|
HC ACU LAT FIBULA PLATE 9-H R
|
Facility
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602775
|
|
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 L FRAG PLATE 2.7MM LEFT
|
Facility
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,866.24
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
|
|
HC ACU L FRAG PLATE 2.7MM LEFT
|
Facility
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Aetna Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,350.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$819.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.08
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Centivo All Commercial |
$1,101.60
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Humana Medicare |
$1,101.60
|
| Rate for Payer: Lucent All Commercial |
$1,101.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare Medicare |
$712.80
|
|
|
HC ACU L FRAG PLATE 2.7MM RIGHT
|
Facility
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Aetna Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,350.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$819.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.08
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Centivo All Commercial |
$1,101.60
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Humana Medicare |
$1,101.60
|
| Rate for Payer: Lucent All Commercial |
$1,101.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare Medicare |
$712.80
|
|
|
HC ACU L FRAG PLATE 2.7MM RIGHT
|
Facility
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,866.24
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
|
|
HC ACU LOCK PEG HOOK PLATE 2-H
|
Facility
IP
|
$3,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602795
|
|
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 LOCK PEG HOOK PLATE 2-H
|
Facility
OP
|
$3,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602795
|
|
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 LOCK PEG HOOK PLATE 3-H
|
Facility
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602796
|
|
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 ACU LOCK PEG HOOK PLATE 3-H
|
Facility
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602796
|
|
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 MED ANTI-GLIDE PLATE 4-H
|
Facility
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.00 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,488.32
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cigna All Commercial |
$2,485.44
|
| Rate for Payer: CORVEL All Commercial |
$2,678.40
|
| Rate for Payer: Coventry All Commercial |
$2,534.40
|
| Rate for Payer: Encore All Commercial |
$2,651.04
|
| Rate for Payer: Frontpath All Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,487.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,592.00
|
| Rate for Payer: PHCS All Commercial |
$2,160.00
|
| Rate for Payer: PHP All Commercial |
$2,184.19
|
| Rate for Payer: Sagamore Health Network All Products |
$2,223.36
|
| Rate for Payer: Signature Care EPO |
$2,390.40
|
| Rate for Payer: Signature Care PPO |
$2,534.40
|
| Rate for Payer: United Healthcare Commercial |
$2,269.44
|
|
|
HC ACU MED ANTI-GLIDE PLATE 4-H
|
Facility
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,430.72
|
| Rate for Payer: Aetna Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,653.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,800.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,092.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,045.44
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Centivo All Commercial |
$1,468.80
|
| Rate for Payer: Cigna All Commercial |
$2,485.44
|
| Rate for Payer: CORVEL All Commercial |
$2,678.40
|
| Rate for Payer: Coventry All Commercial |
$2,534.40
|
| Rate for Payer: Encore All Commercial |
$2,651.04
|
| Rate for Payer: Frontpath All Commercial |
$2,649.60
|
| Rate for Payer: Humana ChoiceCare |
$2,487.46
|
| Rate for Payer: Humana Medicare |
$1,468.80
|
| Rate for Payer: Lucent All Commercial |
$1,468.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,592.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,160.00
|
| Rate for Payer: PHP All Commercial |
$2,184.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,123.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,223.36
|
| Rate for Payer: Signature Care EPO |
$2,390.40
|
| Rate for Payer: Signature Care PPO |
$2,534.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare Commercial |
$2,269.44
|
| Rate for Payer: United Healthcare Medicare |
$950.40
|
|
|
HC ACU ONE-THIRD TUB PLATE 10-H
|
Facility
IP
|
$903.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$677.25 |
| Max. Negotiated Rate |
$839.79 |
| Rate for Payer: Aetna Commercial |
$780.19
|
| Rate for Payer: Cash Price |
$559.86
|
| Rate for Payer: Cigna All Commercial |
$779.29
|
| Rate for Payer: CORVEL All Commercial |
$839.79
|
| Rate for Payer: Coventry All Commercial |
$794.64
|
| Rate for Payer: Encore All Commercial |
$831.21
|
| Rate for Payer: Frontpath All Commercial |
$830.76
|
| Rate for Payer: Humana ChoiceCare |
$779.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$812.70
|
| Rate for Payer: PHCS All Commercial |
$677.25
|
