|
HC Z SF PLATE COMP 3.5 14
|
Facility
OP
|
$2,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,919.52 |
| Rate for Payer: Aetna Commercial |
$1,742.02
|
| Rate for Payer: Aetna Medicare |
$681.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$681.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,185.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,290.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$783.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$749.23
|
| Rate for Payer: Cash Price |
$1,279.68
|
| Rate for Payer: Cash Price |
$1,279.68
|
| Rate for Payer: Centivo All Commercial |
$1,052.64
|
| Rate for Payer: Cigna All Commercial |
$1,781.23
|
| Rate for Payer: CORVEL All Commercial |
$1,919.52
|
| Rate for Payer: Coventry All Commercial |
$1,816.32
|
| Rate for Payer: Encore All Commercial |
$1,899.91
|
| Rate for Payer: Frontpath All Commercial |
$1,898.88
|
| Rate for Payer: Humana ChoiceCare |
$1,782.68
|
| Rate for Payer: Humana Medicare |
$1,052.64
|
| Rate for Payer: Lucent All Commercial |
$1,052.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,857.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,548.00
|
| Rate for Payer: PHP All Commercial |
$1,565.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$804.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,593.41
|
| Rate for Payer: Signature Care EPO |
$1,713.12
|
| Rate for Payer: Signature Care PPO |
$1,816.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,754.40
|
| Rate for Payer: United Healthcare Commercial |
$1,626.43
|
| Rate for Payer: United Healthcare Medicare |
$681.12
|
|
|
HC Z SF PLATE COMP 3.5 14
|
Facility
IP
|
$2,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.00 |
| Max. Negotiated Rate |
$1,919.52 |
| Rate for Payer: Aetna Commercial |
$1,783.30
|
| Rate for Payer: Cash Price |
$1,279.68
|
| Rate for Payer: Cigna All Commercial |
$1,781.23
|
| Rate for Payer: CORVEL All Commercial |
$1,919.52
|
| Rate for Payer: Coventry All Commercial |
$1,816.32
|
| Rate for Payer: Encore All Commercial |
$1,899.91
|
| Rate for Payer: Frontpath All Commercial |
$1,898.88
|
| Rate for Payer: Humana ChoiceCare |
$1,782.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,857.60
|
| Rate for Payer: PHCS All Commercial |
$1,548.00
|
| Rate for Payer: PHP All Commercial |
$1,565.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,593.41
|
| Rate for Payer: Signature Care EPO |
$1,713.12
|
| Rate for Payer: Signature Care PPO |
$1,816.32
|
| Rate for Payer: United Healthcare Commercial |
$1,626.43
|
|
|
HC Z SF PLATE COMP 3.5 4-
|
Facility
IP
|
$1,298.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.72 |
| Max. Negotiated Rate |
$1,207.42 |
| Rate for Payer: Aetna Commercial |
$1,121.73
|
| Rate for Payer: Cash Price |
$804.95
|
| Rate for Payer: Cigna All Commercial |
$1,120.43
|
| Rate for Payer: CORVEL All Commercial |
$1,207.42
|
| Rate for Payer: Coventry All Commercial |
$1,142.50
|
| Rate for Payer: Encore All Commercial |
$1,195.09
|
| Rate for Payer: Frontpath All Commercial |
$1,194.44
|
| Rate for Payer: Humana ChoiceCare |
$1,121.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,168.47
|
| Rate for Payer: PHCS All Commercial |
$973.72
|
| Rate for Payer: PHP All Commercial |
$984.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,002.29
|
| Rate for Payer: Signature Care EPO |
$1,077.59
|
| Rate for Payer: Signature Care PPO |
$1,142.50
|
| Rate for Payer: United Healthcare Commercial |
$1,023.06
|
|
|
HC Z SF PLATE COMP 3.5 4-
|
Facility
OP
|
$1,298.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.44 |
| Max. Negotiated Rate |
$1,207.42 |
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna Medicare |
$428.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$428.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$745.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$811.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$492.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$471.28
