|
HC Z VNGD CR ILOK FEM 67.5 R
|
Facility
IP
|
$12,175.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,131.67 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,519.68
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
|
|
HC Z VNGD CR ILOK FEM 67.5 R
|
Facility
OP
|
$12,175.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,276.17
|
| Rate for Payer: Aetna Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,992.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,610.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,620.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,419.73
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Centivo All Commercial |
$6,209.54
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Humana Medicare |
$6,209.54
|
| Rate for Payer: Lucent All Commercial |
$6,209.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,748.47
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,349.23
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
| Rate for Payer: United Healthcare Medicare |
$4,017.93
|
|
|
HC Z VNGD CR ILOK FEM 70 R
|
Facility
IP
|
$12,175.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,131.67 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,519.68
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
|
|
HC Z VNGD CR ILOK FEM 70 R
|
Facility
OP
|
$12,175.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,276.17
|
| Rate for Payer: Aetna Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,992.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,610.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,620.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,419.73
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Centivo All Commercial |
$6,209.54
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Humana Medicare |
$6,209.54
|
| Rate for Payer: Lucent All Commercial |
$6,209.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,748.47
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,349.23
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
| Rate for Payer: United Healthcare Medicare |
$4,017.93
|
|
|
HC Z VNGD CR ILOK FEM 72.5 L
|
Facility
IP
|
$12,175.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,131.67 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,519.68
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
|
|
HC Z VNGD CR ILOK FEM 72.5 L
|
Facility
OP
|
$12,175.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,276.17
|
| Rate for Payer: Aetna Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,992.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,610.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,620.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,419.73
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Centivo All Commercial |
$6,209.54
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Humana Medicare |
$6,209.54
|
| Rate for Payer: Lucent All Commercial |
$6,209.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,748.47
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,349.23
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
| Rate for Payer: United Healthcare Medicare |
$4,017.93
|
|
|
HC Z VNGD CR ILOK FEM 72.5 R
|
Facility
OP
|
$13,234.32
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,307.92 |
| Rate for Payer: Aetna Commercial |
$11,169.77
|
| Rate for Payer: Aetna Medicare |
$4,367.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,367.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,600.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,272.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,022.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,804.06
|
| Rate for Payer: Cash Price |
$8,205.28
|
| Rate for Payer: Cash Price |
$8,205.28
|
| Rate for Payer: Centivo All Commercial |
$6,749.50
|
| Rate for Payer: Cigna All Commercial |
$11,421.22
|
| Rate for Payer: CORVEL All Commercial |
$12,307.92
|
| Rate for Payer: Coventry All Commercial |
$11,646.20
|
| Rate for Payer: Encore All Commercial |
$12,182.19
|
| Rate for Payer: Frontpath All Commercial |
$12,175.57
|
| Rate for Payer: Humana ChoiceCare |
$11,430.48
|
| Rate for Payer: Humana Medicare |
$6,749.50
|
| Rate for Payer: Lucent All Commercial |
$6,749.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,910.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,925.74
|
| Rate for Payer: PHP All Commercial |
$10,036.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,161.38
|
| Rate for Payer: Sagamore Health Network All Products |
$10,216.90
|
| Rate for Payer: Signature Care EPO |
