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Service Code CPT 86708
Hospital Charge Code 63001956
Hospital Revenue Code 300
Min. Negotiated Rate $12.39
Max. Negotiated Rate $155.48
Rate for Payer: Aetna Commercial $141.10
Rate for Payer: Aetna Medicare $55.17
Rate for Payer: Anthem Blue Cross of IN Medicare $55.17
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $96.01
Rate for Payer: Anthem Blue Cross of IN Traditional $104.50
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $12.39
Rate for Payer: CareSource Indiana of IN Just 4 Me $63.44
Rate for Payer: CareSource Indiana of IN Medicare $60.69
Rate for Payer: Cash Price $103.65
Rate for Payer: Cash Price $103.65
Rate for Payer: Centivo All Commercial $85.26
Rate for Payer: Cigna All Commercial $144.27
Rate for Payer: CORVEL All Commercial $155.48
Rate for Payer: Coventry All Commercial $147.12
Rate for Payer: Encore All Commercial $153.89
Rate for Payer: Frontpath All Commercial $153.80
Rate for Payer: Humana ChoiceCare $144.39
Rate for Payer: Humana Medicare $85.26
Rate for Payer: Lucent All Commercial $85.26
Rate for Payer: Lutheran Preferred All Commercial $150.46
Rate for Payer: Managed Health Services Medicaid $12.39
Rate for Payer: MDWise Medicaid $12.39
Rate for Payer: PHCS All Commercial $125.38
Rate for Payer: PHP All Commercial $126.79
Rate for Payer: Plain Church Group Ministry All Commercial $65.20
Rate for Payer: Sagamore Health Network All Products $129.06
Rate for Payer: Signature Care EPO $138.76
Rate for Payer: Signature Care PPO $147.12
Rate for Payer: Three Rivers Preferred All Commercial $142.10
Rate for Payer: United Healthcare Commercial $131.74
Rate for Payer: United Healthcare Medicare $55.17
Service Code CPT 86708
Hospital Charge Code 63001956
Hospital Revenue Code 300
Min. Negotiated Rate $125.38
Max. Negotiated Rate $155.48
Rate for Payer: Aetna Commercial $144.44
Rate for Payer: Cash Price $103.65
Rate for Payer: Cigna All Commercial $144.27
Rate for Payer: CORVEL All Commercial $155.48
Rate for Payer: Coventry All Commercial $147.12
Rate for Payer: Encore All Commercial $153.89
Rate for Payer: Frontpath All Commercial $153.80
Rate for Payer: Humana ChoiceCare $144.39
Rate for Payer: Lutheran Preferred All Commercial $150.46
Rate for Payer: PHCS All Commercial $125.38
Rate for Payer: PHP All Commercial $126.79
Rate for Payer: Sagamore Health Network All Products $129.06
Rate for Payer: Signature Care EPO $138.76
Rate for Payer: Signature Care PPO $147.12
Rate for Payer: United Healthcare Commercial $131.74
Service Code CPT 86708
Hospital Charge Code 63001957
Hospital Revenue Code 300
Min. Negotiated Rate $12.39
Max. Negotiated Rate $155.48
Rate for Payer: Aetna Commercial $141.10
Rate for Payer: Aetna Medicare $55.17
Rate for Payer: Anthem Blue Cross of IN Medicare $55.17
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $96.01
Rate for Payer: Anthem Blue Cross of IN Traditional $104.50
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $12.39
Rate for Payer: CareSource Indiana of IN Just 4 Me $63.44
Rate for Payer: CareSource Indiana of IN Medicare $60.69
Rate for Payer: Cash Price $103.65
Rate for Payer: Cash Price $103.65
Rate for Payer: Centivo All Commercial $85.26
Rate for Payer: Cigna All Commercial $144.27
Rate for Payer: CORVEL All Commercial $155.48
Rate for Payer: Coventry All Commercial $147.12
Rate for Payer: Encore All Commercial $153.89
Rate for Payer: Frontpath All Commercial $153.80
