|
HC CT LOWER EXT W/O CONTRAST LT
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
01663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT LOWER EXT W/O CONTRAST LT
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
01663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT LOWER EXT W/O CONTRAST RT
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
11663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT LOWER EXT W/O CONTRAST RT
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
11663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT LOWER EXT W/WO CONTRAST LT
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 73702 LT
|
| Hospital Charge Code |
01663702
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT LOWER EXT W/WO CONTRAST LT
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 73702 LT
|
| Hospital Charge Code |
01663702
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$992.97 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
|
HC CT LOWER EXT W/WO CONTRAST RT
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 73702 RT
|
| Hospital Charge Code |
11663702
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$992.97 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
|
HC CT LOWER EXT W/WO CONTRAST RT
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 73702 RT
|
| Hospital Charge Code |
11663702
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT LUMBAR SPINE-STRGHT W/CON
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
01662132
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$481.77 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$481.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.15
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Centivo All Commercial |
$1,039.88
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$1,039.88
|
| Rate for Payer: Lucent All Commercial |
$1,039.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$481.77
|
| Rate for Payer: MDWise Medicaid |
$481.77
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$672.86
|
|
|
HC CT LUMBAR SPINE-STRGHT W/CON
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
01662132
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT LUMBAR SPINE-STRGHT W/O CON
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
01662146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT LUMBAR SPINE-STRGHT W/O CON
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
01662146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$382.24 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$382.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$382.24
|
| Rate for Payer: MDWise Medicaid |
$382.24
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT LUMBAR SPINE-STRT W/WO CON
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
01662133
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT LUMBAR SPINE-STRT W/WO CON
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
01662133
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$602.51 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$602.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$602.51
|
| Rate for Payer: MDWise Medicaid |
$602.51
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
|
HC CT NECK W/CONTRAST
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
01660465
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$478.84 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$478.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.15
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Centivo All Commercial |
$1,039.88
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$1,039.88
|
| Rate for Payer: Lucent All Commercial |
$1,039.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$478.84
|
| Rate for Payer: MDWise Medicaid |
$478.84
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$672.86
|
|
|
HC CT NECK W/CONTRAST
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
01660465
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT NECK W/O CONTRAST
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
01660455
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$381.26 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$381.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$381.26
|
| Rate for Payer: MDWise Medicaid |
$381.26
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT NECK W/O CONTRAST
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
01660455
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT NECK W/WO CONTRAST
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
01660475
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT NECK W/WO CONTRAST
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
01660475
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$594.79 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$594.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$594.79
|
| Rate for Payer: MDWise Medicaid |
$594.79
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
|
HC CT - ORBIT SELLA MID/INNER EAR W CONTR BIL
|
Facility
IP
|
$3,570.00
|
|
|
Service Code
|
CPT 70481 50
|
| Hospital Charge Code |
21660481