$10,984.49
|
| Rate for Payer: Signature Care PPO |
$11,646.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,249.17
|
| Rate for Payer: United Healthcare Commercial |
$10,428.64
|
| Rate for Payer: United Healthcare Medicare |
$4,367.33
|
|
|
HC Z VNGD CR ILOK FEM 72.5 R
|
Facility
IP
|
$13,234.32
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,925.74 |
| Max. Negotiated Rate |
$12,307.92 |
| Rate for Payer: Aetna Commercial |
$11,434.45
|
| Rate for Payer: Cash Price |
$8,205.28
|
| Rate for Payer: Cigna All Commercial |
$11,421.22
|
| Rate for Payer: CORVEL All Commercial |
$12,307.92
|
| Rate for Payer: Coventry All Commercial |
$11,646.20
|
| Rate for Payer: Encore All Commercial |
$12,182.19
|
| Rate for Payer: Frontpath All Commercial |
$12,175.57
|
| Rate for Payer: Humana ChoiceCare |
$11,430.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,910.89
|
| Rate for Payer: PHCS All Commercial |
$9,925.74
|
| Rate for Payer: PHP All Commercial |
$10,036.91
|
| Rate for Payer: Sagamore Health Network All Products |
$10,216.90
|
| Rate for Payer: Signature Care EPO |
$10,984.49
|
| Rate for Payer: Signature Care PPO |
$11,646.20
|
| Rate for Payer: United Healthcare Commercial |
$10,428.64
|
|
|
HC Z VNGD CR ILOK FEM 75 L
|
Facility
IP
|
$12,175.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,131.67 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,519.68
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
|
|
HC Z VNGD CR ILOK FEM 75 L
|
Facility
OP
|
$12,175.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,276.17
|
| Rate for Payer: Aetna Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,992.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,610.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,620.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,419.73
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Centivo All Commercial |
$6,209.54
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Humana Medicare |
$6,209.54
|
| Rate for Payer: Lucent All Commercial |
$6,209.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,748.47
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,349.23
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
| Rate for Payer: United Healthcare Medicare |
$4,017.93
|
|
|
HC Z VNGD CR ILOK FEM 75 R
|
Facility
OP
|
$12,175.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,276.17
|
| Rate for Payer: Aetna Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,992.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,610.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,620.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,419.73
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Centivo All Commercial |
$6,209.54
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Humana Medicare |
$6,209.54
|
| Rate for Payer: Lucent All Commercial |
$6,209.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,748.47
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,349.23
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
| Rate for Payer: United Healthcare Medicare |
$4,017.93
|
|
|
HC Z VNGD CR ILOK FEM 75 R
|
Facility
IP
|
$12,175.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,131.67 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,519.68
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
|
|
HC Z VNGD CR ILOK FEM 80 L
|
Facility
IP
|
$12,175.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,131.67 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,519.68
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
|
|
HC Z VNGD CR ILOK FEM 80 L
|
Facility
OP
|
$12,175.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,323.27 |
| Rate for Payer: Aetna Commercial |
$10,276.17
|
| Rate for Payer: Aetna Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,017.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,992.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,610.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,620.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,419.73
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Cash Price |
$7,548.85
|
| Rate for Payer: Centivo All Commercial |
$6,209.54
|
| Rate for Payer: Cigna All Commercial |
$10,507.51
|
| Rate for Payer: CORVEL All Commercial |
$11,323.27
|
| Rate for Payer: Coventry All Commercial |
$10,714.49
|
| Rate for Payer: Encore All Commercial |
$11,207.60
|
| Rate for Payer: Frontpath All Commercial |
$11,201.52
|
| Rate for Payer: Humana ChoiceCare |
$10,516.03
|
| Rate for Payer: Humana Medicare |
$6,209.54
|
| Rate for Payer: Lucent All Commercial |
