|
HC ACU HOOK PLATE 2-H
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,096.90 |
| Rate for Payer: Aetna Commercial |
$2,810.52
|
| Rate for Payer: Aetna Medicare |
$1,098.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,098.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,912.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,081.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,263.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,208.79
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Centivo All Commercial |
$1,698.30
|
| Rate for Payer: Cigna All Commercial |
$2,873.79
|
| Rate for Payer: CORVEL All Commercial |
$3,096.90
|
| Rate for Payer: Coventry All Commercial |
$2,930.40
|
| Rate for Payer: Encore All Commercial |
$3,065.26
|
| Rate for Payer: Frontpath All Commercial |
$3,063.60
|
| Rate for Payer: Humana ChoiceCare |
$2,876.12
|
| Rate for Payer: Humana Medicare |
$1,698.30
|
| Rate for Payer: Lucent All Commercial |
$1,698.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,997.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,497.50
|
| Rate for Payer: PHP All Commercial |
$2,525.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,298.70
|
| Rate for Payer: Sagamore Health Network All Products |
$2,570.76
|
| Rate for Payer: Signature Care EPO |
$2,763.90
|
| Rate for Payer: Signature Care PPO |
$2,930.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,830.50
|
| Rate for Payer: United Healthcare Commercial |
$2,624.04
|
| Rate for Payer: United Healthcare Medicare |
$1,098.90
|
|
|
HC ACU HOOK PLATE 2-H
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.50 |
| Max. Negotiated Rate |
$3,096.90 |
| Rate for Payer: Aetna Commercial |
$2,877.12
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna All Commercial |
$2,873.79
|
| Rate for Payer: CORVEL All Commercial |
$3,096.90
|
| Rate for Payer: Coventry All Commercial |
$2,930.40
|
| Rate for Payer: Encore All Commercial |
$3,065.26
|
| Rate for Payer: Frontpath All Commercial |
$3,063.60
|
| Rate for Payer: Humana ChoiceCare |
$2,876.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,997.00
|
| Rate for Payer: PHCS All Commercial |
$2,497.50
|
| Rate for Payer: PHP All Commercial |
$2,525.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2,570.76
|
| Rate for Payer: Signature Care EPO |
$2,763.90
|
| Rate for Payer: Signature Care PPO |
$2,930.40
|
| Rate for Payer: United Healthcare Commercial |
$2,624.04
|
|
|
HC ACU HOOK PLATE 3-H
|
Facility
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,264.30 |
| Rate for Payer: Aetna Commercial |
$2,962.44
|
| Rate for Payer: Aetna Medicare |
$1,158.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,158.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,015.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,194.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,332.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,274.13
|
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Centivo All Commercial |
$1,790.10
|
| Rate for Payer: Cigna All Commercial |
$3,029.13
|
| Rate for Payer: CORVEL All Commercial |
$3,264.30
|
| Rate for Payer: Coventry All Commercial |
$3,088.80
|
| Rate for Payer: Encore All Commercial |
$3,230.96
|
| Rate for Payer: Frontpath All Commercial |
$3,229.20
|
| Rate for Payer: Humana ChoiceCare |
$3,031.59
|
| Rate for Payer: Humana Medicare |
$1,790.10
|
| Rate for Payer: Lucent All Commercial |
$1,790.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,159.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,632.50
|
| Rate for Payer: PHP All Commercial |
$2,661.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,368.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2,709.72
|
| Rate for Payer: Signature Care EPO |
$2,913.30
|
| Rate for Payer: Signature Care PPO |
$3,088.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,983.50
|
| Rate for Payer: United Healthcare Commercial |
$2,765.88
|
| Rate for Payer: United Healthcare Medicare |
$1,158.30
|
|
|
HC ACU HOOK PLATE 3-H
|
Facility
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.50 |
| Max. Negotiated Rate |