|
| Rate for Payer: Cash Price |
$804.95
|
| Rate for Payer: Cash Price |
$804.95
|
| Rate for Payer: Centivo All Commercial |
$662.13
|
| Rate for Payer: Cigna All Commercial |
$1,120.43
|
| Rate for Payer: CORVEL All Commercial |
$1,207.42
|
| Rate for Payer: Coventry All Commercial |
$1,142.50
|
| Rate for Payer: Encore All Commercial |
$1,195.09
|
| Rate for Payer: Frontpath All Commercial |
$1,194.44
|
| Rate for Payer: Humana ChoiceCare |
$1,121.34
|
| Rate for Payer: Humana Medicare |
$662.13
|
| Rate for Payer: Lucent All Commercial |
$662.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,168.47
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$973.72
|
| Rate for Payer: PHP All Commercial |
$984.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$506.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,002.29
|
| Rate for Payer: Signature Care EPO |
$1,077.59
|
| Rate for Payer: Signature Care PPO |
$1,142.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,103.56
|
| Rate for Payer: United Healthcare Commercial |
$1,023.06
|
| Rate for Payer: United Healthcare Medicare |
$428.44
|
|
|
HC Z SF PLATE COMP 3.5 5-
|
Facility
IP
|
$1,364.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.68 |
| Max. Negotiated Rate |
$1,269.36 |
| Rate for Payer: Aetna Commercial |
$1,179.27
|
| Rate for Payer: Cash Price |
$846.24
|
| Rate for Payer: Cigna All Commercial |
$1,177.91
|
| Rate for Payer: CORVEL All Commercial |
$1,269.36
|
| Rate for Payer: Coventry All Commercial |
$1,201.11
|
| Rate for Payer: Encore All Commercial |
$1,256.39
|
| Rate for Payer: Frontpath All Commercial |
$1,255.71
|
| Rate for Payer: Humana ChoiceCare |
$1,178.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,228.41
|
| Rate for Payer: PHCS All Commercial |
$1,023.68
|
| Rate for Payer: PHP All Commercial |
$1,035.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,053.70
|
| Rate for Payer: Signature Care EPO |
$1,132.87
|
| Rate for Payer: Signature Care PPO |
$1,201.11
|
| Rate for Payer: United Healthcare Commercial |
$1,075.54
|
|
|
HC Z SF PLATE COMP 3.5 5-
|
Facility
OP
|
$1,364.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.42 |
| Max. Negotiated Rate |
$1,269.36 |
| Rate for Payer: Aetna Commercial |
$1,151.98
|
| Rate for Payer: Aetna Medicare |
$450.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$450.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$783.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$853.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$517.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$495.46
|
| Rate for Payer: Cash Price |
$846.24
|
| Rate for Payer: Cash Price |
$846.24
|
| Rate for Payer: Centivo All Commercial |
$696.10
|
| Rate for Payer: Cigna All Commercial |
$1,177.91
|
| Rate for Payer: CORVEL All Commercial |
$1,269.36
|
| Rate for Payer: Coventry All Commercial |
$1,201.11
|
| Rate for Payer: Encore All Commercial |
$1,256.39
|
| Rate for Payer: Frontpath All Commercial |
$1,255.71
|
| Rate for Payer: Humana ChoiceCare |
$1,178.86
|
| Rate for Payer: Humana Medicare |
$696.10
|
| Rate for Payer: Lucent All Commercial |
$696.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,228.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,023.68
|
| Rate for Payer: PHP All Commercial |
$1,035.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$532.31
|
| Rate for Payer: Sagamore Health Network All Products |
$1,053.70
|
| Rate for Payer: Signature Care EPO |
$1,132.87
|
| Rate for Payer: Signature Care PPO |
$1,201.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,160.16
|
| Rate for Payer: United Healthcare Commercial |
$1,075.54
|
| Rate for Payer: United Healthcare Medicare |
$450.42
|
|
|
HC Z SF PLATE COMP 3.5 6-
|
Facility
OP
|
$1,448.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.89 |
| Max. Negotiated Rate |
$1,346.78 |
| Rate for Payer: Aetna Commercial |
$1,222.24
|
| Rate for Payer: Aetna Medicare |