| Rate for Payer: PHP All Commercial |
$684.84
|
| Rate for Payer: Sagamore Health Network All Products |
$697.12
|
| Rate for Payer: Signature Care EPO |
$749.49
|
| Rate for Payer: Signature Care PPO |
$794.64
|
| Rate for Payer: United Healthcare Commercial |
$711.56
|
|
|
HC ACU ONE-THIRD TUB PLATE 10-H
|
Facility
OP
|
$903.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.99 |
| Max. Negotiated Rate |
$839.79 |
| Rate for Payer: Aetna Commercial |
$762.13
|
| Rate for Payer: Aetna Medicare |
$297.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$297.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$518.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$564.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$342.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$327.79
|
| Rate for Payer: Cash Price |
$559.86
|
| Rate for Payer: Cash Price |
$559.86
|
| Rate for Payer: Centivo All Commercial |
$460.53
|
| Rate for Payer: Cigna All Commercial |
$779.29
|
| Rate for Payer: CORVEL All Commercial |
$839.79
|
| Rate for Payer: Coventry All Commercial |
$794.64
|
| Rate for Payer: Encore All Commercial |
$831.21
|
| Rate for Payer: Frontpath All Commercial |
$830.76
|
| Rate for Payer: Humana ChoiceCare |
$779.92
|
| Rate for Payer: Humana Medicare |
$460.53
|
| Rate for Payer: Lucent All Commercial |
$460.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$812.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$677.25
|
| Rate for Payer: PHP All Commercial |
$684.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$352.17
|
| Rate for Payer: Sagamore Health Network All Products |
$697.12
|
| Rate for Payer: Signature Care EPO |
$749.49
|
| Rate for Payer: Signature Care PPO |
$794.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$767.55
|
| Rate for Payer: United Healthcare Commercial |
$711.56
|
| Rate for Payer: United Healthcare Medicare |
$297.99
|
|
|
HC ACU ONE-THIRD TUB PLATE 12-H
|
Facility
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$953.25 |
| Rate for Payer: Aetna Commercial |
$865.10
|
| Rate for Payer: Aetna Medicare |
$338.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$588.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$640.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$388.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.08
|
| Rate for Payer: Cash Price |
$635.50
|
| Rate for Payer: Cash Price |
$635.50
|
| Rate for Payer: Centivo All Commercial |
$522.75
|
| Rate for Payer: Cigna All Commercial |
$884.58
|
| Rate for Payer: CORVEL All Commercial |
$953.25
|
| Rate for Payer: Coventry All Commercial |
$902.00
|
| Rate for Payer: Encore All Commercial |
$943.51
|
| Rate for Payer: Frontpath All Commercial |
$943.00
|
| Rate for Payer: Humana ChoiceCare |
$885.29
|
| Rate for Payer: Humana Medicare |
$522.75
|
| Rate for Payer: Lucent All Commercial |
$522.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$768.75
|
| Rate for Payer: PHP All Commercial |
$777.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.75
|
| Rate for Payer: Sagamore Health Network All Products |
$791.30
|
| Rate for Payer: Signature Care EPO |
$850.75
|
| Rate for Payer: Signature Care PPO |
$902.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.25
|
| Rate for Payer: United Healthcare Commercial |
$807.70
|
| Rate for Payer: United Healthcare Medicare |
$338.25
|
|
|
HC ACU ONE-THIRD TUB PLATE 12-H
|
Facility
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.75 |
| Max. Negotiated Rate |
$953.25 |
| Rate for Payer: Aetna Commercial |
$885.60
|
| Rate for Payer: Cash Price |
$635.50
|
| Rate for Payer: Cigna All Commercial |
$884.58
|
| Rate for Payer: CORVEL All Commercial |
$953.25
|
| Rate for Payer: Coventry All Commercial |
$902.00
|
| Rate for Payer: Encore All Commercial |
$943.51
|
| Rate for Payer: Frontpath All Commercial |
$943.00
|
| Rate for Payer: Humana ChoiceCare |
$885.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.50
|
| Rate for Payer: PHCS All Commercial |
$768.75
|
| Rate for Payer: PHP All Commercial |
$777.36
|
| Rate for Payer: Sagamore Health Network All Products |
$791.30
|
| Rate for Payer: Signature Care EPO |
$850.75
|
| Rate for Payer: Signature Care PPO |
$902.00
|
| Rate for Payer: United Healthcare Commercial |
$807.70
|
|
|
HC ACU ONE-THIRD TUB PLATE 3-H
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
|
|
HC ACU ONE-THIRD TUB PLATE 3-H
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.85 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC ACU ONE-THIRD TUB PLATE 4-H
|
Facility
OP
|
$672.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$567.17
|
| Rate for Payer: Aetna Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$385.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$420.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$255.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$243.94
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Centivo All Commercial |
$342.72
|
| Rate for Payer: Cigna All Commercial |
$579.94
|
| Rate for Payer: CORVEL All Commercial |
$624.96
|
| Rate for Payer: Coventry All Commercial |
$591.36
|
| Rate for Payer: Encore All Commercial |
$618.58
|
| Rate for Payer: Frontpath All Commercial |