$3,264.30 |
| Rate for Payer: Aetna Commercial |
$3,032.64
|
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Cigna All Commercial |
$3,029.13
|
| Rate for Payer: CORVEL All Commercial |
$3,264.30
|
| Rate for Payer: Coventry All Commercial |
$3,088.80
|
| Rate for Payer: Encore All Commercial |
$3,230.96
|
| Rate for Payer: Frontpath All Commercial |
$3,229.20
|
| Rate for Payer: Humana ChoiceCare |
$3,031.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,159.00
|
| Rate for Payer: PHCS All Commercial |
$2,632.50
|
| Rate for Payer: PHP All Commercial |
$2,661.98
|
| Rate for Payer: Sagamore Health Network All Products |
$2,709.72
|
| Rate for Payer: Signature Care EPO |
$2,913.30
|
| Rate for Payer: Signature Care PPO |
$3,088.80
|
| Rate for Payer: United Healthcare Commercial |
$2,765.88
|
|
|
HC ACUITY PRO LEAD DELIV SYS
|
Facility
OP
|
$3,093.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,877.19 |
| Rate for Payer: Aetna Commercial |
$2,611.12
|
| Rate for Payer: Aetna Medicare |
$1,020.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,020.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,776.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,933.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,174.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,123.03
|
| Rate for Payer: Cash Price |
$1,918.13
|
| Rate for Payer: Cash Price |
$1,918.13
|
| Rate for Payer: Centivo All Commercial |
$1,577.81
|
| Rate for Payer: Cigna All Commercial |
$2,669.91
|
| Rate for Payer: CORVEL All Commercial |
$2,877.19
|
| Rate for Payer: Coventry All Commercial |
$2,722.50
|
| Rate for Payer: Encore All Commercial |
$2,847.80
|
| Rate for Payer: Frontpath All Commercial |
$2,846.25
|
| Rate for Payer: Humana ChoiceCare |
$2,672.07
|
| Rate for Payer: Humana Medicare |
$1,577.81
|
| Rate for Payer: Lucent All Commercial |
$1,577.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,784.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,320.31
|
| Rate for Payer: PHP All Commercial |
$2,346.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,206.56
|
| Rate for Payer: Sagamore Health Network All Products |
$2,388.38
|
| Rate for Payer: Signature Care EPO |
$2,567.81
|
| Rate for Payer: Signature Care PPO |
$2,722.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,629.69
|
| Rate for Payer: United Healthcare Commercial |
$2,437.88
|
| Rate for Payer: United Healthcare Medicare |
$1,020.94
|
|
|
HC ACUITY PRO LEAD DELIV SYS
|
Facility
IP
|
$3,093.75
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
41607271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,320.31 |
| Max. Negotiated Rate |
$2,877.19 |
| Rate for Payer: Aetna Commercial |
$2,673.00
|
| Rate for Payer: Cash Price |
$1,918.13
|
| Rate for Payer: Cigna All Commercial |
$2,669.91
|
| Rate for Payer: CORVEL All Commercial |
$2,877.19
|
| Rate for Payer: Coventry All Commercial |
$2,722.50
|
| Rate for Payer: Encore All Commercial |
$2,847.80
|
| Rate for Payer: Frontpath All Commercial |
$2,846.25
|
| Rate for Payer: Humana ChoiceCare |
$2,672.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,784.38
|
| Rate for Payer: PHCS All Commercial |
$2,320.31
|
| Rate for Payer: PHP All Commercial |
$2,346.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,388.38
|
| Rate for Payer: Signature Care EPO |
$2,567.81
|
| Rate for Payer: Signature Care PPO |
$2,722.50
|
| Rate for Payer: United Healthcare Commercial |
$2,437.88
|
|
|
HC ACU LAT FIBULA PLATE 4-H L
|
Facility
IP
|
$3,326.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.80 |
| Max. Negotiated Rate |
$3,093.55 |
| Rate for Payer: Aetna Commercial |
$2,874.01
|
| Rate for Payer: Cash Price |
$2,062.37
|
| Rate for Payer: Cigna All Commercial |
$2,870.68
|
| Rate for Payer: CORVEL All Commercial |
$3,093.55
|
| Rate for Payer: Coventry All Commercial |
$2,927.23
|
| Rate for Payer: Encore All Commercial |
$3,061.95
|
| Rate for Payer: Frontpath All Commercial |
$3,060.29
|
| Rate for Payer: Humana ChoiceCare |
$2,873.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,993.76
|
| Rate for Payer: PHCS All Commercial |
