |
$4,449.80
|
| Rate for Payer: United Healthcare Medicare |
$1,863.50
|
|
|
HC Z NEXGEN STEM 12X100
|
Facility
IP
|
$5,646.96
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,235.22 |
| Max. Negotiated Rate |
$5,251.67 |
| Rate for Payer: Aetna Commercial |
$4,878.97
|
| Rate for Payer: Cash Price |
$3,501.12
|
| Rate for Payer: Cigna All Commercial |
$4,873.33
|
| Rate for Payer: CORVEL All Commercial |
$5,251.67
|
| Rate for Payer: Coventry All Commercial |
$4,969.32
|
| Rate for Payer: Encore All Commercial |
$5,198.03
|
| Rate for Payer: Frontpath All Commercial |
$5,195.20
|
| Rate for Payer: Humana ChoiceCare |
$4,877.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,082.26
|
| Rate for Payer: PHCS All Commercial |
$4,235.22
|
| Rate for Payer: PHP All Commercial |
$4,282.65
|
| Rate for Payer: Sagamore Health Network All Products |
$4,359.45
|
| Rate for Payer: Signature Care EPO |
$4,686.98
|
| Rate for Payer: Signature Care PPO |
$4,969.32
|
| Rate for Payer: United Healthcare Commercial |
$4,449.80
|
|
|
HC Z NEXGEN STEM 14X145
|
Facility
OP
|
$5,646.96
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,251.67 |
| Rate for Payer: Aetna Commercial |
$4,766.03
|
| Rate for Payer: Aetna Medicare |
$1,863.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,863.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,243.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,529.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,143.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,049.85
|
| Rate for Payer: Cash Price |
$3,501.12
|
| Rate for Payer: Cash Price |
$3,501.12
|
| Rate for Payer: Centivo All Commercial |
$2,879.95
|
| Rate for Payer: Cigna All Commercial |
$4,873.33
|
| Rate for Payer: CORVEL All Commercial |
$5,251.67
|
| Rate for Payer: Coventry All Commercial |
$4,969.32
|
| Rate for Payer: Encore All Commercial |
$5,198.03
|
| Rate for Payer: Frontpath All Commercial |
$5,195.20
|
| Rate for Payer: Humana ChoiceCare |
$4,877.28
|
| Rate for Payer: Humana Medicare |
$2,879.95
|
| Rate for Payer: Lucent All Commercial |
$2,879.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,082.26
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,235.22
|
| Rate for Payer: PHP All Commercial |
$4,282.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,202.31
|
| Rate for Payer: Sagamore Health Network All Products |
$4,359.45
|
| Rate for Payer: Signature Care EPO |
$4,686.98
|
| Rate for Payer: Signature Care PPO |
$4,969.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,799.92
|
| Rate for Payer: United Healthcare Commercial |
$4,449.80
|
| Rate for Payer: United Healthcare Medicare |
$1,863.50
|
|
|
HC Z NEXGEN STEM 14X145
|
Facility
IP
|
$5,646.96
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,235.22 |
| Max. Negotiated Rate |
$5,251.67 |
| Rate for Payer: Aetna Commercial |
$4,878.97
|
| Rate for Payer: Cash Price |
$3,501.12
|
| Rate for Payer: Cigna All Commercial |
$4,873.33
|
| Rate for Payer: CORVEL All Commercial |
$5,251.67
|
| Rate for Payer: Coventry All Commercial |
$4,969.32
|
| Rate for Payer: Encore All Commercial |
$5,198.03
|
| Rate for Payer: Frontpath All Commercial |
$5,195.20
|
| Rate for Payer: Humana ChoiceCare |
$4,877.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,082.26
|
| Rate for Payer: PHCS All Commercial |
$4,235.22
|
| Rate for Payer: PHP All Commercial |
$4,282.65
|
| Rate for Payer: Sagamore Health Network All Products |
$4,359.45
|
| Rate for Payer: Signature Care EPO |
$4,686.98
|
| Rate for Payer: Signature Care PPO |
$4,969.32
|
| Rate for Payer: United Healthcare Commercial |
$4,449.80
|
|
|
HC Z NEXGEN STEM 15X100 ST
|
Facility
OP
|
$4,335.41
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,031.93 |
| Rate for Payer: Aetna Commercial |
$3,659.09
|
| Rate for Payer: Aetna Medicare |
$1,430.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,430.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,489.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,710.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,645.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,573.75
|
| Rate for Payer: Cash Price |
$2,687.95
|
| Rate for Payer: Cash Price |
$2,687.95
|
| Rate for Payer: Centivo All Commercial |
$2,211.06
|
| Rate for Payer: Cigna All Commercial |
$3,741.46
|
| Rate for Payer: CORVEL All Commercial |
$4,031.93
|
| Rate for Payer: Coventry All Commercial |
$3,815.16
|
| Rate for Payer: Encore All Commercial |
$3,990.74
|
| Rate for Payer: Frontpath All Commercial |
