|
HC CTA HEART (CONGENITAL)
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
1660150
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$188.43 |
| Max. Negotiated Rate |
$926.28 |
| Rate for Payer: Aetna Commercial |
$840.62
|
| Rate for Payer: Aetna Medicare |
$318.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$188.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$308.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$572.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$622.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$188.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.59
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Centivo All Commercial |
$541.82
|
| Rate for Payer: Cigna All Commercial |
$859.55
|
| Rate for Payer: CORVEL All Commercial |
$926.28
|
| Rate for Payer: Coventry All Commercial |
$876.48
|
| Rate for Payer: Encore All Commercial |
$916.82
|
| Rate for Payer: Frontpath All Commercial |
$916.32
|
| Rate for Payer: Humana ChoiceCare |
$860.25
|
| Rate for Payer: Humana Medicare |
$318.72
|
| Rate for Payer: Lucent All Commercial |
$541.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$896.40
|
| Rate for Payer: Managed Health Services Medicaid |
$188.43
|
| Rate for Payer: MDWise Medicaid |
$188.43
|
| Rate for Payer: PHCS All Commercial |
$747.00
|
| Rate for Payer: PHP All Commercial |
$755.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.44
|
| Rate for Payer: Sagamore Health Network All Products |
$768.91
|
| Rate for Payer: Signature Care EPO |
$826.68
|
| Rate for Payer: Signature Care PPO |
$876.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$846.60
|
| Rate for Payer: United Healthcare Commercial |
$784.85
|
| Rate for Payer: United Healthcare Medicare |
$318.72
|
|
|
HC CTA HEART (COR/MORPH/CAL)
|
Facility
|
IP
|
$3,351.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
1660149
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,513.25 |
| Max. Negotiated Rate |
$3,116.43 |
| Rate for Payer: Aetna Commercial |
$2,895.26
|
| Rate for Payer: Cash Price |
$2,010.60
|
| Rate for Payer: Cigna All Commercial |
$2,891.91
|
| Rate for Payer: CORVEL All Commercial |
$3,116.43
|
| Rate for Payer: Coventry All Commercial |
$2,948.88
|
| Rate for Payer: Encore All Commercial |
$3,084.60
|
| Rate for Payer: Frontpath All Commercial |
$3,082.92
|
| Rate for Payer: Humana ChoiceCare |
$2,894.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,015.90
|
| Rate for Payer: PHCS All Commercial |
$2,513.25
|
| Rate for Payer: PHP All Commercial |
$2,541.40
|
| Rate for Payer: Sagamore Health Network All Products |
$2,586.97
|
| Rate for Payer: Signature Care EPO |
$2,781.33
|
| Rate for Payer: Signature Care PPO |
$2,948.88
|
| Rate for Payer: United Healthcare Commercial |
$2,640.59
|
|
|
HC CTA HEART (COR/MORPH/CAL)
|
Facility
|
OP
|
$3,351.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
1660149
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$210.47 |
| Max. Negotiated Rate |
$3,116.43 |
| Rate for Payer: Aetna Commercial |
$2,828.24
|
| Rate for Payer: Aetna Medicare |
$1,072.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$210.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,038.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,924.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,094.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$210.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,233.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,179.55
|
| Rate for Payer: Cash Price |
$2,010.60
|
| Rate for Payer: Cash Price |
$2,010.60
|
| Rate for Payer: Centivo All Commercial |
$1,822.94
|
| Rate for Payer: Cigna All Commercial |
$2,891.91
|
| Rate for Payer: CORVEL All Commercial |
$3,116.43
|
| Rate for Payer: Coventry All Commercial |
$2,948.88
|
| Rate for Payer: Encore All Commercial |
$3,084.60
|
| Rate for Payer: Frontpath All Commercial |
$3,082.92
|
| Rate for Payer: Humana ChoiceCare |
$2,894.26
|
| Rate for Payer: Humana Medicare |
$1,072.32
|
| Rate for Payer: Lucent All Commercial |
$1,822.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,015.90
|
| Rate for Payer: Managed Health Services Medicaid |
$210.47
|
| Rate for Payer: MDWise Medicaid |
$210.47
|
| Rate for Payer: PHCS All Commercial |
$2,513.25
|
| Rate for Payer: PHP All Commercial |
$2,541.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,306.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,586.97
|
| Rate for Payer: Signature Care EPO |
$2,781.33
|
| Rate for Payer: Signature Care PPO |
$2,948.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,848.35
