|
HC ACU ONE-THIRD TUB PLATE 8-H
|
Facility
IP
|
$925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.75 |
| Max. Negotiated Rate |
$860.25 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Cash Price |
$573.50
|
| Rate for Payer: Cigna All Commercial |
$798.28
|
| Rate for Payer: CORVEL All Commercial |
$860.25
|
| Rate for Payer: Coventry All Commercial |
$814.00
|
| Rate for Payer: Encore All Commercial |
$851.46
|
| Rate for Payer: Frontpath All Commercial |
$851.00
|
| Rate for Payer: Humana ChoiceCare |
$798.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.50
|
| Rate for Payer: PHCS All Commercial |
$693.75
|
| Rate for Payer: PHP All Commercial |
$701.52
|
| Rate for Payer: Sagamore Health Network All Products |
$714.10
|
| Rate for Payer: Signature Care EPO |
$767.75
|
| Rate for Payer: Signature Care PPO |
$814.00
|
| Rate for Payer: United Healthcare Commercial |
$728.90
|
|
|
HC ACU ONE-THIRD TUB PLATE 8-H
|
Facility
OP
|
$925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$860.25 |
| Rate for Payer: Aetna Commercial |
$780.70
|
| Rate for Payer: Aetna Medicare |
$305.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$531.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$578.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$351.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.78
|
| Rate for Payer: Cash Price |
$573.50
|
| Rate for Payer: Cash Price |
$573.50
|
| Rate for Payer: Centivo All Commercial |
$471.75
|
| Rate for Payer: Cigna All Commercial |
$798.28
|
| Rate for Payer: CORVEL All Commercial |
$860.25
|
| Rate for Payer: Coventry All Commercial |
$814.00
|
| Rate for Payer: Encore All Commercial |
$851.46
|
| Rate for Payer: Frontpath All Commercial |
$851.00
|
| Rate for Payer: Humana ChoiceCare |
$798.92
|
| Rate for Payer: Humana Medicare |
$471.75
|
| Rate for Payer: Lucent All Commercial |
$471.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$693.75
|
| Rate for Payer: PHP All Commercial |
$701.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.75
|
| Rate for Payer: Sagamore Health Network All Products |
$714.10
|
| Rate for Payer: Signature Care EPO |
$767.75
|
| Rate for Payer: Signature Care PPO |
$814.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$786.25
|
| Rate for Payer: United Healthcare Commercial |
$728.90
|
| Rate for Payer: United Healthcare Medicare |
$305.25
|
|
|
HC ACU PLATE LP CLAVICL 8 H
|
Facility
OP
|
$4,197.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,903.77 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Aetna Medicare |
$1,385.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,385.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,410.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,623.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,592.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,523.73
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Centivo All Commercial |
$2,140.78
|
| Rate for Payer: Cigna All Commercial |
$3,622.53
|
| Rate for Payer: CORVEL All Commercial |
$3,903.77
|
| Rate for Payer: Coventry All Commercial |
$3,693.89
|
| Rate for Payer: Encore All Commercial |
$3,863.89
|
| Rate for Payer: Frontpath All Commercial |
$3,861.79
|
| Rate for Payer: Humana ChoiceCare |
$3,625.47
|
| Rate for Payer: Humana Medicare |
$2,140.78
|
| Rate for Payer: Lucent All Commercial |
$2,140.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,777.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,148.20
|
| Rate for Payer: PHP All Commercial |
$3,183.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,637.06
|
| Rate for Payer: Sagamore Health Network All Products |
$3,240.55
|
| Rate for Payer: Signature Care EPO |
$3,484.01
|
| Rate for Payer: Signature Care PPO |
$3,693.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,567.96
|
| Rate for Payer: United Healthcare Commercial |
$3,307.71
|
| Rate for Payer: United Healthcare Medicare |
$1,385.21
|
|
|
HC ACU PLATE LP CLAVICL 8 H
|
Facility
IP
|
$4,197.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,148.20 |
| Max. Negotiated Rate |
$3,903.77 |
| Rate for Payer: Aetna Commercial |
$3,626.73
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Cigna All Commercial |
$3,622.53
|
| Rate for Payer: CORVEL All Commercial |
$3,903.77
|
| Rate for Payer: Coventry All Commercial |
$3,693.89
|
| Rate for Payer: Encore All Commercial |
$3,863.89
|