$2,494.80
|
| Rate for Payer: PHP All Commercial |
$2,522.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,567.98
|
| Rate for Payer: Signature Care EPO |
$2,760.91
|
| Rate for Payer: Signature Care PPO |
$2,927.23
|
| Rate for Payer: United Healthcare Commercial |
$2,621.20
|
|
|
HC ACU LAT FIBULA PLATE 4-H L
|
Facility
OP
|
$3,326.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,093.55 |
| Rate for Payer: Aetna Commercial |
$2,807.48
|
| Rate for Payer: Aetna Medicare |
$1,097.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,097.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,910.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,079.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,262.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,207.48
|
| Rate for Payer: Cash Price |
$2,062.37
|
| Rate for Payer: Cash Price |
$2,062.37
|
| Rate for Payer: Centivo All Commercial |
$1,696.46
|
| Rate for Payer: Cigna All Commercial |
$2,870.68
|
| Rate for Payer: CORVEL All Commercial |
$3,093.55
|
| Rate for Payer: Coventry All Commercial |
$2,927.23
|
| Rate for Payer: Encore All Commercial |
$3,061.95
|
| Rate for Payer: Frontpath All Commercial |
$3,060.29
|
| Rate for Payer: Humana ChoiceCare |
$2,873.01
|
| Rate for Payer: Humana Medicare |
$1,696.46
|
| Rate for Payer: Lucent All Commercial |
$1,696.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,993.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,494.80
|
| Rate for Payer: PHP All Commercial |
$2,522.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,297.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,567.98
|
| Rate for Payer: Signature Care EPO |
$2,760.91
|
| Rate for Payer: Signature Care PPO |
$2,927.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,827.44
|
| Rate for Payer: United Healthcare Commercial |
$2,621.20
|
| Rate for Payer: United Healthcare Medicare |
$1,097.71
|
|
|
HC ACU LAT FIBULA PLATE 4-H R
|
Facility
IP
|
$3,326.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.80 |
| Max. Negotiated Rate |
$3,093.55 |
| Rate for Payer: Aetna Commercial |
$2,874.01
|
| Rate for Payer: Cash Price |
$2,062.37
|
| Rate for Payer: Cigna All Commercial |
$2,870.68
|
| Rate for Payer: CORVEL All Commercial |
$3,093.55
|
| Rate for Payer: Coventry All Commercial |
$2,927.23
|
| Rate for Payer: Encore All Commercial |
$3,061.95
|
| Rate for Payer: Frontpath All Commercial |
$3,060.29
|
| Rate for Payer: Humana ChoiceCare |
$2,873.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,993.76
|
| Rate for Payer: PHCS All Commercial |
$2,494.80
|
| Rate for Payer: PHP All Commercial |
$2,522.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2,567.98
|
| Rate for Payer: Signature Care EPO |
$2,760.91
|
| Rate for Payer: Signature Care PPO |
$2,927.23
|
| Rate for Payer: United Healthcare Commercial |
$2,621.20
|
|
|
HC ACU LAT FIBULA PLATE 4-H R
|
Facility
OP
|
$3,326.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,093.55 |
| Rate for Payer: Aetna Commercial |
$2,807.48
|
| Rate for Payer: Aetna Medicare |
$1,097.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,097.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,910.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,079.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,262.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,207.48
|
| Rate for Payer: Cash Price |
$2,062.37
|
| Rate for Payer: Cash Price |
$2,062.37
|
| Rate for Payer: Centivo All Commercial |
$1,696.46
|
| Rate for Payer: Cigna All Commercial |
$2,870.68
|
| Rate for Payer: CORVEL All Commercial |
$3,093.55
|
| Rate for Payer: Coventry All Commercial |
$2,927.23
|
| Rate for Payer: Encore All Commercial |
$3,061.95
|
| Rate for Payer: Frontpath All Commercial |
$3,060.29
|
| Rate for Payer: Humana ChoiceCare |
$2,873.01
|
| Rate for Payer: Humana Medicare |
$1,696.46
|
| Rate for Payer: Lucent All Commercial |
$1,696.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,993.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,494.80
|
| Rate for Payer: PHP All Commercial |