$477.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$477.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$831.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$905.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$549.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$525.68
|
| Rate for Payer: Cash Price |
$897.85
|
| Rate for Payer: Cash Price |
$897.85
|
| Rate for Payer: Centivo All Commercial |
$738.56
|
| Rate for Payer: Cigna All Commercial |
$1,249.75
|
| Rate for Payer: CORVEL All Commercial |
$1,346.78
|
| Rate for Payer: Coventry All Commercial |
$1,274.37
|
| Rate for Payer: Encore All Commercial |
$1,333.02
|
| Rate for Payer: Frontpath All Commercial |
$1,332.30
|
| Rate for Payer: Humana ChoiceCare |
$1,250.77
|
| Rate for Payer: Humana Medicare |
$738.56
|
| Rate for Payer: Lucent All Commercial |
$738.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,303.34
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,086.11
|
| Rate for Payer: PHP All Commercial |
$1,098.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$564.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,117.97
|
| Rate for Payer: Signature Care EPO |
$1,201.96
|
| Rate for Payer: Signature Care PPO |
$1,274.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,230.93
|
| Rate for Payer: United Healthcare Commercial |
$1,141.14
|
| Rate for Payer: United Healthcare Medicare |
$477.89
|
|
|
HC Z SF PLATE COMP 3.5 6-
|
Facility
IP
|
$1,448.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.11 |
| Max. Negotiated Rate |
$1,346.78 |
| Rate for Payer: Aetna Commercial |
$1,251.20
|
| Rate for Payer: Cash Price |
$897.85
|
| Rate for Payer: Cigna All Commercial |
$1,249.75
|
| Rate for Payer: CORVEL All Commercial |
$1,346.78
|
| Rate for Payer: Coventry All Commercial |
$1,274.37
|
| Rate for Payer: Encore All Commercial |
$1,333.02
|
| Rate for Payer: Frontpath All Commercial |
$1,332.30
|
| Rate for Payer: Humana ChoiceCare |
$1,250.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,303.34
|
| Rate for Payer: PHCS All Commercial |
$1,086.11
|
| Rate for Payer: PHP All Commercial |
$1,098.28
|
| Rate for Payer: Sagamore Health Network All Products |
$1,117.97
|
| Rate for Payer: Signature Care EPO |
$1,201.96
|
| Rate for Payer: Signature Care PPO |
$1,274.37
|
| Rate for Payer: United Healthcare Commercial |
$1,141.14
|
|
|
HC Z SF PLATE COMP 3.5 7-
|
Facility
IP
|
$1,514.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.02 |
| Max. Negotiated Rate |
$1,408.67 |
| Rate for Payer: Aetna Commercial |
$1,308.70
|
| Rate for Payer: Cash Price |
$939.11
|
| Rate for Payer: Cigna All Commercial |
$1,307.19
|
| Rate for Payer: CORVEL All Commercial |
$1,408.67
|
| Rate for Payer: Coventry All Commercial |
$1,332.94
|
| Rate for Payer: Encore All Commercial |
$1,394.28
|
| Rate for Payer: Frontpath All Commercial |
$1,393.52
|
| Rate for Payer: Humana ChoiceCare |
$1,308.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,363.23
|
| Rate for Payer: PHCS All Commercial |
$1,136.02
|
| Rate for Payer: PHP All Commercial |
$1,148.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,169.35
|
| Rate for Payer: Signature Care EPO |
$1,257.20
|
| Rate for Payer: Signature Care PPO |
$1,332.94
|
| Rate for Payer: United Healthcare Commercial |
$1,193.58
|
|
|
HC Z SF PLATE COMP 3.5 7-
|
Facility
OP
|
$1,514.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.85 |
| Max. Negotiated Rate |
$1,408.67 |
| Rate for Payer: Aetna Commercial |
$1,278.41
|
| Rate for Payer: Aetna Medicare |
$499.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$499.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$869.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$946.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$574.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$549.84
|
| Rate for Payer: Cash Price |
$939.11
|
| Rate for Payer: Cash Price |
$939.11
|
| Rate for Payer: Centivo All Commercial |
$772.50