| Rate for Payer: Frontpath All Commercial |
$3,861.79
|
| Rate for Payer: Humana ChoiceCare |
$3,625.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,777.84
|
| Rate for Payer: PHCS All Commercial |
$3,148.20
|
| Rate for Payer: PHP All Commercial |
$3,183.46
|
| Rate for Payer: Sagamore Health Network All Products |
$3,240.55
|
| Rate for Payer: Signature Care EPO |
$3,484.01
|
| Rate for Payer: Signature Care PPO |
$3,693.89
|
| Rate for Payer: United Healthcare Commercial |
$3,307.71
|
|
|
HC ACU PLATE POLARUS 3 6-H L
|
Facility
OP
|
$5,479.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,095.66 |
| Rate for Payer: Aetna Commercial |
$4,624.44
|
| Rate for Payer: Aetna Medicare |
$1,808.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,808.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,146.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,425.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,079.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,988.95
|
| Rate for Payer: Cash Price |
$3,397.10
|
| Rate for Payer: Cash Price |
$3,397.10
|
| Rate for Payer: Centivo All Commercial |
$2,794.39
|
| Rate for Payer: Cigna All Commercial |
$4,728.55
|
| Rate for Payer: CORVEL All Commercial |
$5,095.66
|
| Rate for Payer: Coventry All Commercial |
$4,821.70
|
| Rate for Payer: Encore All Commercial |
$5,043.60
|
| Rate for Payer: Frontpath All Commercial |
$5,040.86
|
| Rate for Payer: Humana ChoiceCare |
$4,732.39
|
| Rate for Payer: Humana Medicare |
$2,794.39
|
| Rate for Payer: Lucent All Commercial |
$2,794.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,931.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,109.40
|
| Rate for Payer: PHP All Commercial |
$4,155.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,136.89
|
| Rate for Payer: Sagamore Health Network All Products |
$4,229.94
|
| Rate for Payer: Signature Care EPO |
$4,547.74
|
| Rate for Payer: Signature Care PPO |
$4,821.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,657.32
|
| Rate for Payer: United Healthcare Commercial |
$4,317.61
|
| Rate for Payer: United Healthcare Medicare |
$1,808.14
|
|
|
HC ACU PLATE POLARUS 3 6-H L
|
Facility
IP
|
$5,479.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,109.40 |
| Max. Negotiated Rate |
$5,095.66 |
| Rate for Payer: Aetna Commercial |
$4,734.03
|
| Rate for Payer: Cash Price |
$3,397.10
|
| Rate for Payer: Cigna All Commercial |
$4,728.55
|
| Rate for Payer: CORVEL All Commercial |
$5,095.66
|
| Rate for Payer: Coventry All Commercial |
$4,821.70
|
| Rate for Payer: Encore All Commercial |
$5,043.60
|
| Rate for Payer: Frontpath All Commercial |
$5,040.86
|
| Rate for Payer: Humana ChoiceCare |
$4,732.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,931.28
|
| Rate for Payer: PHCS All Commercial |
$4,109.40
|
| Rate for Payer: PHP All Commercial |
$4,155.43
|
| Rate for Payer: Sagamore Health Network All Products |
$4,229.94
|
| Rate for Payer: Signature Care EPO |
$4,547.74
|
| Rate for Payer: Signature Care PPO |
$4,821.70
|
| Rate for Payer: United Healthcare Commercial |
$4,317.61
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H L
|
Facility
IP
|
$4,197.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,148.20 |
| Max. Negotiated Rate |
$3,903.77 |
| Rate for Payer: Aetna Commercial |
$3,626.73
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Cigna All Commercial |
$3,622.53
|
| Rate for Payer: CORVEL All Commercial |
$3,903.77
|
| Rate for Payer: Coventry All Commercial |
$3,693.89
|
| Rate for Payer: Encore All Commercial |
$3,863.89
|
| Rate for Payer: Frontpath All Commercial |
$3,861.79
|
| Rate for Payer: Humana ChoiceCare |
$3,625.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,777.84
|
| Rate for Payer: PHCS All Commercial |
$3,148.20
|
| Rate for Payer: PHP All Commercial |
$3,183.46
|
| Rate for Payer: Sagamore Health Network All Products |
$3,240.55
|
| Rate for Payer: Signature Care EPO |
$3,484.01
|
| Rate for Payer: Signature Care PPO |
$3,693.89
|
| Rate for Payer: United Healthcare Commercial |
$3,307.71
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H L
|
Facility
OP
|
$4,197.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,903.77 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Aetna Medicare |