Rate for Payer: Humana ChoiceCare $144.39
Rate for Payer: Humana Medicare $85.26
Rate for Payer: Lucent All Commercial $85.26
Rate for Payer: Lutheran Preferred All Commercial $150.46
Rate for Payer: Managed Health Services Medicaid $12.39
Rate for Payer: MDWise Medicaid $12.39
Rate for Payer: PHCS All Commercial $125.38
Rate for Payer: PHP All Commercial $126.79
Rate for Payer: Plain Church Group Ministry All Commercial $65.20
Rate for Payer: Sagamore Health Network All Products $129.06
Rate for Payer: Signature Care EPO $138.76
Rate for Payer: Signature Care PPO $147.12
Rate for Payer: Three Rivers Preferred All Commercial $142.10
Rate for Payer: United Healthcare Commercial $131.74
Rate for Payer: United Healthcare Medicare $55.17
Service Code CPT 86708
Hospital Charge Code 63001957
Hospital Revenue Code 300
Min. Negotiated Rate $125.38
Max. Negotiated Rate $155.48
Rate for Payer: Aetna Commercial $144.44
Rate for Payer: Cash Price $103.65
Rate for Payer: Cigna All Commercial $144.27
Rate for Payer: CORVEL All Commercial $155.48
Rate for Payer: Coventry All Commercial $147.12
Rate for Payer: Encore All Commercial $153.89
Rate for Payer: Frontpath All Commercial $153.80
Rate for Payer: Humana ChoiceCare $144.39
Rate for Payer: Lutheran Preferred All Commercial $150.46
Rate for Payer: PHCS All Commercial $125.38
Rate for Payer: PHP All Commercial $126.79
Rate for Payer: Sagamore Health Network All Products $129.06
Rate for Payer: Signature Care EPO $138.76
Rate for Payer: Signature Care PPO $147.12
Rate for Payer: United Healthcare Commercial $131.74
Service Code CPT 86705
Hospital Charge Code 63001336
Hospital Revenue Code 300
Min. Negotiated Rate $122.67
Max. Negotiated Rate $152.11
Rate for Payer: Aetna Commercial $141.31
Rate for Payer: Cash Price $101.41
Rate for Payer: Cigna All Commercial $141.15
Rate for Payer: CORVEL All Commercial $152.11
Rate for Payer: Coventry All Commercial $143.93
Rate for Payer: Encore All Commercial $150.55
Rate for Payer: Frontpath All Commercial $150.47
Rate for Payer: Humana ChoiceCare $141.26
Rate for Payer: Lutheran Preferred All Commercial $147.20
Rate for Payer: PHCS All Commercial $122.67
Rate for Payer: PHP All Commercial $124.04
Rate for Payer: Sagamore Health Network All Products $126.27
Rate for Payer: Signature Care EPO $135.75
Rate for Payer: Signature Care PPO $143.93
Rate for Payer: United Healthcare Commercial $128.88
Service Code CPT 86705
Hospital Charge Code 63001336
Hospital Revenue Code 300
Min. Negotiated Rate $11.77
Max. Negotiated Rate $152.11
Rate for Payer: Aetna Commercial $138.04
Rate for Payer: Aetna Medicare $53.97
Rate for Payer: Anthem Blue Cross of IN Medicare $53.97
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $75.17
Rate for Payer: Anthem Blue Cross of IN Traditional $75.17
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $11.77
Rate for Payer: CareSource Indiana of IN Just 4 Me $62.07
Rate for Payer: CareSource Indiana of IN Medicare $59.37
Rate for Payer: Cash Price $101.41
Rate for Payer: Cash Price $101.41
Rate for Payer: Centivo All Commercial $83.41
Rate for Payer: Cigna All Commercial $141.15
Rate for Payer: CORVEL All Commercial $152.11
Rate for Payer: Coventry All Commercial $143.93
Rate for Payer: Encore All Commercial $150.55
Rate for Payer: Frontpath All Commercial $150.47
Rate for Payer: Humana ChoiceCare $141.26
Rate for Payer: Humana Medicare $83.41
Rate for Payer: Lucent All Commercial $83.41