$6,209.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,958.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,131.67
|
| Rate for Payer: PHP All Commercial |
$9,233.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,748.47
|
| Rate for Payer: Sagamore Health Network All Products |
$9,399.53
|
| Rate for Payer: Signature Care EPO |
$10,105.71
|
| Rate for Payer: Signature Care PPO |
$10,714.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,349.23
|
| Rate for Payer: United Healthcare Commercial |
$9,594.34
|
| Rate for Payer: United Healthcare Medicare |
$4,017.93
|
|
|
HC Z VNGD PS OPEN FEM 62.5 L
|
Facility
OP
|
$13,137.37
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$12,217.75 |
| Rate for Payer: Aetna Commercial |
$11,087.94
|
| Rate for Payer: Aetna Medicare |
$4,335.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,335.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,544.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,212.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,985.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,768.87
|
| Rate for Payer: Cash Price |
$8,145.17
|
| Rate for Payer: Cash Price |
$8,145.17
|
| Rate for Payer: Centivo All Commercial |
$6,700.06
|
| Rate for Payer: Cigna All Commercial |
$11,337.55
|
| Rate for Payer: CORVEL All Commercial |
$12,217.75
|
| Rate for Payer: Coventry All Commercial |
$11,560.89
|
| Rate for Payer: Encore All Commercial |
$12,092.95
|
| Rate for Payer: Frontpath All Commercial |
$12,086.38
|
| Rate for Payer: Humana ChoiceCare |
$11,346.75
|
| Rate for Payer: Humana Medicare |
$6,700.06
|
| Rate for Payer: Lucent All Commercial |
$6,700.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,823.63
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,853.03
|
| Rate for Payer: PHP All Commercial |
$9,963.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,123.57
|
| Rate for Payer: Sagamore Health Network All Products |
$10,142.05
|
| Rate for Payer: Signature Care EPO |
$10,904.02
|
| Rate for Payer: Signature Care PPO |
$11,560.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,166.76
|
| Rate for Payer: United Healthcare Commercial |
$10,352.25
|
| Rate for Payer: United Healthcare Medicare |
$4,335.33
|
|
|
HC Z VNGD PS OPEN FEM 62.5 L
|
Facility
IP
|
$13,137.37
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,853.03 |
| Max. Negotiated Rate |
$12,217.75 |
| Rate for Payer: Aetna Commercial |
$11,350.69
|
| Rate for Payer: Cash Price |
$8,145.17
|
| Rate for Payer: Cigna All Commercial |
$11,337.55
|
| Rate for Payer: CORVEL All Commercial |
$12,217.75
|
| Rate for Payer: Coventry All Commercial |
$11,560.89
|
| Rate for Payer: Encore All Commercial |
$12,092.95
|
| Rate for Payer: Frontpath All Commercial |
$12,086.38
|
| Rate for Payer: Humana ChoiceCare |
$11,346.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,823.63
|
| Rate for Payer: PHCS All Commercial |
$9,853.03
|
| Rate for Payer: PHP All Commercial |
$9,963.38
|
| Rate for Payer: Sagamore Health Network All Products |
$10,142.05
|
| Rate for Payer: Signature Care EPO |
$10,904.02
|
| Rate for Payer: Signature Care PPO |
$11,560.89
|
| Rate for Payer: United Healthcare Commercial |
$10,352.25
|
|
|
HC Z VNGD TIB BRG 10X75
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
|
HC Z VNGD TIB BRG 10X75
|
Facility
OP
|
$7,525.04
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,351.13
|
| Rate for Payer: Aetna Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,483.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,321.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,703.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,855.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,731.59
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Centivo All Commercial |
$3,837.77
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Humana Medicare |
$3,837.77
|
| Rate for Payer: Lucent All Commercial |
$3,837.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,934.77
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,396.28
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
| Rate for Payer: United Healthcare Medicare |
$2,483.26
|
|
|
HC Z WASHER 1.5 2.0
|
Facility
IP
|
$223.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.84 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Aetna Commercial |
$193.35
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Cigna All Commercial |
$193.13
|
| Rate for Payer: CORVEL All Commercial |
$208.12
|
| Rate for Payer: Coventry All Commercial |
$196.94
|
| Rate for Payer: Encore All Commercial |