$1,385.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,385.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,410.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,623.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,592.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,523.73
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Centivo All Commercial |
$2,140.78
|
| Rate for Payer: Cigna All Commercial |
$3,622.53
|
| Rate for Payer: CORVEL All Commercial |
$3,903.77
|
| Rate for Payer: Coventry All Commercial |
$3,693.89
|
| Rate for Payer: Encore All Commercial |
$3,863.89
|
| Rate for Payer: Frontpath All Commercial |
$3,861.79
|
| Rate for Payer: Humana ChoiceCare |
$3,625.47
|
| Rate for Payer: Humana Medicare |
$2,140.78
|
| Rate for Payer: Lucent All Commercial |
$2,140.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,777.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,148.20
|
| Rate for Payer: PHP All Commercial |
$3,183.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,637.06
|
| Rate for Payer: Sagamore Health Network All Products |
$3,240.55
|
| Rate for Payer: Signature Care EPO |
$3,484.01
|
| Rate for Payer: Signature Care PPO |
$3,693.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,567.96
|
| Rate for Payer: United Healthcare Commercial |
$3,307.71
|
| Rate for Payer: United Healthcare Medicare |
$1,385.21
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H R
|
Facility
OP
|
$4,197.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,903.77 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Aetna Medicare |
$1,385.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,385.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,410.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,623.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,592.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,523.73
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Centivo All Commercial |
$2,140.78
|
| Rate for Payer: Cigna All Commercial |
$3,622.53
|
| Rate for Payer: CORVEL All Commercial |
$3,903.77
|
| Rate for Payer: Coventry All Commercial |
$3,693.89
|
| Rate for Payer: Encore All Commercial |
$3,863.89
|
| Rate for Payer: Frontpath All Commercial |
$3,861.79
|
| Rate for Payer: Humana ChoiceCare |
$3,625.47
|
| Rate for Payer: Humana Medicare |
$2,140.78
|
| Rate for Payer: Lucent All Commercial |
$2,140.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,777.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,148.20
|
| Rate for Payer: PHP All Commercial |
$3,183.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,637.06
|
| Rate for Payer: Sagamore Health Network All Products |
$3,240.55
|
| Rate for Payer: Signature Care EPO |
$3,484.01
|
| Rate for Payer: Signature Care PPO |
$3,693.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,567.96
|
| Rate for Payer: United Healthcare Commercial |
$3,307.71
|
| Rate for Payer: United Healthcare Medicare |
$1,385.21
|
|
|
HC ACU PLATE PROF CLAVICLE 6-H R
|
Facility
IP
|
$4,197.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,148.20 |
| Max. Negotiated Rate |
$3,903.77 |
| Rate for Payer: Aetna Commercial |
$3,626.73
|
| Rate for Payer: Cash Price |
$2,602.51
|
| Rate for Payer: Cigna All Commercial |
$3,622.53
|
| Rate for Payer: CORVEL All Commercial |
$3,903.77
|
| Rate for Payer: Coventry All Commercial |
$3,693.89
|
| Rate for Payer: Encore All Commercial |
$3,863.89
|
| Rate for Payer: Frontpath All Commercial |
$3,861.79
|
| Rate for Payer: Humana ChoiceCare |
$3,625.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,777.84
|
| Rate for Payer: PHCS All Commercial |
$3,148.20
|
| Rate for Payer: PHP All Commercial |
$3,183.46
|
| Rate for Payer: Sagamore Health Network All Products |
$3,240.55
|
| Rate for Payer: Signature Care EPO |
$3,484.01
|
| Rate for Payer: Signature Care PPO |
$3,693.89
|
| Rate for Payer: United Healthcare Commercial |
$3,307.71
|
|
|
HC ACU PLATE PROF CLAVICLE 8-H L
|
Facility
IP
|
$4,323.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,242.70 |
| Max. Negotiated Rate |
$4,020.95 |
| Rate for Payer: Aetna Commercial |
$3,735.59
|
| Rate for Payer: Cash Price |
$2,680.63
|
| Rate for Payer: Cigna All Commercial |
$3,731.27
|
| Rate for Payer: CORVEL All Commercial |
$4,020.95
|
| Rate for Payer: Coventry All Commercial |
$3,804.77
|
| Rate for Payer: Encore All Commercial |
$3,979.87
|
| Rate for Payer: Frontpath All Commercial |
$3,977.71
|
| Rate for Payer: Humana ChoiceCare |
$3,734.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,891.24
