|
HC ACU POST LAT FIB PLATE 3-H R
|
Facility
OP
|
$5,040.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602777
|
|
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 4-H L
|
Facility
OP
|
$5,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,329.72
|
| Rate for Payer: Aetna Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,946.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,206.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,946.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,862.19
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Centivo All Commercial |
$2,616.30
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Humana Medicare |
$2,616.30
|
| Rate for Payer: Lucent All Commercial |
$2,616.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,000.70
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,360.50
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
| Rate for Payer: United Healthcare Medicare |
$1,692.90
|
|
|
HC ACU POST LAT FIB PLATE 4-H L
|
Facility
IP
|
$5,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.50 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,432.32
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
|
|
HC ACU POST LAT FIB PLATE 4-H R
|
Facility
OP
|
$5,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,329.72
|
| Rate for Payer: Aetna Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,692.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,946.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,206.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,946.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,862.19
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Centivo All Commercial |
$2,616.30
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Humana Medicare |
$2,616.30
|
| Rate for Payer: Lucent All Commercial |
$2,616.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,000.70
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,360.50
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
| Rate for Payer: United Healthcare Medicare |
$1,692.90
|
|
|
HC ACU POST LAT FIB PLATE 4-H R
|
Facility
IP
|
$5,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.50 |
| Max. Negotiated Rate |
$4,770.90 |
| Rate for Payer: Aetna Commercial |
$4,432.32
|
| Rate for Payer: Cash Price |
$3,180.60
|
| Rate for Payer: Cigna All Commercial |
$4,427.19
|
| Rate for Payer: CORVEL All Commercial |
$4,770.90
|
| Rate for Payer: Coventry All Commercial |
$4,514.40
|
| Rate for Payer: Encore All Commercial |
$4,722.16
|
| Rate for Payer: Frontpath All Commercial |
$4,719.60
|
| Rate for Payer: Humana ChoiceCare |
$4,430.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,617.00
|
| Rate for Payer: PHCS All Commercial |
$3,847.50
|
| Rate for Payer: PHP All Commercial |
$3,890.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,960.36
|
| Rate for Payer: Signature Care EPO |
$4,257.90
|
| Rate for Payer: Signature Care PPO |
$4,514.40
|
| Rate for Payer: United Healthcare Commercial |
$4,042.44
|
|
|
HC ACU POST LAT FIB PLATE 5-H L
|
Facility
IP
|
$5,220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602780
|
|
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 POST LAT FIB PLATE 5-H L
|
Facility
OP
|
$5,220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602780
|
|
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 POST LAT FIB PLATE 5-H R
|
Facility
OP
|
$5,220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602781
|
|
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 POST LAT FIB PLATE 5-H R
|
Facility
IP
|
$5,220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602781
|
|
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 POST LAT FIB PLATE 6-H L
|
Facility
OP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602782
|
|
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 POST LAT FIB PLATE 6-H L
|
Facility
IP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602782
|
|
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 POST LAT FIB PLATE 6-H R
|
Facility
IP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602783
|
|
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 POST LAT FIB PLATE 6-H R
|
Facility
OP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602783
|
|
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 POST LAT FIB PLATE 7-H L