|
| Rate for Payer: Cigna All Commercial |
$1,307.19
|
| Rate for Payer: CORVEL All Commercial |
$1,408.67
|
| Rate for Payer: Coventry All Commercial |
$1,332.94
|
| Rate for Payer: Encore All Commercial |
$1,394.28
|
| Rate for Payer: Frontpath All Commercial |
$1,393.52
|
| Rate for Payer: Humana ChoiceCare |
$1,308.25
|
| Rate for Payer: Humana Medicare |
$772.50
|
| Rate for Payer: Lucent All Commercial |
$772.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,363.23
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,136.02
|
| Rate for Payer: PHP All Commercial |
$1,148.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$590.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,169.35
|
| Rate for Payer: Signature Care EPO |
$1,257.20
|
| Rate for Payer: Signature Care PPO |
$1,332.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,287.50
|
| Rate for Payer: United Healthcare Commercial |
$1,193.58
|
| Rate for Payer: United Healthcare Medicare |
$499.85
|
|
|
HC Z SF PLATE COMP 3.5 8-
|
Facility
OP
|
$1,581.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.81 |
| Max. Negotiated Rate |
$1,470.56 |
| Rate for Payer: Aetna Commercial |
$1,334.58
|
| Rate for Payer: Aetna Medicare |
$521.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$521.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$908.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$988.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$600.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$573.99
|
| Rate for Payer: Cash Price |
$980.38
|
| Rate for Payer: Cash Price |
$980.38
|
| Rate for Payer: Centivo All Commercial |
$806.44
|
| Rate for Payer: Cigna All Commercial |
$1,364.62
|
| Rate for Payer: CORVEL All Commercial |
$1,470.56
|
| Rate for Payer: Coventry All Commercial |
$1,391.50
|
| Rate for Payer: Encore All Commercial |
$1,455.54
|
| Rate for Payer: Frontpath All Commercial |
$1,454.75
|
| Rate for Payer: Humana ChoiceCare |
$1,365.73
|
| Rate for Payer: Humana Medicare |
$806.44
|
| Rate for Payer: Lucent All Commercial |
$806.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,423.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,185.94
|
| Rate for Payer: PHP All Commercial |
$1,199.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$616.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,220.72
|
| Rate for Payer: Signature Care EPO |
$1,312.44
|
| Rate for Payer: Signature Care PPO |
$1,391.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,344.06
|
| Rate for Payer: United Healthcare Commercial |
$1,246.02
|
| Rate for Payer: United Healthcare Medicare |
$521.81
|
|
|
HC Z SF PLATE COMP 3.5 8-
|
Facility
IP
|
$1,581.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.94 |
| Max. Negotiated Rate |
$1,470.56 |
| Rate for Payer: Aetna Commercial |
$1,366.20
|
| Rate for Payer: Cash Price |
$980.38
|
| Rate for Payer: Cigna All Commercial |
$1,364.62
|
| Rate for Payer: CORVEL All Commercial |
$1,470.56
|
| Rate for Payer: Coventry All Commercial |
$1,391.50
|
| Rate for Payer: Encore All Commercial |
$1,455.54
|
| Rate for Payer: Frontpath All Commercial |
$1,454.75
|
| Rate for Payer: Humana ChoiceCare |
$1,365.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,423.12
|
| Rate for Payer: PHCS All Commercial |
$1,185.94
|
| Rate for Payer: PHP All Commercial |
$1,199.22
|
| Rate for Payer: Sagamore Health Network All Products |
$1,220.72
|
| Rate for Payer: Signature Care EPO |
$1,312.44
|
| Rate for Payer: Signature Care PPO |
$1,391.50
|
| Rate for Payer: United Healthcare Commercial |
$1,246.02
|
|
|
HC Z SF PLATE COMP 3.5 9-
|
Facility
OP
|
$1,614.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,501.58 |
| Rate for Payer: Aetna Commercial |
$1,362.72
|
| Rate for Payer: Aetna Medicare |
$532.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$532.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$927.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,009.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$612.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$586.10