|
| Rate for Payer: PHCS All Commercial |
$3,242.70
|
| Rate for Payer: PHP All Commercial |
$3,279.02
|
| Rate for Payer: Sagamore Health Network All Products |
$3,337.82
|
| Rate for Payer: Signature Care EPO |
$3,588.59
|
| Rate for Payer: Signature Care PPO |
$3,804.77
|
| Rate for Payer: United Healthcare Commercial |
$3,407.00
|
|
|
HC ACU PLATE PROF CLAVICLE 8-H L
|
Facility
OP
|
$4,323.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,020.95 |
| Rate for Payer: Aetna Commercial |
$3,649.12
|
| Rate for Payer: Aetna Medicare |
$1,426.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,426.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,483.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,702.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,640.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,569.47
|
| Rate for Payer: Cash Price |
$2,680.63
|
| Rate for Payer: Cash Price |
$2,680.63
|
| Rate for Payer: Centivo All Commercial |
$2,205.04
|
| Rate for Payer: Cigna All Commercial |
$3,731.27
|
| Rate for Payer: CORVEL All Commercial |
$4,020.95
|
| Rate for Payer: Coventry All Commercial |
$3,804.77
|
| Rate for Payer: Encore All Commercial |
$3,979.87
|
| Rate for Payer: Frontpath All Commercial |
$3,977.71
|
| Rate for Payer: Humana ChoiceCare |
$3,734.29
|
| Rate for Payer: Humana Medicare |
$2,205.04
|
| Rate for Payer: Lucent All Commercial |
$2,205.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,891.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,242.70
|
| Rate for Payer: PHP All Commercial |
$3,279.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,686.20
|
| Rate for Payer: Sagamore Health Network All Products |
$3,337.82
|
| Rate for Payer: Signature Care EPO |
$3,588.59
|
| Rate for Payer: Signature Care PPO |
$3,804.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,675.06
|
| Rate for Payer: United Healthcare Commercial |
$3,407.00
|
| Rate for Payer: United Healthcare Medicare |
$1,426.79
|
|
|
HC ACU PLATE RAD HEAD 3-H LOCK SM
|
Facility
OP
|
$4,377.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,071.17 |
| Rate for Payer: Aetna Commercial |
$3,694.69
|
| Rate for Payer: Aetna Medicare |
$1,444.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,444.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,514.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,736.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,661.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,589.07
|
| Rate for Payer: Cash Price |
$2,714.11
|
| Rate for Payer: Cash Price |
$2,714.11
|
| Rate for Payer: Centivo All Commercial |
$2,232.58
|
| Rate for Payer: Cigna All Commercial |
$3,777.87
|
| Rate for Payer: CORVEL All Commercial |
$4,071.17
|
| Rate for Payer: Coventry All Commercial |
$3,852.29
|
| Rate for Payer: Encore All Commercial |
$4,029.58
|
| Rate for Payer: Frontpath All Commercial |
$4,027.39
|
| Rate for Payer: Humana ChoiceCare |
$3,780.93
|
| Rate for Payer: Humana Medicare |
$2,232.58
|
| Rate for Payer: Lucent All Commercial |
$2,232.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,939.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,283.20
|
| Rate for Payer: PHP All Commercial |
$3,319.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,707.26
|
| Rate for Payer: Sagamore Health Network All Products |
$3,379.51
|
| Rate for Payer: Signature Care EPO |
$3,633.41
|
| Rate for Payer: Signature Care PPO |
$3,852.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,720.96
|
| Rate for Payer: United Healthcare Commercial |
$3,449.55
|
| Rate for Payer: United Healthcare Medicare |
$1,444.61
|
|
|
HC ACU PLATE RAD HEAD 3-H LOCK SM
|
Facility
IP
|
$4,377.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,283.20 |
| Max. Negotiated Rate |
$4,071.17 |
| Rate for Payer: Aetna Commercial |
$3,782.25
|
| Rate for Payer: Cash Price |
$2,714.11
|
| Rate for Payer: Cigna All Commercial |
$3,777.87
|
| Rate for Payer: CORVEL All Commercial |
$4,071.17
|
| Rate for Payer: Coventry All Commercial |
$3,852.29
|
| Rate for Payer: Encore All Commercial |
$4,029.58
|
| Rate for Payer: Frontpath All Commercial |
$4,027.39
|
| Rate for Payer: Humana ChoiceCare |
$3,780.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,939.84
|
| Rate for Payer: PHCS All Commercial |
$3,283.20
|
| Rate for Payer: PHP All Commercial |
$3,319.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,379.51