$3,988.58
|
| Rate for Payer: Humana ChoiceCare |
$3,744.49
|
| Rate for Payer: Humana Medicare |
$2,211.06
|
| Rate for Payer: Lucent All Commercial |
$2,211.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.87
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,251.56
|
| Rate for Payer: PHP All Commercial |
$3,287.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.81
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.94
|
| Rate for Payer: Signature Care EPO |
$3,598.39
|
| Rate for Payer: Signature Care PPO |
$3,815.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,685.10
|
| Rate for Payer: United Healthcare Commercial |
$3,416.30
|
| Rate for Payer: United Healthcare Medicare |
$1,430.69
|
|
|
HC Z NEXGEN STEM 15X100 ST
|
Facility
IP
|
$4,335.41
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,251.56 |
| Max. Negotiated Rate |
$4,031.93 |
| Rate for Payer: Aetna Commercial |
$3,745.79
|
| Rate for Payer: Cash Price |
$2,687.95
|
| Rate for Payer: Cigna All Commercial |
$3,741.46
|
| Rate for Payer: CORVEL All Commercial |
$4,031.93
|
| Rate for Payer: Coventry All Commercial |
$3,815.16
|
| Rate for Payer: Encore All Commercial |
$3,990.74
|
| Rate for Payer: Frontpath All Commercial |
$3,988.58
|
| Rate for Payer: Humana ChoiceCare |
$3,744.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.87
|
| Rate for Payer: PHCS All Commercial |
$3,251.56
|
| Rate for Payer: PHP All Commercial |
$3,287.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.94
|
| Rate for Payer: Signature Care EPO |
$3,598.39
|
| Rate for Payer: Signature Care PPO |
$3,815.16
|
| Rate for Payer: United Healthcare Commercial |
$3,416.30
|
|
|
HC Z NEXGEN TIB STM 4
|
Facility
IP
|
$5,130.00
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41606114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.50 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,432.32
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
|
|
HC Z NEXGEN TIB STM 4
|
Facility
OP
|
$5,130.00
|
|
|
Service Code
|
CPT C1716
|
| Hospital Charge Code |
41606114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,329.72
|
| Rate for Payer: Aetna Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,946.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,206.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,946.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,862.19
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Centivo All Commercial |
$2,616.30
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Humana Medicare |
$2,616.30
|
| Rate for Payer: Lucent All Commercial |
$2,616.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,000.70
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,360.50
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
| Rate for Payer: United Healthcare Medicare |
$1,692.90
|
|
|
HC Z NEXGEN TIB STM 6
|
Facility
IP
|
$5,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.50 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,432.32
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
|
|
HC Z NEXGEN TIB STM 6
|
Facility
OP
|
$5,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,329.72
|
| Rate for Payer: Aetna Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,946.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,206.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,946.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,862.19
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Centivo All Commercial |
$2,616.30
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Humana Medicare |
$2,616.30
|
| Rate for Payer: Lucent All Commercial |
$2,616.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,000.70
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,360.50
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
| Rate for Payer: United Healthcare Medicare |
$1,692.90
|
|
|
HC Z N-FORCE BONE MATERIAL 10CC
|
Facility
IP
|
$13,399.88
|
|
| Hospital Charge Code |
41606090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,049.91 |
| Max. Negotiated Rate |
$12,461.89 |
| Rate for Payer: Aetna Commercial |
$11,577.50
|
| Rate for Payer: Cash Price |
$8,307.93
|
| Rate for Payer: Cigna All Commercial |
$11,564.10
|
| Rate for Payer: CORVEL All Commercial |
$12,461.89
|
| Rate for Payer: Coventry All Commercial |
$11,791.89
|
| Rate for Payer: Encore All Commercial |
$12,334.59
|
| Rate for Payer: Frontpath All Commercial |
$12,327.89
|
| Rate for Payer: Humana ChoiceCare |
$11,573.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,059.89
