|
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
|
|
|
HC CT ORBIT W/CONTRAST
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
01660481
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$606.37 |
| 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 |
$606.37
|
| 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 |
$606.37
|
| Rate for Payer: MDWise Medicaid |
$606.37
|
| 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 ORBIT W/CONTRAST
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
01660481
|
|
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 ORBIT W/O CONTRAST
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
01660480
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$507.86 |
| 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 |
$507.86
|
| 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 |
$507.86
|
| Rate for Payer: MDWise Medicaid |
$507.86
|
| 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 ORBIT W/O CONTRAST
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
01660480
|
|
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 ORBIT W/WO CONTRAST
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
01660482
|
|
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 ORBIT W/WO CONTRAST
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
01660482
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$681.72 |
| 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 |
$681.72
|
| 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 |
$681.72
|
| Rate for Payer: MDWise Medicaid |
$681.72
|
| 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 PELVIS W/CONTRAST
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
01662193
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.79 |
| 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 |
$480.79
|
| 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 |
$480.79
|
| Rate for Payer: MDWise Medicaid |
$480.79
|
| 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 PELVIS W/CONTRAST
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
01662193
|
|
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 PELVIS W/O CONTRAST
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
01662192
|
|
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 PELVIS W/O CONTRAST
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
01662192
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$262.47 |
| 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 |
$262.47
|
| 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 |
$262.47
|
| Rate for Payer: MDWise Medicaid |
$262.47
|
| 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 PELVIS W/WO CONTRAST
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
01662194
|
|
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 PELVIS W/WO CONTRAST
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
01662194
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$583.21 |
| 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 |
$583.21
|
| 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 |
$583.21
|
| Rate for Payer: MDWise Medicaid |
$583.21
|
| 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 C TRACHOMATIS-AMP PROBE
|
Facility
OP
|
$138.74
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$129.03 |
| Rate for Payer: Aetna Commercial |
$117.10
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.36
|
| Rate for Payer: Cash Price |
$86.02
|
| Rate for Payer: Cash Price |
$86.02
|
| Rate for Payer: Centivo All Commercial |
$70.76
|
| Rate for Payer: Cigna All Commercial |
$119.73
|
| Rate for Payer: CORVEL All Commercial |
$129.03
|
| Rate for Payer: Coventry All Commercial |
$122.09
|
| Rate for Payer: Encore All Commercial |
$127.71
|
| Rate for Payer: Frontpath All Commercial |
$127.64
|
| Rate for Payer: Humana ChoiceCare |
$119.83
|
| Rate for Payer: Humana Medicare |
$70.76
|
| Rate for Payer: Lucent All Commercial |
$70.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.87
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$104.06
|
| Rate for Payer: PHP All Commercial |
$105.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.11
|
| Rate for Payer: Sagamore Health Network All Products |
$107.11
|
| Rate for Payer: Signature Care EPO |
$115.15
|
| Rate for Payer: Signature Care PPO |
$122.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.93
|
| Rate for Payer: United Healthcare Commercial |
$109.33
|
| Rate for Payer: United Healthcare Medicare |
$45.78
|
|
|
HC C TRACHOMATIS-AMP PROBE
|
Facility
IP
|
$138.74
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
63002034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$129.03 |
| Rate for Payer: Aetna Commercial |
$119.87
|
| Rate for Payer: Cash Price |
$86.02
|
| Rate for Payer: Cigna All Commercial |
$119.73
|
| Rate for Payer: CORVEL All Commercial |
$129.03
|
| Rate for Payer: Coventry All Commercial |
$122.09
|
| Rate for Payer: Encore All Commercial |
$127.71
|
| Rate for Payer: Frontpath All Commercial |
$127.64
|
| Rate for Payer: Humana ChoiceCare |
