|
HC CT HEAD SCAN W/O CONTRAST
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
1660450
|
|
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 |
$1,040.40
|
| 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 HEAD SCAN W/WO CONTRAST
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
1660470
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.17
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Centivo All Commercial |
$1,636.90
|
| 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 |
$962.88
|
| Rate for Payer: Lucent All Commercial |
$1,636.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$97.02
|
| Rate for Payer: MDWise Medicaid |
$97.02
|
| 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 |
$962.88
|
|
|
HC CT HEAD SCAN W/WO CONTRAST
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
1660470
|
|
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 |
$1,805.40
|
| 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 HEART W/O CON (CALC SCORE)
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1660144
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna All Commercial |
$43.15
|
| Rate for Payer: CORVEL All Commercial |
$46.50
|
| Rate for Payer: Coventry All Commercial |
$44.00
|
| Rate for Payer: Encore All Commercial |
$46.02
|
| Rate for Payer: Frontpath All Commercial |
$46.00
|
| Rate for Payer: Humana ChoiceCare |
$43.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: PHCS All Commercial |
$37.50
|
| Rate for Payer: PHP All Commercial |
$37.92
|
| Rate for Payer: Sagamore Health Network All Products |
$38.60
|
| Rate for Payer: Signature Care EPO |
$41.50
|
| Rate for Payer: Signature Care PPO |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$39.40
|
|
|
HC CT HEART W/O CON (CALC SCORE)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1660144
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$53.92 |
| Rate for Payer: Aetna Commercial |
$42.20
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$53.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.60
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Centivo All Commercial |
$27.20
|
| Rate for Payer: Cigna All Commercial |
$43.15
|
| Rate for Payer: CORVEL All Commercial |
$46.50
|
| Rate for Payer: Coventry All Commercial |
$44.00
|
| Rate for Payer: Encore All Commercial |
$46.02
|
| Rate for Payer: Frontpath All Commercial |
$46.00
|
| Rate for Payer: Humana ChoiceCare |
$43.19
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Lucent All Commercial |
$27.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: Managed Health Services Medicaid |
$53.92
|
| Rate for Payer: MDWise Medicaid |
$53.92
|
| Rate for Payer: PHCS All Commercial |
$37.50
|
| Rate for Payer: PHP All Commercial |
$37.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.50
|
| Rate for Payer: Sagamore Health Network All Products |
$38.60
|
| Rate for Payer: Signature Care EPO |
$41.50
|
| Rate for Payer: Signature Care PPO |
$44.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.50
|
| Rate for Payer: United Healthcare Commercial |
$39.40
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
|
|
HC CT LIMITED SINUS WO CONTR
|
Facility
|
IP
|
$1,428.00
|
|
|
Service Code
|
CPT 70486 52
|
| Hospital Charge Code |
1660016
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$1,328.04 |
| Rate for Payer: Aetna Commercial |
$1,233.79
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna All Commercial |
$1,232.36
|
| Rate for Payer: CORVEL All Commercial |
$1,328.04
|
| Rate for Payer: Coventry All Commercial |
$1,256.64
|
| Rate for Payer: Encore All Commercial |
$1,314.47
|
| Rate for Payer: Frontpath All Commercial |
$1,313.76
|
| Rate for Payer: Humana ChoiceCare |
$1,233.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,285.20
|
| Rate for Payer: PHCS All Commercial |
$1,071.00
|
| Rate for Payer: PHP All Commercial |
$1,083.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,102.42
|
| Rate for Payer: Signature Care EPO |
$1,185.24
|
| Rate for Payer: Signature Care PPO |
$1,256.64
|
| Rate for Payer: United Healthcare Commercial |
$1,125.26
|
|
|
HC CT LIMITED SINUS WO CONTR
|
Facility
|
OP
|
$1,428.00
|
|
|
Service Code
|
CPT 70486 52
|
| Hospital Charge Code |
1660016
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$1,328.04 |
| Rate for Payer: Aetna Commercial |
$1,205.23
|
| Rate for Payer: Aetna Medicare |
$456.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$104.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.68
|
| 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 |
$104.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$525.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$502.66
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Centivo All Commercial |
$776.83
|
| Rate for Payer: Cigna All Commercial |
$1,232.36
|
| Rate for Payer: CORVEL All Commercial |
$1,328.04
|
| Rate for Payer: Coventry All Commercial |
$1,256.64
|
| Rate for Payer: Encore All Commercial |
$1,314.47
|
| Rate for Payer: Frontpath All Commercial |
$1,313.76
|
| Rate for Payer: Humana ChoiceCare |
$1,233.36
|
| Rate for Payer: Humana Medicare |
$456.96
|
| Rate for Payer: Lucent All Commercial |
$776.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,285.20
|
| Rate for Payer: Managed Health Services Medicaid |
$104.21
|
| Rate for Payer: MDWise Medicaid |
$104.21
|
| Rate for Payer: PHCS All Commercial |
$1,071.00
|
| Rate for Payer: PHP All Commercial |
$1,083.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$556.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,102.42
|
| Rate for Payer: Signature Care EPO |
$1,185.24
|
| Rate for Payer: Signature Care PPO |
$1,256.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,213.80
|
| Rate for Payer: United Healthcare Commercial |
$1,125.26
|
| Rate for Payer: United Healthcare Medicare |
$456.96
|
|
|
HC CT LOWER EXT W/CONTRAST BI
|
Facility
|
OP
|
$2,856.00
|
|
|
Service Code
|
CPT 73701 50
|
| Hospital Charge Code |
21663701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$124.02 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,410.46
|
| Rate for Payer: Aetna Medicare |
$913.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$885.36
|
| 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 |
$124.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,051.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,005.31
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Centivo All Commercial |
$1,553.66
|
| 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 |
$913.92
|
| Rate for Payer: Lucent All Commercial |
$1,553.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,570.40
|
| Rate for Payer: Managed Health Services Medicaid |
$124.02
|
| Rate for Payer: MDWise Medicaid |
$124.02
|
| 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 |
$913.92
|
|
|
HC CT LOWER EXT W/CONTRAST BI
|
Facility
|
IP
|
$2,856.00
|
|
|
Service Code
|
CPT 73701 50
|
| Hospital Charge Code |
21663701
|
|
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 |
$1,713.60
|