Rate for Payer: Lutheran Preferred All Commercial $147.20
Rate for Payer: Managed Health Services Medicaid $11.77
Rate for Payer: MDWise Medicaid $11.77
Rate for Payer: PHCS All Commercial $122.67
Rate for Payer: PHP All Commercial $124.04
Rate for Payer: Plain Church Group Ministry All Commercial $63.79
Rate for Payer: Sagamore Health Network All Products $126.27
Rate for Payer: Signature Care EPO $135.75
Rate for Payer: Signature Care PPO $143.93
Rate for Payer: Three Rivers Preferred All Commercial $139.02
Rate for Payer: United Healthcare Commercial $128.88
Rate for Payer: United Healthcare Medicare $53.97
Service Code CPT 86707
Hospital Charge Code 63001955
Hospital Revenue Code 300
Min. Negotiated Rate $6.32
Max. Negotiated Rate $159.13
Rate for Payer: Aetna Commercial $144.41
Rate for Payer: Aetna Medicare $56.46
Rate for Payer: Anthem Blue Cross of IN Medicare $56.46
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $98.27
Rate for Payer: Anthem Blue Cross of IN Traditional $106.96
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $6.32
Rate for Payer: CareSource Indiana of IN Just 4 Me $64.93
Rate for Payer: CareSource Indiana of IN Medicare $62.11
Rate for Payer: Cash Price $106.09
Rate for Payer: Cash Price $106.09
Rate for Payer: Centivo All Commercial $87.26
Rate for Payer: Cigna All Commercial $147.66
Rate for Payer: CORVEL All Commercial $159.13
Rate for Payer: Coventry All Commercial $150.57
Rate for Payer: Encore All Commercial $157.50
Rate for Payer: Frontpath All Commercial $157.42
Rate for Payer: Humana ChoiceCare $147.78
Rate for Payer: Humana Medicare $87.26
Rate for Payer: Lucent All Commercial $87.26
Rate for Payer: Lutheran Preferred All Commercial $153.99
Rate for Payer: Managed Health Services Medicaid $6.32
Rate for Payer: MDWise Medicaid $6.32
Rate for Payer: PHCS All Commercial $128.33
Rate for Payer: PHP All Commercial $129.77
Rate for Payer: Plain Church Group Ministry All Commercial $66.73
Rate for Payer: Sagamore Health Network All Products $132.09
Rate for Payer: Signature Care EPO $142.02
Rate for Payer: Signature Care PPO $150.57
Rate for Payer: Three Rivers Preferred All Commercial $145.44
Rate for Payer: United Healthcare Commercial $134.83
Rate for Payer: United Healthcare Medicare $56.46
Service Code CPT 86707
Hospital Charge Code 63001955
Hospital Revenue Code 300
Min. Negotiated Rate $128.33
Max. Negotiated Rate $159.13
Rate for Payer: Aetna Commercial $147.83
Rate for Payer: Cash Price $106.09
Rate for Payer: Cigna All Commercial $147.66
Rate for Payer: CORVEL All Commercial $159.13
Rate for Payer: Coventry All Commercial $150.57
Rate for Payer: Encore All Commercial $157.50
Rate for Payer: Frontpath All Commercial $157.42
Rate for Payer: Humana ChoiceCare $147.78
Rate for Payer: Lutheran Preferred All Commercial $153.99
Rate for Payer: PHCS All Commercial $128.33
Rate for Payer: PHP All Commercial $129.77
Rate for Payer: Sagamore Health Network All Products $132.09
Rate for Payer: Signature Care EPO $142.02
Rate for Payer: Signature Care PPO $150.57
Rate for Payer: United Healthcare Commercial $134.83
Service Code CPT 87350
Hospital Charge Code 63002030
Hospital Revenue Code 300
Min. Negotiated Rate $11.53
Max. Negotiated Rate $130.43
Rate for Payer: Aetna Commercial $118.37
Rate for Payer: Aetna Medicare $46.28
Rate for Payer: Anthem Blue Cross of IN Medicare $46.28
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $80.55
Rate for Payer: Anthem Blue Cross of IN Traditional $87.67