|
| Rate for Payer: Cash Price |
$1,001.05
|
| Rate for Payer: Cash Price |
$1,001.05
|
| Rate for Payer: Centivo All Commercial |
$823.45
|
| Rate for Payer: Cigna All Commercial |
$1,393.40
|
| Rate for Payer: CORVEL All Commercial |
$1,501.58
|
| Rate for Payer: Coventry All Commercial |
$1,420.85
|
| Rate for Payer: Encore All Commercial |
$1,486.24
|
| Rate for Payer: Frontpath All Commercial |
$1,485.43
|
| Rate for Payer: Humana ChoiceCare |
$1,394.53
|
| Rate for Payer: Humana Medicare |
$823.45
|
| Rate for Payer: Lucent All Commercial |
$823.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,453.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,210.95
|
| Rate for Payer: PHP All Commercial |
$1,224.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$629.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,246.47
|
| Rate for Payer: Signature Care EPO |
$1,340.12
|
| Rate for Payer: Signature Care PPO |
$1,420.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,372.41
|
| Rate for Payer: United Healthcare Commercial |
$1,272.30
|
| Rate for Payer: United Healthcare Medicare |
$532.82
|
|
|
HC Z SF PLATE COMP 3.5 9-
|
Facility
IP
|
$1,614.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.95 |
| Max. Negotiated Rate |
$1,501.58 |
| Rate for Payer: Aetna Commercial |
$1,395.01
|
| Rate for Payer: Cash Price |
$1,001.05
|
| Rate for Payer: Cigna All Commercial |
$1,393.40
|
| Rate for Payer: CORVEL All Commercial |
$1,501.58
|
| Rate for Payer: Coventry All Commercial |
$1,420.85
|
| Rate for Payer: Encore All Commercial |
$1,486.24
|
| Rate for Payer: Frontpath All Commercial |
$1,485.43
|
| Rate for Payer: Humana ChoiceCare |
$1,394.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,453.14
|
| Rate for Payer: PHCS All Commercial |
$1,210.95
|
| Rate for Payer: PHP All Commercial |
$1,224.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,246.47
|
| Rate for Payer: Signature Care EPO |
$1,340.12
|
| Rate for Payer: Signature Care PPO |
$1,420.85
|
| Rate for Payer: United Healthcare Commercial |
$1,272.30
|
|
|
HC Z SF PLATE RECB 3.5 12
|
Facility
OP
|
$1,941.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,805.58 |
| Rate for Payer: Aetna Commercial |
$1,638.61
|
| Rate for Payer: Aetna Medicare |
$640.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$640.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,114.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,213.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$736.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$704.76
|
| Rate for Payer: Cash Price |
$1,203.72
|
| Rate for Payer: Cash Price |
$1,203.72
|
| Rate for Payer: Centivo All Commercial |
$990.15
|
| Rate for Payer: Cigna All Commercial |
$1,675.50
|
| Rate for Payer: CORVEL All Commercial |
$1,805.58
|
| Rate for Payer: Coventry All Commercial |
$1,708.50
|
| Rate for Payer: Encore All Commercial |
$1,787.13
|
| Rate for Payer: Frontpath All Commercial |
$1,786.16
|
| Rate for Payer: Humana ChoiceCare |
$1,676.86
|
| Rate for Payer: Humana Medicare |
$990.15
|
| Rate for Payer: Lucent All Commercial |
$990.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,747.33
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,456.11
|
| Rate for Payer: PHP All Commercial |
$1,472.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$757.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,498.82
|
| Rate for Payer: Signature Care EPO |
$1,611.43
|
| Rate for Payer: Signature Care PPO |
$1,708.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,650.26
|
| Rate for Payer: United Healthcare Commercial |
$1,529.89
|
| Rate for Payer: United Healthcare Medicare |
$640.69
|
|
|
HC Z SF PLATE RECB 3.5 12
|
Facility
IP
|
$1,941.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.11 |
| Max. Negotiated Rate |
$1,805.58 |
| Rate for Payer: Aetna Commercial |