$2,522.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,297.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,567.98
|
| Rate for Payer: Signature Care EPO |
$2,760.91
|
| Rate for Payer: Signature Care PPO |
$2,927.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,827.44
|
| Rate for Payer: United Healthcare Commercial |
$2,621.20
|
| Rate for Payer: United Healthcare Medicare |
$1,097.71
|
|
|
HC ACU LAT FIBULA PLATE 5-H L
|
Facility
IP
|
$3,387.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,540.70 |
| Max. Negotiated Rate |
$3,150.47 |
| Rate for Payer: Aetna Commercial |
$2,926.89
|
| Rate for Payer: Cash Price |
$2,100.31
|
| Rate for Payer: Cigna All Commercial |
$2,923.50
|
| Rate for Payer: CORVEL All Commercial |
$3,150.47
|
| Rate for Payer: Coventry All Commercial |
$2,981.09
|
| Rate for Payer: Encore All Commercial |
$3,118.29
|
| Rate for Payer: Frontpath All Commercial |
$3,116.59
|
| Rate for Payer: Humana ChoiceCare |
$2,925.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,048.84
|
| Rate for Payer: PHCS All Commercial |
$2,540.70
|
| Rate for Payer: PHP All Commercial |
$2,569.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2,615.23
|
| Rate for Payer: Signature Care EPO |
$2,811.71
|
| Rate for Payer: Signature Care PPO |
$2,981.09
|
| Rate for Payer: United Healthcare Commercial |
$2,669.43
|
|
|
HC ACU LAT FIBULA PLATE 5-H L
|
Facility
OP
|
$3,387.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,150.47 |
| Rate for Payer: Aetna Commercial |
$2,859.13
|
| Rate for Payer: Aetna Medicare |
$1,117.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,117.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,945.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,117.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,285.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,229.70
|
| Rate for Payer: Cash Price |
$2,100.31
|
| Rate for Payer: Cash Price |
$2,100.31
|
| Rate for Payer: Centivo All Commercial |
$1,727.68
|
| Rate for Payer: Cigna All Commercial |
$2,923.50
|
| Rate for Payer: CORVEL All Commercial |
$3,150.47
|
| Rate for Payer: Coventry All Commercial |
$2,981.09
|
| Rate for Payer: Encore All Commercial |
$3,118.29
|
| Rate for Payer: Frontpath All Commercial |
$3,116.59
|
| Rate for Payer: Humana ChoiceCare |
$2,925.87
|
| Rate for Payer: Humana Medicare |
$1,727.68
|
| Rate for Payer: Lucent All Commercial |
$1,727.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,048.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,540.70
|
| Rate for Payer: PHP All Commercial |
$2,569.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,321.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2,615.23
|
| Rate for Payer: Signature Care EPO |
$2,811.71
|
| Rate for Payer: Signature Care PPO |
$2,981.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,879.46
|
| Rate for Payer: United Healthcare Commercial |
$2,669.43
|
| Rate for Payer: United Healthcare Medicare |
$1,117.91
|
|
|
HC ACU LAT FIBULA PLATE 5-H R
|
Facility
OP
|
$3,387.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,150.47 |
| Rate for Payer: Aetna Commercial |
$2,859.13
|
| Rate for Payer: Aetna Medicare |
$1,117.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,117.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,945.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,117.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,285.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,229.70
|
| Rate for Payer: Cash Price |
$2,100.31
|
| Rate for Payer: Cash Price |
$2,100.31
|
| Rate for Payer: Centivo All Commercial |
$1,727.68
|
| Rate for Payer: Cigna All Commercial |
$2,923.50
|
| Rate for Payer: CORVEL All Commercial |
$3,150.47
|
| Rate for Payer: Coventry All Commercial |
$2,981.09
|
| Rate for Payer: Encore All Commercial |
$3,118.29
|
| Rate for Payer: Frontpath All Commercial |
$3,116.59
|
| Rate for Payer: Humana ChoiceCare |
$2,925.87
|
| Rate for Payer: Humana Medicare |
$1,727.68
|
| Rate for Payer: Lucent All Commercial |
$1,727.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,048.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,540.70