|
| Rate for Payer: PHCS All Commercial |
$10,049.91
|
| Rate for Payer: PHP All Commercial |
$10,162.47
|
| Rate for Payer: Sagamore Health Network All Products |
$10,344.71
|
| Rate for Payer: Signature Care EPO |
$11,121.90
|
| Rate for Payer: Signature Care PPO |
$11,791.89
|
| Rate for Payer: United Healthcare Commercial |
$10,559.11
|
|
|
HC Z N-FORCE BONE MATERIAL 10CC
|
Facility
OP
|
$13,399.88
|
|
| Hospital Charge Code |
41606090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$12,461.89 |
| Rate for Payer: Aetna Commercial |
$11,309.50
|
| Rate for Payer: Aetna Medicare |
$4,421.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,421.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,695.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,376.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,085.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,864.16
|
| Rate for Payer: Cash Price |
$8,307.93
|
| Rate for Payer: Cash Price |
$8,307.93
|
| Rate for Payer: Centivo All Commercial |
$6,833.94
|
| Rate for Payer: Cigna All Commercial |
$11,564.10
|
| Rate for Payer: CORVEL All Commercial |
$12,461.89
|
| Rate for Payer: Coventry All Commercial |
$11,791.89
|
| Rate for Payer: Encore All Commercial |
$12,334.59
|
| Rate for Payer: Frontpath All Commercial |
$12,327.89
|
| Rate for Payer: Humana ChoiceCare |
$11,573.48
|
| Rate for Payer: Humana Medicare |
$6,833.94
|
| Rate for Payer: Lucent All Commercial |
$6,833.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,059.89
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10,049.91
|
| Rate for Payer: PHP All Commercial |
$10,162.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,225.95
|
| Rate for Payer: Sagamore Health Network All Products |
$10,344.71
|
| Rate for Payer: Signature Care EPO |
$11,121.90
|
| Rate for Payer: Signature Care PPO |
$11,791.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,389.90
|
| Rate for Payer: United Healthcare Commercial |
$10,559.11
|
| Rate for Payer: United Healthcare Medicare |
$4,421.96
|
|
|
HC Z N-FORCE DRILL BIT 2.7 CANN
|
Facility
IP
|
$880.00
|
|
| Hospital Charge Code |
41606130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$818.40 |
| Rate for Payer: Aetna Commercial |
$760.32
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cigna All Commercial |
$759.44
|
| Rate for Payer: CORVEL All Commercial |
$818.40
|
| Rate for Payer: Coventry All Commercial |
$774.40
|
| Rate for Payer: Encore All Commercial |
$810.04
|
| Rate for Payer: Frontpath All Commercial |
$809.60
|
| Rate for Payer: Humana ChoiceCare |
$760.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$792.00
|
| Rate for Payer: PHCS All Commercial |
$660.00
|
| Rate for Payer: PHP All Commercial |
$667.39
|
| Rate for Payer: Sagamore Health Network All Products |
$679.36
|
| Rate for Payer: Signature Care EPO |
$730.40
|
| Rate for Payer: Signature Care PPO |
$774.40
|
| Rate for Payer: United Healthcare Commercial |
$693.44
|
|
|
HC Z N-FORCE DRILL BIT 2.7 CANN
|
Facility
OP
|
$880.00
|
|
| Hospital Charge Code |
41606130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$818.40 |
| Rate for Payer: Aetna Commercial |
$742.72
|
| Rate for Payer: Aetna Medicare |
$290.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$290.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$505.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$550.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$319.44
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Centivo All Commercial |
$448.80
|
| Rate for Payer: Cigna All Commercial |
$759.44
|
| Rate for Payer: CORVEL All Commercial |
$818.40
|
| Rate for Payer: Coventry All Commercial |
$774.40
|
| Rate for Payer: Encore All Commercial |
$810.04
|
| Rate for Payer: Frontpath All Commercial |
$809.60
|
| Rate for Payer: Humana ChoiceCare |
$760.06
|
| Rate for Payer: Humana Medicare |
$448.80
|
| Rate for Payer: Lucent All Commercial |
$448.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$792.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$660.00
|
| Rate for Payer: PHP All Commercial |
$667.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$343.20
|
| Rate for Payer: Sagamore Health Network All Products |
$679.36
|
| Rate for Payer: Signature Care EPO |
$730.40
|
| Rate for Payer: Signature Care PPO |
$774.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$748.00
|
| Rate for Payer: United Healthcare Commercial |
$693.44
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
|