| 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 LOWER EXT W/CONTRAST LT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
1663701
|
|
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
|
|
|
HC CT LOWER EXT W/CONTRAST LT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
1663701
|
|
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 |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| 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 LOWER EXT W/CONTRAST RT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
11663701
|
|
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
|
|
|
HC CT LOWER EXT W/CONTRAST RT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
11663701
|
|
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 |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| 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 LOWER EXT W/O CONTRAST BI
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
CPT 73700 50
|
| Hospital Charge Code |
21663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Aetna Commercial |
$1,762.56
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cigna All Commercial |
$1,760.52
|
| Rate for Payer: CORVEL All Commercial |
$1,897.20
|
| Rate for Payer: Coventry All Commercial |
$1,795.20
|
| Rate for Payer: Encore All Commercial |
$1,877.82
|
| Rate for Payer: Frontpath All Commercial |
$1,876.80
|
| Rate for Payer: Humana ChoiceCare |
$1,761.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,836.00
|
| Rate for Payer: PHCS All Commercial |
$1,530.00
|
| Rate for Payer: PHP All Commercial |
$1,547.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.88
|
| Rate for Payer: Signature Care EPO |
$1,693.20
|
| Rate for Payer: Signature Care PPO |
$1,795.20
|
| Rate for Payer: United Healthcare Commercial |
$1,607.52
|
|
|
HC CT LOWER EXT W/O CONTRAST BI
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
CPT 73700 50
|
| Hospital Charge Code |
21663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Aetna Commercial |
$1,721.76
|
| Rate for Payer: Aetna Medicare |
$652.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.40
|
| 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 |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$718.08
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Centivo All Commercial |
$1,109.76
|
| Rate for Payer: Cigna All Commercial |
$1,760.52
|
| Rate for Payer: CORVEL All Commercial |
$1,897.20
|
| Rate for Payer: Coventry All Commercial |
$1,795.20
|
| Rate for Payer: Encore All Commercial |
$1,877.82
|
| Rate for Payer: Frontpath All Commercial |
$1,876.80
|
| Rate for Payer: Humana ChoiceCare |
$1,761.95
|
| Rate for Payer: Humana Medicare |
$652.80
|
| Rate for Payer: Lucent All Commercial |
$1,109.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,836.00
|
| Rate for Payer: Managed Health Services Medicaid |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| Rate for Payer: PHCS All Commercial |
$1,530.00
|
| Rate for Payer: PHP All Commercial |
$1,547.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.88
|
| Rate for Payer: Signature Care EPO |
$1,693.20
|
| Rate for Payer: Signature Care PPO |
$1,795.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,734.00
|
| Rate for Payer: United Healthcare Commercial |
$1,607.52
|
| Rate for Payer: United Healthcare Medicare |
$652.80
|
|
|
HC CT LOWER EXT W/O CONTRAST LT
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
1663700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| 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 |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$638.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$610.37
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Centivo All Commercial |
$943.30
|
| 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 |
$554.88
|
| Rate for Payer: Lucent All Commercial |
$943.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| 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 |
$554.88
|
|
|
HC CT LOWER EXT W/O CONTRAST LT
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
1663700
|
|
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 |
$1,040.40
|
| 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 |
$97.76 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| 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 |
$97.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$638.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$610.37
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Centivo All Commercial |
$943.30
|
| 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 |
$554.88
|
| Rate for Payer: Lucent All Commercial |
$943.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| 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 |
$554.88
|
|
|
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 |
$1,040.40
|
| 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/WO CONTRAST LT
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 73702 LT
|
| Hospital Charge Code |
1663702
|
|
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 |
$1,805.40
|
| 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 |
1663702
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$163.41 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$163.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$163.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.17
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Centivo All Commercial |
$1,636.90
|
| 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 |
$962.88
|
| Rate for Payer: Lucent All Commercial |
$1,636.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$163.41
|
| Rate for Payer: MDWise Medicaid |
$163.41
|
| 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 |
$962.88
|
|
|
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 |
$163.41 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$163.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$163.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.17
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Centivo All Commercial |
$1,636.90
|
| 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 |
$962.88
|
| Rate for Payer: Lucent All Commercial |
$1,636.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$163.41
|
| Rate for Payer: MDWise Medicaid |
$163.41
|
| 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 |
$962.88
|
|
|
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 |
$1,805.40
|
| 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
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
1662132
|
|
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
|
|
|
HC CT LUMBAR SPINE-STRGHT W/CON
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
1662132
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.53 |
| 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 |
$123.53
|
| 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 |
$123.53
|
| 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 |
$123.53
|
| Rate for Payer: MDWise Medicaid |
$123.53
|
| 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
|
|