|
| Rate for Payer: PHP All Commercial |
$2,569.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,321.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2,615.23
|
| Rate for Payer: Signature Care EPO |
$2,811.71
|
| Rate for Payer: Signature Care PPO |
$2,981.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,879.46
|
| Rate for Payer: United Healthcare Commercial |
$2,669.43
|
| Rate for Payer: United Healthcare Medicare |
$1,117.91
|
|
|
HC ACU LAT FIBULA PLATE 5-H R
|
Facility
IP
|
$3,387.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,540.70 |
| Max. Negotiated Rate |
$3,150.47 |
| Rate for Payer: Aetna Commercial |
$2,926.89
|
| Rate for Payer: Cash Price |
$2,100.31
|
| Rate for Payer: Cigna All Commercial |
$2,923.50
|
| Rate for Payer: CORVEL All Commercial |
$3,150.47
|
| Rate for Payer: Coventry All Commercial |
$2,981.09
|
| Rate for Payer: Encore All Commercial |
$3,118.29
|
| Rate for Payer: Frontpath All Commercial |
$3,116.59
|
| Rate for Payer: Humana ChoiceCare |
$2,925.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,048.84
|
| Rate for Payer: PHCS All Commercial |
$2,540.70
|
| Rate for Payer: PHP All Commercial |
$2,569.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2,615.23
|
| Rate for Payer: Signature Care EPO |
$2,811.71
|
| Rate for Payer: Signature Care PPO |
$2,981.09
|
| Rate for Payer: United Healthcare Commercial |
$2,669.43
|
|
|
HC ACU LAT FIBULA PLATE 6-H L
|
Facility
OP
|
$5,220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,854.60 |
| Rate for Payer: Aetna Commercial |
$4,405.68
|
| Rate for Payer: Aetna Medicare |
$1,722.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,722.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,997.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,263.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,980.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,894.86
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Centivo All Commercial |
$2,662.20
|
| Rate for Payer: Cigna All Commercial |
$4,504.86
|
| Rate for Payer: CORVEL All Commercial |
$4,854.60
|
| Rate for Payer: Coventry All Commercial |
$4,593.60
|
| Rate for Payer: Encore All Commercial |
$4,805.01
|
| Rate for Payer: Frontpath All Commercial |
$4,802.40
|
| Rate for Payer: Humana ChoiceCare |
$4,508.51
|
| Rate for Payer: Humana Medicare |
$2,662.20
|
| Rate for Payer: Lucent All Commercial |
$2,662.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,698.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,915.00
|
| Rate for Payer: PHP All Commercial |
$3,958.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,035.80
|
| Rate for Payer: Sagamore Health Network All Products |
$4,029.84
|
| Rate for Payer: Signature Care EPO |
$4,332.60
|
| Rate for Payer: Signature Care PPO |
$4,593.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,437.00
|
| Rate for Payer: United Healthcare Commercial |
$4,113.36
|
| Rate for Payer: United Healthcare Medicare |
$1,722.60
|
|
|
HC ACU LAT FIBULA PLATE 6-H L
|
Facility
IP
|
$5,220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,915.00 |
| Max. Negotiated Rate |
$4,854.60 |
| Rate for Payer: Aetna Commercial |
$4,510.08
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna All Commercial |
$4,504.86
|
| Rate for Payer: CORVEL All Commercial |
$4,854.60
|
| Rate for Payer: Coventry All Commercial |
$4,593.60
|
| Rate for Payer: Encore All Commercial |
$4,805.01
|
| Rate for Payer: Frontpath All Commercial |
$4,802.40
|
| Rate for Payer: Humana ChoiceCare |
$4,508.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,698.00
|
| Rate for Payer: PHCS All Commercial |
$3,915.00
|
| Rate for Payer: PHP All Commercial |
$3,958.85
|
| Rate for Payer: Sagamore Health Network All Products |
$4,029.84
|
| Rate for Payer: Signature Care EPO |
$4,332.60
|
| Rate for Payer: Signature Care PPO |
$4,593.60
|
| Rate for Payer: United Healthcare Commercial |
$4,113.36
|
|
|
HC ACU LAT FIBULA PLATE 6-H R
|
Facility
IP
|
$3,132.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,349.00 |
| Max. Negotiated Rate |
$2,912.76 |
| Rate for Payer: Aetna Commercial |