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,677.50 |
| Max. Negotiated Rate |
$3,320.10 |
| Rate for Payer: Aetna Commercial |
$3,084.48
|
| Rate for Payer: Cash Price |
$2,213.40
|
| Rate for Payer: Cigna All Commercial |
$3,080.91
|
| Rate for Payer: CORVEL All Commercial |
$3,320.10
|
| Rate for Payer: Coventry All Commercial |
$3,141.60
|
| Rate for Payer: Encore All Commercial |
$3,286.18
|
| Rate for Payer: Frontpath All Commercial |
$3,284.40
|
| Rate for Payer: Humana ChoiceCare |
$3,083.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,213.00
|
| Rate for Payer: PHCS All Commercial |
$2,677.50
|
| Rate for Payer: PHP All Commercial |
$2,707.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2,756.04
|
| Rate for Payer: Signature Care EPO |
$2,963.10
|
| Rate for Payer: Signature Care PPO |
$3,141.60
|
| Rate for Payer: United Healthcare Commercial |
$2,813.16
|
|
|
HC CT - ORBIT SELLA MID/INNER EAR W CONTR BIL
|
Facility
OP
|
$3,570.00
|
|
|
Service Code
|
CPT 70481 50
|
| Hospital Charge Code |
21660481
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,177.00 |
| Max. Negotiated Rate |
$3,320.10 |
| Rate for Payer: Aetna Commercial |
$3,013.08
|
| Rate for Payer: Aetna Medicare |
$1,178.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,178.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,354.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,295.91
|
| Rate for Payer: Cash Price |
$2,213.40
|
| Rate for Payer: Cash Price |
$2,213.40
|
| Rate for Payer: Centivo All Commercial |
$1,820.70
|
| Rate for Payer: Cigna All Commercial |
$3,080.91
|
| Rate for Payer: CORVEL All Commercial |
$3,320.10
|
| Rate for Payer: Coventry All Commercial |
$3,141.60
|
| Rate for Payer: Encore All Commercial |
$3,286.18
|
| Rate for Payer: Frontpath All Commercial |
$3,284.40
|
| Rate for Payer: Humana ChoiceCare |
$3,083.41
|
| Rate for Payer: Humana Medicare |
$1,820.70
|
| Rate for Payer: Lucent All Commercial |
$1,820.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,213.00
|
| Rate for Payer: PHCS All Commercial |
$2,677.50
|
| Rate for Payer: PHP All Commercial |
$2,707.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,392.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,756.04
|
| Rate for Payer: Signature Care EPO |
$2,963.10
|
| Rate for Payer: Signature Care PPO |
$3,141.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,034.50
|
| Rate for Payer: United Healthcare Commercial |
$2,813.16
|
| Rate for Payer: United Healthcare Medicare |
$1,178.10
|
|
|
HC CT - ORBIT SELLA MID/INNER EAR WO CONT BIL
|
Facility
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 70480 50
|
| Hospital Charge Code |
21660480
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$875.16 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$875.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$875.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,006.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$962.68
|
| Rate for Payer: Cash Price |
$1,644.24
|
| Rate for Payer: Cash Price |
$1,644.24
|
| Rate for Payer: Centivo All Commercial |
$1,352.52
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$1,352.52
|
| Rate for Payer: Lucent All Commercial |
$1,352.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$875.16
|
|
|
HC CT - ORBIT SELLA MID/INNER EAR WO CONT BIL
|
Facility
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 70480 50
|
| Hospital Charge Code |
21660480
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,644.24
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC CT - ORBIT SELLA MID/INNER EAR W & WO BIL
|
Facility
OP
|
$4,564.50
|
|
|
Service Code
|
CPT 70482 50
|
| Hospital Charge Code |
21660482
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,506.28 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,852.44
|
| Rate for Payer: Aetna Medicare |
$1,506.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,506.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,621.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,853.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,732.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,656.91
|
| Rate for Payer: Cash Price |
$2,829.99
|
| Rate for Payer: Centivo All Commercial |
$2,327.90
|
| Rate for Payer: Cigna All Commercial |
$3,939.16
|
| Rate for Payer: CORVEL All Commercial |
$4,244.98
|
| Rate for Payer: Coventry All Commercial |
$4,016.76
|
| Rate for Payer: Encore All Commercial |
$4,201.62
|
| Rate for Payer: Frontpath All Commercial |
$4,199.34
|
| Rate for Payer: Humana ChoiceCare |
$3,942.36
|
| Rate for Payer: Humana Medicare |
$2,327.90
|
| Rate for Payer: Lucent All Commercial |
$2,327.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,108.05
|
| Rate for Payer: PHCS All Commercial |
$3,423.38
|
| Rate for Payer: PHP All Commercial |
$3,461.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,780.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.54
|
| Rate for Payer: Signature Care PPO |
$4,016.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,879.82
|
| Rate for Payer: United Healthcare Commercial |
$3,596.83
|
| Rate for Payer: United Healthcare Medicare |
$1,506.28
|
|