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $11.53
Rate for Payer: CareSource Indiana of IN Just 4 Me $53.22
Rate for Payer: CareSource Indiana of IN Medicare $50.91
Rate for Payer: Cash Price $86.96
Rate for Payer: Cash Price $86.96
Rate for Payer: Centivo All Commercial $71.53
Rate for Payer: Cigna All Commercial $121.04
Rate for Payer: CORVEL All Commercial $130.43
Rate for Payer: Coventry All Commercial $123.42
Rate for Payer: Encore All Commercial $129.10
Rate for Payer: Frontpath All Commercial $129.03
Rate for Payer: Humana ChoiceCare $121.13
Rate for Payer: Humana Medicare $71.53
Rate for Payer: Lucent All Commercial $71.53
Rate for Payer: Lutheran Preferred All Commercial $126.22
Rate for Payer: Managed Health Services Medicaid $11.53
Rate for Payer: MDWise Medicaid $11.53
Rate for Payer: PHCS All Commercial $105.19
Rate for Payer: PHP All Commercial $106.37
Rate for Payer: Plain Church Group Ministry All Commercial $54.70
Rate for Payer: Sagamore Health Network All Products $108.27
Rate for Payer: Signature Care EPO $116.41
Rate for Payer: Signature Care PPO $123.42
Rate for Payer: Three Rivers Preferred All Commercial $119.21
Rate for Payer: United Healthcare Commercial $110.52
Rate for Payer: United Healthcare Medicare $46.28
Service Code CPT 87350
Hospital Charge Code 63002030
Hospital Revenue Code 300
Min. Negotiated Rate $105.19
Max. Negotiated Rate $130.43
Rate for Payer: Aetna Commercial $121.18
Rate for Payer: Cash Price $86.96
Rate for Payer: Cigna All Commercial $121.04
Rate for Payer: CORVEL All Commercial $130.43
Rate for Payer: Coventry All Commercial $123.42
Rate for Payer: Encore All Commercial $129.10
Rate for Payer: Frontpath All Commercial $129.03
Rate for Payer: Humana ChoiceCare $121.13
Rate for Payer: Lutheran Preferred All Commercial $126.22
Rate for Payer: PHCS All Commercial $105.19
Rate for Payer: PHP All Commercial $106.37
Rate for Payer: Sagamore Health Network All Products $108.27
Rate for Payer: Signature Care EPO $116.41
Rate for Payer: Signature Care PPO $123.42
Rate for Payer: United Healthcare Commercial $110.52
Service Code CPT G0499
Hospital Charge Code 63001215
Hospital Revenue Code 300
Min. Negotiated Rate $116.13
Max. Negotiated Rate $144.00
Rate for Payer: Aetna Commercial $133.78
Rate for Payer: Cash Price $96.00
Rate for Payer: Cigna All Commercial $133.62
Rate for Payer: CORVEL All Commercial $144.00
Rate for Payer: Coventry All Commercial $136.26
Rate for Payer: Encore All Commercial $142.53
Rate for Payer: Frontpath All Commercial $142.45
Rate for Payer: Humana ChoiceCare $133.73
Rate for Payer: Lutheran Preferred All Commercial $139.35
Rate for Payer: PHCS All Commercial $116.13
Rate for Payer: PHP All Commercial $117.43
Rate for Payer: Sagamore Health Network All Products $119.53
Rate for Payer: Signature Care EPO $128.51
Rate for Payer: Signature Care PPO $136.26
Rate for Payer: United Healthcare Commercial $122.01
Service Code CPT G0499
Hospital Charge Code 63001215
Hospital Revenue Code 300
Min. Negotiated Rate $28.27
Max. Negotiated Rate $144.00
Rate for Payer: Aetna Commercial $130.68
Rate for Payer: Aetna Medicare $51.10
Rate for Payer: Anthem Blue Cross of IN Medicare $51.10
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $88.92
Rate for Payer: Anthem Blue Cross of IN Traditional $96.79
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $28.27
Rate for Payer: CareSource Indiana of IN Just 4 Me $58.76