$2,706.05
|
| Rate for Payer: Cash Price |
$1,941.84
|
| Rate for Payer: Cigna All Commercial |
$2,702.92
|
| Rate for Payer: CORVEL All Commercial |
$2,912.76
|
| Rate for Payer: Coventry All Commercial |
$2,756.16
|
| Rate for Payer: Encore All Commercial |
$2,883.01
|
| Rate for Payer: Frontpath All Commercial |
$2,881.44
|
| Rate for Payer: Humana ChoiceCare |
$2,705.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,818.80
|
| Rate for Payer: PHCS All Commercial |
$2,349.00
|
| Rate for Payer: PHP All Commercial |
$2,375.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,417.90
|
| Rate for Payer: Signature Care EPO |
$2,599.56
|
| Rate for Payer: Signature Care PPO |
$2,756.16
|
| Rate for Payer: United Healthcare Commercial |
$2,468.02
|
|
|
HC ACU LAT FIBULA PLATE 6-H R
|
Facility
OP
|
$3,132.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,912.76 |
| Rate for Payer: Aetna Commercial |
$2,643.41
|
| Rate for Payer: Aetna Medicare |
$1,033.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,033.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,798.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,957.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,188.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,136.92
|
| Rate for Payer: Cash Price |
$1,941.84
|
| Rate for Payer: Cash Price |
$1,941.84
|
| Rate for Payer: Centivo All Commercial |
$1,597.32
|
| Rate for Payer: Cigna All Commercial |
$2,702.92
|
| Rate for Payer: CORVEL All Commercial |
$2,912.76
|
| Rate for Payer: Coventry All Commercial |
$2,756.16
|
| Rate for Payer: Encore All Commercial |
$2,883.01
|
| Rate for Payer: Frontpath All Commercial |
$2,881.44
|
| Rate for Payer: Humana ChoiceCare |
$2,705.11
|
| Rate for Payer: Humana Medicare |
$1,597.32
|
| Rate for Payer: Lucent All Commercial |
$1,597.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,818.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,349.00
|
| Rate for Payer: PHP All Commercial |
$2,375.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,221.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,417.90
|
| Rate for Payer: Signature Care EPO |
$2,599.56
|
| Rate for Payer: Signature Care PPO |
$2,756.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,662.20
|
| Rate for Payer: United Healthcare Commercial |
$2,468.02
|
| Rate for Payer: United Healthcare Medicare |
$1,033.56
|
|
|
HC ACU LAT FIBULA PLATE 7-H L
|
Facility
IP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,982.50 |
| Max. Negotiated Rate |
$4,938.30 |
| Rate for Payer: Aetna Commercial |
$4,587.84
|
| Rate for Payer: Cash Price |
$3,292.20
|
| Rate for Payer: Cigna All Commercial |
$4,582.53
|
| Rate for Payer: CORVEL All Commercial |
$4,938.30
|
| Rate for Payer: Coventry All Commercial |
$4,672.80
|
| Rate for Payer: Encore All Commercial |
$4,887.86
|
| Rate for Payer: Frontpath All Commercial |
$4,885.20
|
| Rate for Payer: Humana ChoiceCare |
$4,586.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,779.00
|
| Rate for Payer: PHCS All Commercial |
$3,982.50
|
| Rate for Payer: PHP All Commercial |
$4,027.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,099.32
|
| Rate for Payer: Signature Care EPO |
$4,407.30
|
| Rate for Payer: Signature Care PPO |
$4,672.80
|
| Rate for Payer: United Healthcare Commercial |
$4,184.28
|
|
|
HC ACU LAT FIBULA PLATE 7-H L
|
Facility
OP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,938.30 |
| Rate for Payer: Aetna Commercial |
$4,481.64
|
| Rate for Payer: Aetna Medicare |
$1,752.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,752.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,049.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,319.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,015.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,927.53
|
| Rate for Payer: Cash Price |
$3,292.20
|
| Rate for Payer: Cash Price |
$3,292.20
|
| Rate for Payer: Centivo All Commercial |
$2,708.10
|
| Rate for Payer: Cigna All Commercial |
$4,582.53
|
| Rate for Payer: CORVEL All Commercial |
$4,938.30
|
| Rate for Payer: Coventry All Commercial |
$4,672.80
|