|
| Rate for Payer: Signature Care EPO |
$3,633.41
|
| Rate for Payer: Signature Care PPO |
$3,852.29
|
| Rate for Payer: United Healthcare Commercial |
$3,449.55
|
|
|
HC ACU POST LAT DIS TIB PLT 3H L
|
Facility
OP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Aetna Commercial |
$3,342.24
|
| Rate for Payer: Aetna Medicare |
$1,306.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,306.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,274.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,475.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,502.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,437.48
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Centivo All Commercial |
$2,019.60
|
| Rate for Payer: Cigna All Commercial |
$3,417.48
|
| Rate for Payer: CORVEL All Commercial |
$3,682.80
|
| Rate for Payer: Coventry All Commercial |
$3,484.80
|
| Rate for Payer: Encore All Commercial |
$3,645.18
|
| Rate for Payer: Frontpath All Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$3,420.25
|
| Rate for Payer: Humana Medicare |
$2,019.60
|
| Rate for Payer: Lucent All Commercial |
$2,019.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,564.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,970.00
|
| Rate for Payer: PHP All Commercial |
$3,003.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,544.40
|
| Rate for Payer: Sagamore Health Network All Products |
$3,057.12
|
| Rate for Payer: Signature Care EPO |
$3,286.80
|
| Rate for Payer: Signature Care PPO |
$3,484.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,366.00
|
| Rate for Payer: United Healthcare Commercial |
$3,120.48
|
| Rate for Payer: United Healthcare Medicare |
$1,306.80
|
|
|
HC ACU POST LAT DIS TIB PLT 3H L
|
Facility
IP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,970.00 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Aetna Commercial |
$3,421.44
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna All Commercial |
$3,417.48
|
| Rate for Payer: CORVEL All Commercial |
$3,682.80
|
| Rate for Payer: Coventry All Commercial |
$3,484.80
|
| Rate for Payer: Encore All Commercial |
$3,645.18
|
| Rate for Payer: Frontpath All Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$3,420.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,564.00
|
| Rate for Payer: PHCS All Commercial |
$2,970.00
|
| Rate for Payer: PHP All Commercial |
$3,003.26
|
| Rate for Payer: Sagamore Health Network All Products |
$3,057.12
|
| Rate for Payer: Signature Care EPO |
$3,286.80
|
| Rate for Payer: Signature Care PPO |
$3,484.80
|
| Rate for Payer: United Healthcare Commercial |
$3,120.48
|
|
|
HC ACU POST LAT DIS TIB PLT 3H R
|
Facility
OP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Aetna Commercial |
$3,342.24
|
| Rate for Payer: Aetna Medicare |
$1,306.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,306.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,274.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,475.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,502.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,437.48
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Centivo All Commercial |
$2,019.60
|
| Rate for Payer: Cigna All Commercial |
$3,417.48
|
| Rate for Payer: CORVEL All Commercial |
$3,682.80
|
| Rate for Payer: Coventry All Commercial |
$3,484.80
|
| Rate for Payer: Encore All Commercial |
$3,645.18
|
| Rate for Payer: Frontpath All Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$3,420.25
|
| Rate for Payer: Humana Medicare |
$2,019.60
|
| Rate for Payer: Lucent All Commercial |
$2,019.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,564.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,970.00
|
| Rate for Payer: PHP All Commercial |
$3,003.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,544.40
|
| Rate for Payer: Sagamore Health Network All Products |
$3,057.12
|
| Rate for Payer: Signature Care EPO |
$3,286.80
|
| Rate for Payer: Signature Care PPO |
$3,484.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,366.00
|
| Rate for Payer: United Healthcare Commercial |
$3,120.48
|
| Rate for Payer: United Healthcare Medicare |
$1,306.80
|
|
|
HC ACU POST LAT DIS TIB PLT 3H R
|
Facility
IP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,970.00 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Aetna Commercial |
$3,421.44
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna All Commercial |