|
| Rate for Payer: United Healthcare Commercial |
$2,640.59
|
| Rate for Payer: United Healthcare Medicare |
$1,072.32
|
|
|
HC CTA-LOWER EXTREMITY BILATERAL
|
Facility
|
OP
|
$4,564.50
|
|
|
Service Code
|
CPT 73706 50
|
| Hospital Charge Code |
21663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$193.63 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,852.44
|
| Rate for Payer: Aetna Medicare |
$1,460.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,414.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,621.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,853.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,679.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,606.70
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Centivo All Commercial |
$2,483.09
|
| 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 |
$1,460.64
|
| Rate for Payer: Lucent All Commercial |
$2,483.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,108.05
|
| Rate for Payer: Managed Health Services Medicaid |
$193.63
|
| Rate for Payer: MDWise Medicaid |
$193.63
|
| 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 |
$1,780.15
|
| Rate for Payer: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.53
|
| 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 |
$1,460.64
|
|
|
HC CTA-LOWER EXTREMITY BILATERAL
|
Facility
|
IP
|
$4,564.50
|
|
|
Service Code
|
CPT 73706 50
|
| Hospital Charge Code |
21663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,423.38 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,943.73
|
| Rate for Payer: Cash Price |
$2,738.70
|
| 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: 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: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.53
|
| Rate for Payer: Signature Care PPO |
$4,016.76
|
| Rate for Payer: United Healthcare Commercial |
$3,596.83
|
|
|
HC CTA-LOWER EXTREMITY LEFT
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
1663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$193.63 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$193.63
|
| Rate for Payer: MDWise Medicaid |
$193.63
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$897.60
|
|
|
HC CTA-LOWER EXTREMITY LEFT
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
1663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-LOWER EXTREMITY RIGHT
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
11663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$193.63 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$193.63
|
| Rate for Payer: MDWise Medicaid |
$193.63
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$897.60
|
|
|
HC CTA-LOWER EXTREMITY RIGHT
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
11663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-NECK
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
1660498
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$262.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$262.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$262.25
|
| Rate for Payer: MDWise Medicaid |
$262.25
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$897.60
|
|
|
HC CTA-NECK
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
1660498
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-PELVIS
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
1662191
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.50 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$207.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$207.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$207.50
|
| Rate for Payer: MDWise Medicaid |
$207.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$897.60
|
|
|
HC CTA-PELVIS
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
1662191
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-UPPER EXTREMITY LEFT
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
1663206
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$171.09 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$171.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$171.09
|
| Rate for Payer: MDWise Medicaid |
$171.09
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$897.60
|
|
|
HC CTA-UPPER EXTREMITY LEFT
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
1663206
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-UPPER EXTREMITY RIGHT
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
11663206
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-UPPER EXTREMITY RIGHT
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
11663206