$119.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.87
|
| Rate for Payer: PHCS All Commercial |
$104.06
|
| Rate for Payer: PHP All Commercial |
$105.22
|
| Rate for Payer: Sagamore Health Network All Products |
$107.11
|
| Rate for Payer: Signature Care EPO |
$115.15
|
| Rate for Payer: Signature Care PPO |
$122.09
|
| Rate for Payer: United Healthcare Commercial |
$109.33
|
|
|
HC CT THORACIC SPINE W/CONTRAST
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
01662129
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$483.68 |
| 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 |
$483.68
|
| 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 |
$483.68
|
| Rate for Payer: MDWise Medicaid |
$483.68
|
| 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 THORACIC SPINE W/CONTRAST
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
01662129
|
|
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 THORACIC SPINE W/O CONTRAST
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
01662149
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$384.19 |
| 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 |
$384.19
|
| 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 |
$384.19
|
| Rate for Payer: MDWise Medicaid |
$384.19
|
| 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 THORACIC SPINE W/O CONTRAST
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
01662149
|
|
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 THORACIC SPINE W/WO CONTRST
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
01662130
|
|
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 THORACIC SPINE W/WO CONTRST
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
01662130
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$610.23 |
| 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 |
$610.23
|
| 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 |
$610.23
|
| Rate for Payer: MDWise Medicaid |
$610.23
|
| 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 UPPER EXT W/CONTRAST BI
|
Facility
IP
|
$2,856.00
|
|
|
Service Code
|
CPT 73201 50
|
| Hospital Charge Code |
21663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,142.00 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,467.58
|
| Rate for Payer: Cash Price |
$1,770.72
|
| Rate for Payer: Cigna All Commercial |
$2,464.73
|
| Rate for Payer: CORVEL All Commercial |
$2,656.08
|
| Rate for Payer: Coventry All Commercial |
$2,513.28
|
| Rate for Payer: Encore All Commercial |
$2,628.95
|
| Rate for Payer: Frontpath All Commercial |
$2,627.52
|
| Rate for Payer: Humana ChoiceCare |
$2,466.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,570.40
|
| Rate for Payer: PHCS All Commercial |
$2,142.00
|
| Rate for Payer: PHP All Commercial |
$2,165.99
|
| Rate for Payer: Sagamore Health Network All Products |
$2,204.83
|
| Rate for Payer: Signature Care EPO |
$2,370.48
|
| Rate for Payer: Signature Care PPO |
$2,513.28
|
| Rate for Payer: United Healthcare Commercial |
$2,250.53
|
|
|
HC CT UPPER EXT W/CONTRAST BI
|
Facility
OP
|
$2,856.00
|
|
|
Service Code
|
CPT 73201 50
|
| Hospital Charge Code |
21663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.48 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,410.46
|
| Rate for Payer: Aetna Medicare |
$942.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$942.48
|
| 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 |
$1,083.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,036.73
|
| Rate for Payer: Cash Price |
$1,770.72
|
| Rate for Payer: Cash Price |
$1,770.72
|
| Rate for Payer: Centivo All Commercial |
$1,456.56
|
| Rate for Payer: Cigna All Commercial |
$2,464.73
|
| Rate for Payer: CORVEL All Commercial |
$2,656.08
|
| Rate for Payer: Coventry All Commercial |
$2,513.28
|
| Rate for Payer: Encore All Commercial |
$2,628.95
|
| Rate for Payer: Frontpath All Commercial |
$2,627.52
|
| Rate for Payer: Humana ChoiceCare |
$2,466.73
|
| Rate for Payer: Humana Medicare |
$1,456.56
|
| Rate for Payer: Lucent All Commercial |
$1,456.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,570.40
|
| Rate for Payer: PHCS All Commercial |
$2,142.00
|
| Rate for Payer: PHP All Commercial |
$2,165.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,113.84
|
| Rate for Payer: Sagamore Health Network All Products |
$2,204.83
|
| Rate for Payer: Signature Care EPO |
$2,370.48
|
| Rate for Payer: Signature Care PPO |
$2,513.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,427.60
|
| Rate for Payer: United Healthcare Commercial |
$2,250.53
|
| Rate for Payer: United Healthcare Medicare |
$942.48
|
|
|
HC CT UPPER EXT W/CONTRAST LT
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
01663201
|
|
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 UPPER EXT W/CONTRAST LT
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
01663201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$672.86 |
| 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 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: 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
|
|