$206.00
|
| Rate for Payer: Frontpath All Commercial |
$205.89
|
| Rate for Payer: Humana ChoiceCare |
$193.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.41
|
| Rate for Payer: PHCS All Commercial |
$167.84
|
| Rate for Payer: PHP All Commercial |
$169.72
|
| Rate for Payer: Sagamore Health Network All Products |
$172.77
|
| Rate for Payer: Signature Care EPO |
$185.75
|
| Rate for Payer: Signature Care PPO |
$196.94
|
| Rate for Payer: United Healthcare Commercial |
$176.35
|
|
|
HC Z WASHER 1.5 2.0
|
Facility
OP
|
$223.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$188.88
|
| Rate for Payer: Aetna Medicare |
$73.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.24
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Centivo All Commercial |
$114.13
|
| Rate for Payer: Cigna All Commercial |
$193.13
|
| Rate for Payer: CORVEL All Commercial |
$208.12
|
| Rate for Payer: Coventry All Commercial |
$196.94
|
| Rate for Payer: Encore All Commercial |
$206.00
|
| Rate for Payer: Frontpath All Commercial |
$205.89
|
| Rate for Payer: Humana ChoiceCare |
$193.29
|
| Rate for Payer: Humana Medicare |
$114.13
|
| Rate for Payer: Lucent All Commercial |
$114.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$201.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$167.84
|
| Rate for Payer: PHP All Commercial |
$169.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.28
|
| Rate for Payer: Sagamore Health Network All Products |
$172.77
|
| Rate for Payer: Signature Care EPO |
$185.75
|
| Rate for Payer: Signature Care PPO |
$196.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.22
|
| Rate for Payer: United Healthcare Commercial |
$176.35
|
| Rate for Payer: United Healthcare Medicare |
$73.85
|
|
|
HC Z WASHER 2.5 THREADED
|
Facility
IP
|
$268.66
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna Commercial |
$232.12
|
| Rate for Payer: Cash Price |
$166.57
|
| Rate for Payer: Cigna All Commercial |
$231.85
|
| Rate for Payer: CORVEL All Commercial |
$249.85
|
| Rate for Payer: Coventry All Commercial |
$236.42
|
| Rate for Payer: Encore All Commercial |
$247.30
|
| Rate for Payer: Frontpath All Commercial |
$247.17
|
| Rate for Payer: Humana ChoiceCare |
$232.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.79
|
| Rate for Payer: PHCS All Commercial |
$201.50
|
| Rate for Payer: PHP All Commercial |
$203.75
|
| Rate for Payer: Sagamore Health Network All Products |
$207.41
|
| Rate for Payer: Signature Care EPO |
$222.99
|
| Rate for Payer: Signature Care PPO |
$236.42
|
| Rate for Payer: United Healthcare Commercial |
$211.70
|
|
|
HC Z WASHER 2.5 THREADED
|
Facility
OP
|
$268.66
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$226.75
|
| Rate for Payer: Aetna Medicare |
$88.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$167.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.52
|
| Rate for Payer: Cash Price |
$166.57
|
| Rate for Payer: Cash Price |
$166.57
|
| Rate for Payer: Centivo All Commercial |
$137.02
|
| Rate for Payer: Cigna All Commercial |
$231.85
|
| Rate for Payer: CORVEL All Commercial |
$249.85
|
| Rate for Payer: Coventry All Commercial |
$236.42
|
| Rate for Payer: Encore All Commercial |
$247.30
|
| Rate for Payer: Frontpath All Commercial |
$247.17
|
| Rate for Payer: Humana ChoiceCare |
$232.04
|
| Rate for Payer: Humana Medicare |
$137.02
|
| Rate for Payer: Lucent All Commercial |
$137.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.79
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$201.50
|
| Rate for Payer: PHP All Commercial |
$203.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.78
|
| Rate for Payer: Sagamore Health Network All Products |
$207.41
|
| Rate for Payer: Signature Care EPO |
$222.99
|
| Rate for Payer: Signature Care PPO |
$236.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$228.36
|
| Rate for Payer: United Healthcare Commercial |
$211.70
|
| Rate for Payer: United Healthcare Medicare |
$88.66
|
|
|
HC Z WASHER 2.7 3.5 4.0
|
Facility
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.15
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Centivo All Commercial |
$76.08
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$76.08
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
|
|
HC Z WASHER 2.7 3.5 4.0
|
Facility
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$92.49
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z WASHER 3.5 4.0
|
Facility
IP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$242.76 |
| Rate for Payer: Aetna Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
|