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$171.09 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$171.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$171.09
|
| Rate for Payer: MDWise Medicaid |
$171.09
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$897.60
|
|
|
HC CT BIOPSY LIVER
|
Facility
|
IP
|
$2,936.07
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
1667000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,202.05 |
| Max. Negotiated Rate |
$2,730.55 |
| Rate for Payer: Aetna Commercial |
$2,536.76
|
| Rate for Payer: Cash Price |
$1,761.64
|
| Rate for Payer: Cigna All Commercial |
$2,533.83
|
| Rate for Payer: CORVEL All Commercial |
$2,730.55
|
| Rate for Payer: Coventry All Commercial |
$2,583.74
|
| Rate for Payer: Encore All Commercial |
$2,702.65
|
| Rate for Payer: Frontpath All Commercial |
$2,701.18
|
| Rate for Payer: Humana ChoiceCare |
$2,535.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,642.46
|
| Rate for Payer: PHCS All Commercial |
$2,202.05
|
| Rate for Payer: PHP All Commercial |
$2,226.72
|
| Rate for Payer: Sagamore Health Network All Products |
$2,266.65
|
| Rate for Payer: Signature Care EPO |
$2,436.94
|
| Rate for Payer: Signature Care PPO |
$2,583.74
|
| Rate for Payer: United Healthcare Commercial |
$2,313.62
|
|
|
HC CT BIOPSY LIVER
|
Facility
|
OP
|
$2,936.07
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
1667000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$910.18 |
| Max. Negotiated Rate |
$2,730.55 |
| Rate for Payer: Aetna Commercial |
$2,478.04
|
| Rate for Payer: Aetna Medicare |
$939.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,106.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$910.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,686.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,835.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,106.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,080.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,033.50
|
| Rate for Payer: Cash Price |
$1,761.64
|
| Rate for Payer: Cash Price |
$1,761.64
|
| Rate for Payer: Centivo All Commercial |
$1,597.22
|
| Rate for Payer: Cigna All Commercial |
$2,533.83
|
| Rate for Payer: CORVEL All Commercial |
$2,730.55
|
| Rate for Payer: Coventry All Commercial |
$2,583.74
|
| Rate for Payer: Encore All Commercial |
$2,702.65
|
| Rate for Payer: Frontpath All Commercial |
$2,701.18
|
| Rate for Payer: Humana ChoiceCare |
$2,535.88
|
| Rate for Payer: Humana Medicare |
$939.54
|
| Rate for Payer: Lucent All Commercial |
$1,597.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,642.46
|
| Rate for Payer: Managed Health Services Medicaid |
$1,106.60
|
| Rate for Payer: MDWise Medicaid |
$1,106.60
|
| Rate for Payer: PHCS All Commercial |
$2,202.05
|
| Rate for Payer: PHP All Commercial |
$2,226.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,145.07
|
| Rate for Payer: Sagamore Health Network All Products |
$2,266.65
|
| Rate for Payer: Signature Care EPO |
$2,436.94
|
| Rate for Payer: Signature Care PPO |
$2,583.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,495.66
|
| Rate for Payer: United Healthcare Commercial |
$2,313.62
|
| Rate for Payer: United Healthcare Medicare |
$939.54
|
|
|
HC CT BIOPSY - UNLISTED
|
Facility
|
IP
|
$1,083.43
|
|
| Hospital Charge Code |
1669000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.57 |
| Max. Negotiated Rate |
$1,007.59 |
| Rate for Payer: Aetna Commercial |
$936.08
|
| Rate for Payer: Cash Price |
$650.06
|
| Rate for Payer: Cigna All Commercial |
$935.00
|
| Rate for Payer: CORVEL All Commercial |
$1,007.59
|
| Rate for Payer: Coventry All Commercial |
$953.42
|
| Rate for Payer: Encore All Commercial |
$997.30
|
| Rate for Payer: Frontpath All Commercial |
$996.76
|
| Rate for Payer: Humana ChoiceCare |
$935.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.09
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Sagamore Health Network All Products |
$836.41
|
| Rate for Payer: Signature Care EPO |
$899.25
|
| Rate for Payer: Signature Care PPO |
$953.42
|
| Rate for Payer: United Healthcare Commercial |
$853.74
|
|
|
HC CT BIOPSY - UNLISTED
|
Facility
|
OP
|
$1,083.43
|
|
| Hospital Charge Code |
1669000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.86 |
| Max. Negotiated Rate |
$1,007.59 |
| Rate for Payer: Aetna Commercial |
$914.41
|
| Rate for Payer: Aetna Medicare |
$346.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$335.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$622.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$677.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$381.37