$1,677.44
|
| Rate for Payer: Cash Price |
$1,203.72
|
| Rate for Payer: Cigna All Commercial |
$1,675.50
|
| Rate for Payer: CORVEL All Commercial |
$1,805.58
|
| Rate for Payer: Coventry All Commercial |
$1,708.50
|
| Rate for Payer: Encore All Commercial |
$1,787.13
|
| Rate for Payer: Frontpath All Commercial |
$1,786.16
|
| Rate for Payer: Humana ChoiceCare |
$1,676.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,747.33
|
| Rate for Payer: PHCS All Commercial |
$1,456.11
|
| Rate for Payer: PHP All Commercial |
$1,472.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,498.82
|
| Rate for Payer: Signature Care EPO |
$1,611.43
|
| Rate for Payer: Signature Care PPO |
$1,708.50
|
| Rate for Payer: United Healthcare Commercial |
$1,529.89
|
|
|
HC Z SF PLATE RECN 3.5 10
|
Facility
OP
|
$2,496.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,321.93 |
| Rate for Payer: Aetna Commercial |
$2,107.21
|
| Rate for Payer: Aetna Medicare |
$823.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$823.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,433.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,560.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$947.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$906.30
|
| Rate for Payer: Cash Price |
$1,547.95
|
| Rate for Payer: Cash Price |
$1,547.95
|
| Rate for Payer: Centivo All Commercial |
$1,273.32
|
| Rate for Payer: Cigna All Commercial |
$2,154.65
|
| Rate for Payer: CORVEL All Commercial |
$2,321.93
|
| Rate for Payer: Coventry All Commercial |
$2,197.10
|
| Rate for Payer: Encore All Commercial |
$2,298.21
|
| Rate for Payer: Frontpath All Commercial |
$2,296.96
|
| Rate for Payer: Humana ChoiceCare |
$2,156.40
|
| Rate for Payer: Humana Medicare |
$1,273.32
|
| Rate for Payer: Lucent All Commercial |
$1,273.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,247.03
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,872.52
|
| Rate for Payer: PHP All Commercial |
$1,893.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$973.71
|
| Rate for Payer: Sagamore Health Network All Products |
$1,927.45
|
| Rate for Payer: Signature Care EPO |
$2,072.26
|
| Rate for Payer: Signature Care PPO |
$2,197.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,122.20
|
| Rate for Payer: United Healthcare Commercial |
$1,967.40
|
| Rate for Payer: United Healthcare Medicare |
$823.91
|
|
|
HC Z SF PLATE RECN 3.5 10
|
Facility
IP
|
$2,496.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,872.52 |
| Max. Negotiated Rate |
$2,321.93 |
| Rate for Payer: Aetna Commercial |
$2,157.15
|
| Rate for Payer: Cash Price |
$1,547.95
|
| Rate for Payer: Cigna All Commercial |
$2,154.65
|
| Rate for Payer: CORVEL All Commercial |
$2,321.93
|
| Rate for Payer: Coventry All Commercial |
$2,197.10
|
| Rate for Payer: Encore All Commercial |
$2,298.21
|
| Rate for Payer: Frontpath All Commercial |
$2,296.96
|
| Rate for Payer: Humana ChoiceCare |
$2,156.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,247.03
|
| Rate for Payer: PHCS All Commercial |
$1,872.52
|
| Rate for Payer: PHP All Commercial |
$1,893.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,927.45
|
| Rate for Payer: Signature Care EPO |
$2,072.26
|
| Rate for Payer: Signature Care PPO |
$2,197.10
|
| Rate for Payer: United Healthcare Commercial |
$1,967.40
|
|
|
HC Z SF PLATE RECN 3.5 11
|
Facility
OP
|
$1,881.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,749.83 |
| Rate for Payer: Aetna Commercial |
$1,588.02
|
| Rate for Payer: Aetna Medicare |
$620.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$620.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,080.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,176.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$714.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$683.00
|
| Rate for Payer: Cash Price |
$1,166.56
|
| Rate for Payer: Cash Price |
$1,166.56
|
| Rate for Payer: Centivo All Commercial |