$3,417.48
|
| Rate for Payer: CORVEL All Commercial |
$3,682.80
|
| Rate for Payer: Coventry All Commercial |
$3,484.80
|
| Rate for Payer: Encore All Commercial |
$3,645.18
|
| Rate for Payer: Frontpath All Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$3,420.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,564.00
|
| Rate for Payer: PHCS All Commercial |
$2,970.00
|
| Rate for Payer: PHP All Commercial |
$3,003.26
|
| Rate for Payer: Sagamore Health Network All Products |
$3,057.12
|
| Rate for Payer: Signature Care EPO |
$3,286.80
|
| Rate for Payer: Signature Care PPO |
$3,484.80
|
| Rate for Payer: United Healthcare Commercial |
$3,120.48
|
|
|
HC ACU POST LAT DIS TIB PLT 4H L
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,494.16
|
| Rate for Payer: Aetna Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,377.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,587.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,571.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,502.82
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Centivo All Commercial |
$2,111.40
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Humana Medicare |
$2,111.40
|
| Rate for Payer: Lucent All Commercial |
$2,111.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,614.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,519.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
|
|
HC ACU POST LAT DIS TIB PLT 4H L
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.00 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
|
|
HC ACU POST LAT DIS TIB PLT 4H R
|
Facility
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.00 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
|
|
HC ACU POST LAT DIS TIB PLT 4H R
|
Facility
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,850.20 |
| Rate for Payer: Aetna Commercial |
$3,494.16
|
| Rate for Payer: Aetna Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,377.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,587.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,571.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,502.82
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Centivo All Commercial |
$2,111.40
|
| Rate for Payer: Cigna All Commercial |
$3,572.82
|
| Rate for Payer: CORVEL All Commercial |
$3,850.20
|
| Rate for Payer: Coventry All Commercial |
$3,643.20
|
| Rate for Payer: Encore All Commercial |
$3,810.87
|
| Rate for Payer: Frontpath All Commercial |
$3,808.80
|
| Rate for Payer: Humana ChoiceCare |
$3,575.72
|
| Rate for Payer: Humana Medicare |
$2,111.40
|
| Rate for Payer: Lucent All Commercial |
$2,111.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,105.00
|
| Rate for Payer: PHP All Commercial |
$3,139.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,614.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,196.08
|
| Rate for Payer: Signature Care EPO |
$3,436.20
|
| Rate for Payer: Signature Care PPO |
$3,643.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,519.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.32
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
|
|
HC ACU POST LAT FIB PLATE 3-H L
|
Facility
OP
|
$5,040.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,253.76
|
| Rate for Payer: Aetna Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,894.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,150.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,912.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,829.52
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Centivo All Commercial |
$2,570.40
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Humana Medicare |
$2,570.40
|
| Rate for Payer: Lucent All Commercial |
$2,570.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,965.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,284.00
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare Medicare |
$1,663.20
|
|
|
HC ACU POST LAT FIB PLATE 3-H L
|
Facility
IP
|
$5,040.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.00 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,354.56
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
|
|
HC ACU POST LAT FIB PLATE 3-H R
|
Facility
IP
|
$5,040.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.00 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,354.56
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
|