Rate for Payer: CareSource Indiana of IN Medicare $56.21
Rate for Payer: Cash Price $96.00
Rate for Payer: Cash Price $96.00
Rate for Payer: Centivo All Commercial $78.97
Rate for Payer: Cigna All Commercial $133.62
Rate for Payer: CORVEL All Commercial $144.00
Rate for Payer: Coventry All Commercial $136.26
Rate for Payer: Encore All Commercial $142.53
Rate for Payer: Frontpath All Commercial $142.45
Rate for Payer: Humana ChoiceCare $133.73
Rate for Payer: Humana Medicare $78.97
Rate for Payer: Lucent All Commercial $78.97
Rate for Payer: Lutheran Preferred All Commercial $139.35
Rate for Payer: Managed Health Services Medicaid $28.27
Rate for Payer: MDWise Medicaid $28.27
Rate for Payer: PHCS All Commercial $116.13
Rate for Payer: PHP All Commercial $117.43
Rate for Payer: Plain Church Group Ministry All Commercial $60.39
Rate for Payer: Sagamore Health Network All Products $119.53
Rate for Payer: Signature Care EPO $128.51
Rate for Payer: Signature Care PPO $136.26
Rate for Payer: Three Rivers Preferred All Commercial $131.61
Rate for Payer: United Healthcare Commercial $122.01
Rate for Payer: United Healthcare Medicare $51.10
Service Code CPT 87517
Hospital Charge Code 63002039
Hospital Revenue Code 300
Min. Negotiated Rate $42.84
Max. Negotiated Rate $438.25
Rate for Payer: Aetna Commercial $397.73
Rate for Payer: Aetna Medicare $155.51
Rate for Payer: Anthem Blue Cross of IN Medicare $155.51
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $270.63
Rate for Payer: Anthem Blue Cross of IN Traditional $294.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $42.84
Rate for Payer: CareSource Indiana of IN Just 4 Me $178.84
Rate for Payer: CareSource Indiana of IN Medicare $171.06
Rate for Payer: Cash Price $292.17
Rate for Payer: Cash Price $292.17
Rate for Payer: Centivo All Commercial $240.33
Rate for Payer: Cigna All Commercial $406.68
Rate for Payer: CORVEL All Commercial $438.25
Rate for Payer: Coventry All Commercial $414.69
Rate for Payer: Encore All Commercial $433.78
Rate for Payer: Frontpath All Commercial $433.54
Rate for Payer: Humana ChoiceCare $407.01
Rate for Payer: Humana Medicare $240.33
Rate for Payer: Lucent All Commercial $240.33
Rate for Payer: Lutheran Preferred All Commercial $424.12
Rate for Payer: Managed Health Services Medicaid $42.84
Rate for Payer: MDWise Medicaid $42.84
Rate for Payer: PHCS All Commercial $353.43
Rate for Payer: PHP All Commercial $357.39
Rate for Payer: Plain Church Group Ministry All Commercial $183.78
Rate for Payer: Sagamore Health Network All Products $363.80
Rate for Payer: Signature Care EPO $391.13
Rate for Payer: Signature Care PPO $414.69
Rate for Payer: Three Rivers Preferred All Commercial $400.55
Rate for Payer: United Healthcare Commercial $371.34
Rate for Payer: United Healthcare Medicare $155.51
Service Code CPT 87517
Hospital Charge Code 63002039
Hospital Revenue Code 300
Min. Negotiated Rate $353.43
Max. Negotiated Rate $438.25
Rate for Payer: Aetna Commercial $407.15
Rate for Payer: Cash Price $292.17
Rate for Payer: Cigna All Commercial $406.68
Rate for Payer: CORVEL All Commercial $438.25
Rate for Payer: Coventry All Commercial $414.69
Rate for Payer: Encore All Commercial $433.78
Rate for Payer: Frontpath All Commercial $433.54
Rate for Payer: Humana ChoiceCare $407.01
Rate for Payer: Lutheran Preferred All Commercial $424.12
Rate for Payer: PHCS All Commercial $353.43
Rate for Payer: PHP All Commercial $357.39