$959.59
|
| Rate for Payer: Cigna All Commercial |
$1,623.77
|
| Rate for Payer: CORVEL All Commercial |
$1,749.83
|
| Rate for Payer: Coventry All Commercial |
$1,655.76
|
| Rate for Payer: Encore All Commercial |
$1,731.96
|
| Rate for Payer: Frontpath All Commercial |
$1,731.02
|
| Rate for Payer: Humana ChoiceCare |
$1,625.09
|
| Rate for Payer: Humana Medicare |
$959.59
|
| Rate for Payer: Lucent All Commercial |
$959.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,693.39
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,411.16
|
| Rate for Payer: PHP All Commercial |
$1,426.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$733.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,452.55
|
| Rate for Payer: Signature Care EPO |
$1,561.68
|
| Rate for Payer: Signature Care PPO |
$1,655.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,599.31
|
| Rate for Payer: United Healthcare Commercial |
$1,482.65
|
| Rate for Payer: United Healthcare Medicare |
$620.91
|
|
|
HC Z SF PLATE RECN 3.5 11
|
Facility
IP
|
$1,881.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.16 |
| Max. Negotiated Rate |
$1,749.83 |
| Rate for Payer: Aetna Commercial |
$1,625.65
|
| Rate for Payer: Cash Price |
$1,166.56
|
| Rate for Payer: Cigna All Commercial |
$1,623.77
|
| Rate for Payer: CORVEL All Commercial |
$1,749.83
|
| Rate for Payer: Coventry All Commercial |
$1,655.76
|
| Rate for Payer: Encore All Commercial |
$1,731.96
|
| Rate for Payer: Frontpath All Commercial |
$1,731.02
|
| Rate for Payer: Humana ChoiceCare |
$1,625.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,693.39
|
| Rate for Payer: PHCS All Commercial |
$1,411.16
|
| Rate for Payer: PHP All Commercial |
$1,426.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,452.55
|
| Rate for Payer: Signature Care EPO |
$1,561.68
|
| Rate for Payer: Signature Care PPO |
$1,655.76
|
| Rate for Payer: United Healthcare Commercial |
$1,482.65
|
|
|
HC Z SF PLATE RECN 3.5 4-
|
Facility
IP
|
$1,930.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.10 |
| Max. Negotiated Rate |
$1,795.64 |
| Rate for Payer: Aetna Commercial |
$1,668.21
|
| Rate for Payer: Cash Price |
$1,197.10
|
| Rate for Payer: Cigna All Commercial |
$1,666.28
|
| Rate for Payer: CORVEL All Commercial |
$1,795.64
|
| Rate for Payer: Coventry All Commercial |
$1,699.10
|
| Rate for Payer: Encore All Commercial |
$1,777.30
|
| Rate for Payer: Frontpath All Commercial |
$1,776.34
|
| Rate for Payer: Humana ChoiceCare |
$1,667.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,737.72
|
| Rate for Payer: PHCS All Commercial |
$1,448.10
|
| Rate for Payer: PHP All Commercial |
$1,464.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,490.58
|
| Rate for Payer: Signature Care EPO |
$1,602.56
|
| Rate for Payer: Signature Care PPO |
$1,699.10
|
| Rate for Payer: United Healthcare Commercial |
$1,521.47
|
|
|
HC Z SF PLATE RECN 3.5 4-
|
Facility
OP
|
$1,930.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,795.64 |
| Rate for Payer: Aetna Commercial |
$1,629.60
|
| Rate for Payer: Aetna Medicare |
$637.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,108.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,206.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$732.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$700.88
|
| Rate for Payer: Cash Price |
$1,197.10
|
| Rate for Payer: Cash Price |
$1,197.10
|
| Rate for Payer: Centivo All Commercial |
$984.71
|
| Rate for Payer: Cigna All Commercial |
$1,666.28
|
| Rate for Payer: CORVEL All Commercial |
$1,795.64
|
| Rate for Payer: Coventry All Commercial |
$1,699.10
|
| Rate for Payer: Encore All Commercial |
$1,777.30
|
| Rate for Payer: Frontpath All Commercial |
$1,776.34
|
| Rate for Payer: Humana ChoiceCare |
$1,667.63
|
| Rate for Payer: Humana Medicare |
$984.71
|
| Rate for Payer: Lucent All Commercial |
$984.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,737.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,448.10