|
| Rate for Payer: Cash Price |
$650.06
|
| Rate for Payer: Centivo All Commercial |
$589.39
|
| Rate for Payer: Cigna All Commercial |
$935.00
|
| Rate for Payer: CORVEL All Commercial |
$1,007.59
|
| Rate for Payer: Coventry All Commercial |
$953.42
|
| Rate for Payer: Encore All Commercial |
$997.30
|
| Rate for Payer: Frontpath All Commercial |
$996.76
|
| Rate for Payer: Humana ChoiceCare |
$935.76
|
| Rate for Payer: Humana Medicare |
$346.70
|
| Rate for Payer: Lucent All Commercial |
$589.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$975.09
|
| Rate for Payer: PHCS All Commercial |
$812.57
|
| Rate for Payer: PHP All Commercial |
$821.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$422.54
|
| Rate for Payer: Sagamore Health Network All Products |
$836.41
|
| Rate for Payer: Signature Care EPO |
$899.25
|
| Rate for Payer: Signature Care PPO |
$953.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$920.92
|
| Rate for Payer: United Healthcare Commercial |
$853.74
|
| Rate for Payer: United Healthcare Medicare |
$346.70
|
|
|
HC CT BX PERC NDL ABD/PERIT MASS
|
Facility
|
OP
|
$2,830.50
|
|
| Hospital Charge Code |
1669180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$877.46 |
| Max. Negotiated Rate |
$2,632.36 |
| Rate for Payer: Aetna Commercial |
$2,388.94
|
| Rate for Payer: Aetna Medicare |
$905.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$877.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,625.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,769.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,041.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$996.34
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Centivo All Commercial |
$1,539.79
|
| Rate for Payer: Cigna All Commercial |
$2,442.72
|
| Rate for Payer: CORVEL All Commercial |
$2,632.36
|
| Rate for Payer: Coventry All Commercial |
$2,490.84
|
| Rate for Payer: Encore All Commercial |
$2,605.48
|
| Rate for Payer: Frontpath All Commercial |
$2,604.06
|
| Rate for Payer: Humana ChoiceCare |
$2,444.70
|
| Rate for Payer: Humana Medicare |
$905.76
|
| Rate for Payer: Lucent All Commercial |
$1,539.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,547.45
|
| Rate for Payer: PHCS All Commercial |
$2,122.88
|
| Rate for Payer: PHP All Commercial |
$2,146.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,103.89
|
| Rate for Payer: Sagamore Health Network All Products |
$2,185.15
|
| Rate for Payer: Signature Care EPO |
$2,349.32
|
| Rate for Payer: Signature Care PPO |
$2,490.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,405.93
|
| Rate for Payer: United Healthcare Commercial |
$2,230.43
|
| Rate for Payer: United Healthcare Medicare |
$905.76
|
|
|
HC CT BX PERC NDL ABD/PERIT MASS
|
Facility
|
IP
|
$2,830.50
|
|
| Hospital Charge Code |
1669180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,122.88 |
| Max. Negotiated Rate |
$2,632.36 |
| Rate for Payer: Aetna Commercial |
$2,445.55
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cigna All Commercial |
$2,442.72
|
| Rate for Payer: CORVEL All Commercial |
$2,632.36
|
| Rate for Payer: Coventry All Commercial |
$2,490.84
|
| Rate for Payer: Encore All Commercial |
$2,605.48
|
| Rate for Payer: Frontpath All Commercial |
$2,604.06
|
| Rate for Payer: Humana ChoiceCare |
$2,444.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,547.45
|
| Rate for Payer: PHCS All Commercial |
$2,122.88
|
| Rate for Payer: PHP All Commercial |
$2,146.65
|
| Rate for Payer: Sagamore Health Network All Products |
$2,185.15
|
| Rate for Payer: Signature Care EPO |
$2,349.32
|
| Rate for Payer: Signature Care PPO |
$2,490.84
|
| Rate for Payer: United Healthcare Commercial |
$2,230.43
|
|
|
HC CT CERVICAL SPINE W/CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
1662126
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$124.02 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$124.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| 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 |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$124.02
|
| Rate for Payer: MDWise Medicaid |
$124.02
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| 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 |
$652.47
|
|
|
HC CT CERVICAL SPINE W/CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
1662126
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| 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 |
$1,529.23
|
| 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
|
|