Rate for Payer: Sagamore Health Network All Products $363.80
Rate for Payer: Signature Care EPO $391.13
Rate for Payer: Signature Care PPO $414.69
Rate for Payer: United Healthcare Commercial $371.34
Service Code CPT 87902
Hospital Charge Code 63002056
Hospital Revenue Code 300
Min. Negotiated Rate $257.45
Max. Negotiated Rate $1,035.11
Rate for Payer: Aetna Commercial $939.39
Rate for Payer: Aetna Medicare $367.30
Rate for Payer: Anthem Blue Cross of IN Medicare $367.30
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $639.21
Rate for Payer: Anthem Blue Cross of IN Traditional $695.75
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $257.45
Rate for Payer: CareSource Indiana of IN Just 4 Me $422.39
Rate for Payer: CareSource Indiana of IN Medicare $404.03
Rate for Payer: Cash Price $690.08
Rate for Payer: Cash Price $690.08
Rate for Payer: Centivo All Commercial $567.64
Rate for Payer: Cigna All Commercial $960.54
Rate for Payer: CORVEL All Commercial $1,035.11
Rate for Payer: Coventry All Commercial $979.46
Rate for Payer: Encore All Commercial $1,024.54
Rate for Payer: Frontpath All Commercial $1,023.98
Rate for Payer: Humana ChoiceCare $961.32
Rate for Payer: Humana Medicare $567.64
Rate for Payer: Lucent All Commercial $567.64
Rate for Payer: Lutheran Preferred All Commercial $1,001.72
Rate for Payer: Managed Health Services Medicaid $257.45
Rate for Payer: MDWise Medicaid $257.45
Rate for Payer: PHCS All Commercial $834.77
Rate for Payer: PHP All Commercial $844.12
Rate for Payer: Plain Church Group Ministry All Commercial $434.08
Rate for Payer: Sagamore Health Network All Products $859.25
Rate for Payer: Signature Care EPO $923.81
Rate for Payer: Signature Care PPO $979.46
Rate for Payer: Three Rivers Preferred All Commercial $946.07
Rate for Payer: United Healthcare Commercial $877.06
Rate for Payer: United Healthcare Medicare $367.30
Service Code CPT 87902
Hospital Charge Code 63002056
Hospital Revenue Code 300
Min. Negotiated Rate $834.77
Max. Negotiated Rate $1,035.11
Rate for Payer: Aetna Commercial $961.65
Rate for Payer: Cash Price $690.08
Rate for Payer: Cigna All Commercial $960.54
Rate for Payer: CORVEL All Commercial $1,035.11
Rate for Payer: Coventry All Commercial $979.46
Rate for Payer: Encore All Commercial $1,024.54
Rate for Payer: Frontpath All Commercial $1,023.98
Rate for Payer: Humana ChoiceCare $961.32
Rate for Payer: Lutheran Preferred All Commercial $1,001.72
Rate for Payer: PHCS All Commercial $834.77
Rate for Payer: PHP All Commercial $844.12
Rate for Payer: Sagamore Health Network All Products $859.25
Rate for Payer: Signature Care EPO $923.81
Rate for Payer: Signature Care PPO $979.46
Rate for Payer: United Healthcare Commercial $877.06
Service Code CPT 87902
Hospital Charge Code 63002057
Hospital Revenue Code 300
Min. Negotiated Rate $1,016.97
Max. Negotiated Rate $1,261.04
Rate for Payer: Aetna Commercial $1,171.55
Rate for Payer: Cash Price $840.69
Rate for Payer: Cigna All Commercial $1,170.19
Rate for Payer: CORVEL All Commercial $1,261.04
Rate for Payer: Coventry All Commercial $1,193.24
Rate for Payer: Encore All Commercial $1,248.16
Rate for Payer: Frontpath All Commercial $1,247.48
Rate for Payer: Humana ChoiceCare $1,171.14
Rate for Payer: Lutheran Preferred All Commercial $1,220.36
Rate for Payer: PHCS All Commercial $1,016.97
Rate for Payer: PHP All Commercial $1,028.36
Rate for Payer: Sagamore Health Network All Products $1,046.80
Rate for Payer: Signature Care EPO $1,125.44