$618.24
|
| Rate for Payer: Humana ChoiceCare |
$580.41
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Lucent All Commercial |
$342.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$504.00
|
| Rate for Payer: PHP All Commercial |
$509.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$262.08
|
| Rate for Payer: Sagamore Health Network All Products |
$518.78
|
| Rate for Payer: Signature Care EPO |
$557.76
|
| Rate for Payer: Signature Care PPO |
$591.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$571.20
|
| Rate for Payer: United Healthcare Commercial |
$529.54
|
| Rate for Payer: United Healthcare Medicare |
$221.76
|
|
|
HC ACU ONE-THIRD TUB PLATE 4-H
|
Facility
IP
|
$672.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$580.61
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cigna All Commercial |
$579.94
|
| Rate for Payer: CORVEL All Commercial |
$624.96
|
| Rate for Payer: Coventry All Commercial |
$591.36
|
| Rate for Payer: Encore All Commercial |
$618.58
|
| Rate for Payer: Frontpath All Commercial |
$618.24
|
| Rate for Payer: Humana ChoiceCare |
$580.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.80
|
| Rate for Payer: PHCS All Commercial |
$504.00
|
| Rate for Payer: PHP All Commercial |
$509.64
|
| Rate for Payer: Sagamore Health Network All Products |
$518.78
|
| Rate for Payer: Signature Care EPO |
$557.76
|
| Rate for Payer: Signature Care PPO |
$591.36
|
| Rate for Payer: United Healthcare Commercial |
$529.54
|
|
|
HC ACU ONE-THIRD TUB PLATE 5-H
|
Facility
OP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$654.10
|
| Rate for Payer: Aetna Medicare |
$255.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$445.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$484.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$281.32
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Centivo All Commercial |
$395.25
|
| Rate for Payer: Cigna All Commercial |
$668.82
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Humana Medicare |
$395.25
|
| Rate for Payer: Lucent All Commercial |
$395.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$302.25
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$658.75
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
| Rate for Payer: United Healthcare Medicare |
$255.75
|
|
|
HC ACU ONE-THIRD TUB PLATE 5-H
|
Facility
IP
|
$775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Cigna All Commercial |
$668.82
|
| Rate for Payer: CORVEL All Commercial |
$720.75
|
| Rate for Payer: Coventry All Commercial |
$682.00
|
| Rate for Payer: Encore All Commercial |
$713.39
|
| Rate for Payer: Frontpath All Commercial |
$713.00
|
| Rate for Payer: Humana ChoiceCare |
$669.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.50
|
| Rate for Payer: PHCS All Commercial |
$581.25
|
| Rate for Payer: PHP All Commercial |
$587.76
|
| Rate for Payer: Sagamore Health Network All Products |
$598.30
|
| Rate for Payer: Signature Care EPO |
$643.25
|
| Rate for Payer: Signature Care PPO |
$682.00
|
| Rate for Payer: United Healthcare Commercial |
$610.70
|
|
|
HC ACU ONE-THIRD TUB PLATE 6-H
|
Facility
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
|
|
HC ACU ONE-THIRD TUB PLATE 6-H
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$696.30
|
| Rate for Payer: Aetna Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.48
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Centivo All Commercial |
$420.75
|
| Rate for Payer: Cigna All Commercial |
$711.98
|
| Rate for Payer: CORVEL All Commercial |
$767.25
|
| Rate for Payer: Coventry All Commercial |
$726.00
|
| Rate for Payer: Encore All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$759.00
|
| Rate for Payer: Humana ChoiceCare |
$712.55
|
| Rate for Payer: Humana Medicare |
$420.75
|
| Rate for Payer: Lucent All Commercial |
$420.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: PHP All Commercial |
$625.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.75
|
| Rate for Payer: Sagamore Health Network All Products |
$636.90
|
| Rate for Payer: Signature Care EPO |
$684.75
|
| Rate for Payer: Signature Care PPO |
$726.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$701.25
|
| Rate for Payer: United Healthcare Commercial |
$650.10
|
| Rate for Payer: United Healthcare Medicare |
$272.25
|
|
|
HC ACU ONE-THIRD TUB PLATE 7-H
|
Facility
OP
|
$875.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$738.50
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$546.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$332.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.62
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Centivo All Commercial |
$446.25
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Humana Medicare |
$446.25
|
| Rate for Payer: Lucent All Commercial |
$446.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.25
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$743.75
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
| Rate for Payer: United Healthcare Medicare |
$288.75
|
|
|
HC ACU ONE-THIRD TUB PLATE 7-H
|
Facility
IP
|
$875.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$756.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
|