|
Facility
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602784
|
|
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 POST LAT FIB PLATE 7-H L
|
Facility
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602784
|
|
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 POST LAT FIB PLATE 7-H R
|
Facility
OP
|
$3,564.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,314.52 |
| Rate for Payer: Aetna Commercial |
$3,008.02
|
| Rate for Payer: Aetna Medicare |
$1,176.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,176.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,046.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,227.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,352.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,293.73
|
| Rate for Payer: Cash Price |
$2,209.68
|
| Rate for Payer: Cash Price |
$2,209.68
|
| Rate for Payer: Centivo All Commercial |
$1,817.64
|
| Rate for Payer: Cigna All Commercial |
$3,075.73
|
| Rate for Payer: CORVEL All Commercial |
$3,314.52
|
| Rate for Payer: Coventry All Commercial |
$3,136.32
|
| Rate for Payer: Encore All Commercial |
$3,280.66
|
| Rate for Payer: Frontpath All Commercial |
$3,278.88
|
| Rate for Payer: Humana ChoiceCare |
$3,078.23
|
| Rate for Payer: Humana Medicare |
$1,817.64
|
| Rate for Payer: Lucent All Commercial |
$1,817.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,207.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,673.00
|
| Rate for Payer: PHP All Commercial |
$2,702.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,389.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,751.41
|
| Rate for Payer: Signature Care EPO |
$2,958.12
|
| Rate for Payer: Signature Care PPO |
$3,136.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,029.40
|
| Rate for Payer: United Healthcare Commercial |
$2,808.43
|
| Rate for Payer: United Healthcare Medicare |
$1,176.12
|
|
|
HC ACU POST LAT FIB PLATE 7-H R
|
Facility
IP
|
$3,564.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$3,314.52 |
| Rate for Payer: Aetna Commercial |
$3,079.30
|
| Rate for Payer: Cash Price |
$2,209.68
|
| Rate for Payer: Cigna All Commercial |
$3,075.73
|
| Rate for Payer: CORVEL All Commercial |
$3,314.52
|
| Rate for Payer: Coventry All Commercial |
$3,136.32
|
| Rate for Payer: Encore All Commercial |
$3,280.66
|
| Rate for Payer: Frontpath All Commercial |
$3,278.88
|
| Rate for Payer: Humana ChoiceCare |
$3,078.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,207.60
|
| Rate for Payer: PHCS All Commercial |
$2,673.00
|
| Rate for Payer: PHP All Commercial |
$2,702.94
|
| Rate for Payer: Sagamore Health Network All Products |
$2,751.41
|
| Rate for Payer: Signature Care EPO |
$2,958.12
|
| Rate for Payer: Signature Care PPO |
$3,136.32
|
| Rate for Payer: United Healthcare Commercial |
$2,808.43
|
|
|
HC ACU POST MED DIS TIB PLT 3H L
|
Facility
OP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602790
|
|
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 MED DIS TIB PLT 3H L
|
Facility
IP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602790
|
|
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 MED DIS TIB PLT 3H R
|
Facility
OP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602791
|
|
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 MED DIS TIB PLT 3H R
|
Facility
IP
|
$3,960.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602791
|
|
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 RADIAL HEAD 22.0 LEFT
|
Facility
IP
|
$11,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,707.50 |
| Max. Negotiated Rate |
$10,797.30 |
| Rate for Payer: Aetna Commercial |
$10,031.04
|
| Rate for Payer: Cash Price |
$7,198.20
|
| Rate for Payer: Cigna All Commercial |
$10,019.43
|
| Rate for Payer: CORVEL All Commercial |
$10,797.30
|
| Rate for Payer: Coventry All Commercial |
$10,216.80
|
| Rate for Payer: Encore All Commercial |
$10,687.00
|
| Rate for Payer: Frontpath All Commercial |
$10,681.20
|
| Rate for Payer: Humana ChoiceCare |
$10,027.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,449.00
|
| Rate for Payer: PHCS All Commercial |
$8,707.50
|
| Rate for Payer: PHP All Commercial |
$8,805.02
|
| Rate for Payer: Sagamore Health Network All Products |
$8,962.92
|
| Rate for Payer: Signature Care EPO |
$9,636.30
|