Rate for Payer: Signature Care PPO $1,193.24
Rate for Payer: United Healthcare Commercial $1,068.49
Service Code CPT 87902
Hospital Charge Code 63002057
Hospital Revenue Code 300
Min. Negotiated Rate $257.45
Max. Negotiated Rate $1,261.04
Rate for Payer: Aetna Commercial $1,144.43
Rate for Payer: Aetna Medicare $447.47
Rate for Payer: Anthem Blue Cross of IN Medicare $447.47
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $778.73
Rate for Payer: Anthem Blue Cross of IN Traditional $847.61
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $257.45
Rate for Payer: CareSource Indiana of IN Just 4 Me $514.59
Rate for Payer: CareSource Indiana of IN Medicare $492.21
Rate for Payer: Cash Price $840.69
Rate for Payer: Cash Price $840.69
Rate for Payer: Centivo All Commercial $691.54
Rate for Payer: Cigna All Commercial $1,170.19
Rate for Payer: CORVEL All Commercial $1,261.04
Rate for Payer: Coventry All Commercial $1,193.24
Rate for Payer: Encore All Commercial $1,248.16
Rate for Payer: Frontpath All Commercial $1,247.48
Rate for Payer: Humana ChoiceCare $1,171.14
Rate for Payer: Humana Medicare $691.54
Rate for Payer: Lucent All Commercial $691.54
Rate for Payer: Lutheran Preferred All Commercial $1,220.36
Rate for Payer: Managed Health Services Medicaid $257.45
Rate for Payer: MDWise Medicaid $257.45
Rate for Payer: PHCS All Commercial $1,016.97
Rate for Payer: PHP All Commercial $1,028.36
Rate for Payer: Plain Church Group Ministry All Commercial $528.82
Rate for Payer: Sagamore Health Network All Products $1,046.80
Rate for Payer: Signature Care EPO $1,125.44
Rate for Payer: Signature Care PPO $1,193.24
Rate for Payer: Three Rivers Preferred All Commercial $1,152.56
Rate for Payer: United Healthcare Commercial $1,068.49
Rate for Payer: United Healthcare Medicare $447.47
Service Code CPT 87521
Hospital Charge Code 63002040
Hospital Revenue Code 300
Min. Negotiated Rate $455.25
Max. Negotiated Rate $564.51
Rate for Payer: Aetna Commercial $524.45
Rate for Payer: Cash Price $376.34
Rate for Payer: Cigna All Commercial $523.84
Rate for Payer: CORVEL All Commercial $564.51
Rate for Payer: Coventry All Commercial $534.16
Rate for Payer: Encore All Commercial $558.75
Rate for Payer: Frontpath All Commercial $558.44
Rate for Payer: Humana ChoiceCare $524.27
Rate for Payer: Lutheran Preferred All Commercial $546.30
Rate for Payer: PHCS All Commercial $455.25
Rate for Payer: PHP All Commercial $460.35
Rate for Payer: Sagamore Health Network All Products $468.61
Rate for Payer: Signature Care EPO $503.81
Rate for Payer: Signature Care PPO $534.16
Rate for Payer: United Healthcare Commercial $478.32
Service Code CPT 87521
Hospital Charge Code 63002040
Hospital Revenue Code 300
Min. Negotiated Rate $35.09
Max. Negotiated Rate $564.51
Rate for Payer: Aetna Commercial $512.31
Rate for Payer: Aetna Medicare $200.31
Rate for Payer: Anthem Blue Cross of IN Medicare $200.31
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $348.60
Rate for Payer: Anthem Blue Cross of IN Traditional $379.44
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $35.09
Rate for Payer: CareSource Indiana of IN Just 4 Me $230.36
Rate for Payer: CareSource Indiana of IN Medicare $220.34
Rate for Payer: Cash Price $376.34
Rate for Payer: Cash Price $376.34
Rate for Payer: Centivo All Commercial $309.57
Rate for Payer: Cigna All Commercial $523.84
Rate for Payer: CORVEL All Commercial $564.51
Rate for Payer: Coventry All Commercial $534.16