| Rate for Payer: Encore All Commercial |
$4,887.86
|
| Rate for Payer: Frontpath All Commercial |
$4,885.20
|
| Rate for Payer: Humana ChoiceCare |
$4,586.25
|
| Rate for Payer: Humana Medicare |
$2,708.10
|
| Rate for Payer: Lucent All Commercial |
$2,708.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,779.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,982.50
|
| Rate for Payer: PHP All Commercial |
$4,027.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,070.90
|
| Rate for Payer: Sagamore Health Network All Products |
$4,099.32
|
| Rate for Payer: Signature Care EPO |
$4,407.30
|
| Rate for Payer: Signature Care PPO |
$4,672.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,513.50
|
| Rate for Payer: United Healthcare Commercial |
$4,184.28
|
| Rate for Payer: United Healthcare Medicare |
$1,752.30
|
|
|
HC ACU LAT FIBULA PLATE 7-H R
|
Facility
IP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,982.50 |
| Max. Negotiated Rate |
$4,938.30 |
| Rate for Payer: Aetna Commercial |
$4,587.84
|
| Rate for Payer: Cash Price |
$3,292.20
|
| Rate for Payer: Cigna All Commercial |
$4,582.53
|
| Rate for Payer: CORVEL All Commercial |
$4,938.30
|
| Rate for Payer: Coventry All Commercial |
$4,672.80
|
| Rate for Payer: Encore All Commercial |
$4,887.86
|
| Rate for Payer: Frontpath All Commercial |
$4,885.20
|
| Rate for Payer: Humana ChoiceCare |
$4,586.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,779.00
|
| Rate for Payer: PHCS All Commercial |
$3,982.50
|
| Rate for Payer: PHP All Commercial |
$4,027.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,099.32
|
| Rate for Payer: Signature Care EPO |
$4,407.30
|
| Rate for Payer: Signature Care PPO |
$4,672.80
|
| Rate for Payer: United Healthcare Commercial |
$4,184.28
|
|
|
HC ACU LAT FIBULA PLATE 7-H R
|
Facility
OP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,938.30 |
| Rate for Payer: Aetna Commercial |
$4,481.64
|
| Rate for Payer: Aetna Medicare |
$1,752.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,752.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,049.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,319.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,015.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,927.53
|
| Rate for Payer: Cash Price |
$3,292.20
|
| Rate for Payer: Cash Price |
$3,292.20
|
| Rate for Payer: Centivo All Commercial |
$2,708.10
|
| Rate for Payer: Cigna All Commercial |
$4,582.53
|
| Rate for Payer: CORVEL All Commercial |
$4,938.30
|
| Rate for Payer: Coventry All Commercial |
$4,672.80
|
| Rate for Payer: Encore All Commercial |
$4,887.86
|
| Rate for Payer: Frontpath All Commercial |
$4,885.20
|
| Rate for Payer: Humana ChoiceCare |
$4,586.25
|
| Rate for Payer: Humana Medicare |
$2,708.10
|
| Rate for Payer: Lucent All Commercial |
$2,708.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,779.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,982.50
|
| Rate for Payer: PHP All Commercial |
$4,027.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,070.90
|
| Rate for Payer: Sagamore Health Network All Products |
$4,099.32
|
| Rate for Payer: Signature Care EPO |
$4,407.30
|
| Rate for Payer: Signature Care PPO |
$4,672.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,513.50
|
| Rate for Payer: United Healthcare Commercial |
$4,184.28
|
| Rate for Payer: United Healthcare Medicare |
$1,752.30
|
|
|
HC ACU LAT FIBULA PLATE 9-H L
|
Facility
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Medicare |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,049.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,960.20
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$2,754.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Humana Medicare |
$2,754.00
|
| Rate for Payer: Lucent All Commercial |
$2,754.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
| Rate for Payer: United Healthcare Medicare |
$1,782.00
|
|
|
HC ACU LAT FIBULA PLATE 9-H L
|
Facility
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
|
HC ACU LAT FIBULA PLATE 9-H R
|
Facility
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