| Rate for Payer: Signature Care PPO |
$10,216.80
|
| Rate for Payer: United Healthcare Commercial |
$9,148.68
|
|
|
HC ACU RADIAL HEAD 22.0 LEFT
|
Facility
OP
|
$11,610.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,797.30 |
| Rate for Payer: Aetna Commercial |
$9,798.84
|
| Rate for Payer: Aetna Medicare |
$3,831.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,831.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,667.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,257.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,406.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,214.43
|
| Rate for Payer: Cash Price |
$7,198.20
|
| Rate for Payer: Cash Price |
$7,198.20
|
| Rate for Payer: Centivo All Commercial |
$5,921.10
|
| Rate for Payer: Cigna All Commercial |
$10,019.43
|
| Rate for Payer: CORVEL All Commercial |
$10,797.30
|
| Rate for Payer: Coventry All Commercial |
$10,216.80
|
| Rate for Payer: Encore All Commercial |
$10,687.00
|
| Rate for Payer: Frontpath All Commercial |
$10,681.20
|
| Rate for Payer: Humana ChoiceCare |
$10,027.56
|
| Rate for Payer: Humana Medicare |
$5,921.10
|
| Rate for Payer: Lucent All Commercial |
$5,921.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,449.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,707.50
|
| Rate for Payer: PHP All Commercial |
$8,805.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,527.90
|
| Rate for Payer: Sagamore Health Network All Products |
$8,962.92
|
| Rate for Payer: Signature Care EPO |
$9,636.30
|
| Rate for Payer: Signature Care PPO |
$10,216.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,868.50
|
| Rate for Payer: United Healthcare Commercial |
$9,148.68
|
| Rate for Payer: United Healthcare Medicare |
$3,831.30
|
|
|
HC ACU RADIAL STEM 9.0X0.00
|
Facility
IP
|
$7,070.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,302.80 |
| Max. Negotiated Rate |
$6,575.47 |
| Rate for Payer: Aetna Commercial |
$6,108.83
|
| Rate for Payer: Cash Price |
$4,383.65
|
| Rate for Payer: Cigna All Commercial |
$6,101.76
|
| Rate for Payer: CORVEL All Commercial |
$6,575.47
|
| Rate for Payer: Coventry All Commercial |
$6,221.95
|
| Rate for Payer: Encore All Commercial |
$6,508.30
|
| Rate for Payer: Frontpath All Commercial |
$6,504.77
|
| Rate for Payer: Humana ChoiceCare |
$6,106.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,363.36
|
| Rate for Payer: PHCS All Commercial |
$5,302.80
|
| Rate for Payer: PHP All Commercial |
$5,362.19
|
| Rate for Payer: Sagamore Health Network All Products |
$5,458.35
|
| Rate for Payer: Signature Care EPO |
$5,868.43
|
| Rate for Payer: Signature Care PPO |
$6,221.95
|
| Rate for Payer: United Healthcare Commercial |
$5,571.48
|
|
|
HC ACU RADIAL STEM 9.0X0.00
|
Facility
OP
|
$7,070.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,575.47 |
| Rate for Payer: Aetna Commercial |
$5,967.42
|
| Rate for Payer: Aetna Medicare |
$2,333.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,333.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,060.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,419.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,683.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,566.56
|
| Rate for Payer: Cash Price |
$4,383.65
|
| Rate for Payer: Cash Price |
$4,383.65
|
| Rate for Payer: Centivo All Commercial |
$3,605.90
|
| Rate for Payer: Cigna All Commercial |
$6,101.76
|
| Rate for Payer: CORVEL All Commercial |
$6,575.47
|
| Rate for Payer: Coventry All Commercial |
$6,221.95
|
| Rate for Payer: Encore All Commercial |
$6,508.30
|
| Rate for Payer: Frontpath All Commercial |
$6,504.77
|
| Rate for Payer: Humana ChoiceCare |
$6,106.70
|
| Rate for Payer: Humana Medicare |
$3,605.90
|
| Rate for Payer: Lucent All Commercial |
$3,605.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,363.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,302.80
|
| Rate for Payer: PHP All Commercial |
$5,362.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,757.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5,458.35
|
| Rate for Payer: Signature Care EPO |
$5,868.43
|
| Rate for Payer: Signature Care PPO |
$6,221.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,009.84
|
| Rate for Payer: United Healthcare Commercial |
$5,571.48
|
| Rate for Payer: United Healthcare Medicare |
$2,333.23
|
|