|
| Rate for Payer: PHP All Commercial |
$1,464.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$753.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,490.58
|
| Rate for Payer: Signature Care EPO |
$1,602.56
|
| Rate for Payer: Signature Care PPO |
$1,699.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,641.18
|
| Rate for Payer: United Healthcare Commercial |
$1,521.47
|
| Rate for Payer: United Healthcare Medicare |
$637.16
|
|
|
HC Z SF PLATE RECN 3.5 5-
|
Facility
IP
|
$1,947.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,460.62 |
| Max. Negotiated Rate |
$1,811.18 |
| Rate for Payer: Aetna Commercial |
$1,682.64
|
| Rate for Payer: Cash Price |
$1,207.45
|
| Rate for Payer: Cigna All Commercial |
$1,680.69
|
| Rate for Payer: CORVEL All Commercial |
$1,811.18
|
| Rate for Payer: Coventry All Commercial |
$1,713.80
|
| Rate for Payer: Encore All Commercial |
$1,792.67
|
| Rate for Payer: Frontpath All Commercial |
$1,791.70
|
| Rate for Payer: Humana ChoiceCare |
$1,682.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,752.75
|
| Rate for Payer: PHCS All Commercial |
$1,460.62
|
| Rate for Payer: PHP All Commercial |
$1,476.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,503.47
|
| Rate for Payer: Signature Care EPO |
$1,616.42
|
| Rate for Payer: Signature Care PPO |
$1,713.80
|
| Rate for Payer: United Healthcare Commercial |
$1,534.63
|
|
|
HC Z SF PLATE RECN 3.5 5-
|
Facility
OP
|
$1,947.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,811.18 |
| Rate for Payer: Aetna Commercial |
$1,643.69
|
| Rate for Payer: Aetna Medicare |
$642.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$642.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,118.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,217.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$739.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$706.94
|
| Rate for Payer: Cash Price |
$1,207.45
|
| Rate for Payer: Cash Price |
$1,207.45
|
| Rate for Payer: Centivo All Commercial |
$993.22
|
| Rate for Payer: Cigna All Commercial |
$1,680.69
|
| Rate for Payer: CORVEL All Commercial |
$1,811.18
|
| Rate for Payer: Coventry All Commercial |
$1,713.80
|
| Rate for Payer: Encore All Commercial |
$1,792.67
|
| Rate for Payer: Frontpath All Commercial |
$1,791.70
|
| Rate for Payer: Humana ChoiceCare |
$1,682.06
|
| Rate for Payer: Humana Medicare |
$993.22
|
| Rate for Payer: Lucent All Commercial |
$993.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,752.75
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,460.62
|
| Rate for Payer: PHP All Commercial |
$1,476.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$759.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1,503.47
|
| Rate for Payer: Signature Care EPO |
$1,616.42
|
| Rate for Payer: Signature Care PPO |
$1,713.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,655.38
|
| Rate for Payer: United Healthcare Commercial |
$1,534.63
|
| Rate for Payer: United Healthcare Medicare |
$642.68
|
|
|
HC Z SF PLATE RECN 3.5 6-
|
Facility
IP
|
$2,230.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.84 |
| Max. Negotiated Rate |
$2,074.32 |
| Rate for Payer: Aetna Commercial |
$1,927.11
|
| Rate for Payer: Cash Price |
$1,382.88
|
| Rate for Payer: Cigna All Commercial |
$1,924.88
|
| Rate for Payer: CORVEL All Commercial |
$2,074.32
|
| Rate for Payer: Coventry All Commercial |
$1,962.80
|
| Rate for Payer: Encore All Commercial |
$2,053.13
|
| Rate for Payer: Frontpath All Commercial |
$2,052.01
|
| Rate for Payer: Humana ChoiceCare |
$1,926.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,007.40
|
| Rate for Payer: PHCS All Commercial |
$1,672.84
|
| Rate for Payer: PHP All Commercial |
$1,691.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,721.91
|
| Rate for Payer: Signature Care EPO |
$1,851.27
|
| Rate for Payer: Signature Care PPO |
$1,962.80
|
| Rate for Payer: United Healthcare Commercial |
$1,757.59
|
|