Rate for Payer: Encore All Commercial $558.75
Rate for Payer: Frontpath All Commercial $558.44
Rate for Payer: Humana ChoiceCare $524.27
Rate for Payer: Humana Medicare $309.57
Rate for Payer: Lucent All Commercial $309.57
Rate for Payer: Lutheran Preferred All Commercial $546.30
Rate for Payer: Managed Health Services Medicaid $35.09
Rate for Payer: MDWise Medicaid $35.09
Rate for Payer: PHCS All Commercial $455.25
Rate for Payer: PHP All Commercial $460.35
Rate for Payer: Plain Church Group Ministry All Commercial $236.73
Rate for Payer: Sagamore Health Network All Products $468.61
Rate for Payer: Signature Care EPO $503.81
Rate for Payer: Signature Care PPO $534.16
Rate for Payer: Three Rivers Preferred All Commercial $515.95
Rate for Payer: United Healthcare Commercial $478.32
Rate for Payer: United Healthcare Medicare $200.31
Service Code CPT 87522
Hospital Charge Code 63002041
Hospital Revenue Code 300
Min. Negotiated Rate $42.84
Max. Negotiated Rate $599.99
Rate for Payer: Aetna Commercial $544.51
Rate for Payer: Aetna Medicare $212.90
Rate for Payer: Anthem Blue Cross of IN Medicare $212.90
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $296.51
Rate for Payer: Anthem Blue Cross of IN Traditional $296.51
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $42.84
Rate for Payer: CareSource Indiana of IN Just 4 Me $244.83
Rate for Payer: CareSource Indiana of IN Medicare $234.19
Rate for Payer: Cash Price $399.99
Rate for Payer: Cash Price $399.99
Rate for Payer: Centivo All Commercial $329.03
Rate for Payer: Cigna All Commercial $556.76
Rate for Payer: CORVEL All Commercial $599.99
Rate for Payer: Coventry All Commercial $567.73
Rate for Payer: Encore All Commercial $593.86
Rate for Payer: Frontpath All Commercial $593.54
Rate for Payer: Humana ChoiceCare $557.22
Rate for Payer: Humana Medicare $329.03
Rate for Payer: Lucent All Commercial $329.03
Rate for Payer: Lutheran Preferred All Commercial $580.64
Rate for Payer: Managed Health Services Medicaid $42.84
Rate for Payer: MDWise Medicaid $42.84
Rate for Payer: PHCS All Commercial $483.86
Rate for Payer: PHP All Commercial $489.28
Rate for Payer: Plain Church Group Ministry All Commercial $251.61
Rate for Payer: Sagamore Health Network All Products $498.06
Rate for Payer: Signature Care EPO $535.47
Rate for Payer: Signature Care PPO $567.73
Rate for Payer: Three Rivers Preferred All Commercial $548.38
Rate for Payer: United Healthcare Commercial $508.38
Rate for Payer: United Healthcare Medicare $212.90
Service Code CPT 87522
Hospital Charge Code 63002041
Hospital Revenue Code 300
Min. Negotiated Rate $483.86
Max. Negotiated Rate $599.99
Rate for Payer: Aetna Commercial $557.41
Rate for Payer: Cash Price $399.99
Rate for Payer: Cigna All Commercial $556.76
Rate for Payer: CORVEL All Commercial $599.99
Rate for Payer: Coventry All Commercial $567.73
Rate for Payer: Encore All Commercial $593.86
Rate for Payer: Frontpath All Commercial $593.54
Rate for Payer: Humana ChoiceCare $557.22
Rate for Payer: Lutheran Preferred All Commercial $580.64
Rate for Payer: PHCS All Commercial $483.86
Rate for Payer: PHP All Commercial $489.28
Rate for Payer: Sagamore Health Network All Products $498.06
Rate for Payer: Signature Care EPO $535.47
Rate for Payer: Signature Care PPO $567.73
Rate for Payer: United Healthcare Commercial $508.38
Service Code CPT 87522
Hospital Charge Code 63002042
Hospital Revenue Code 300
Min. Negotiated Rate $483.86
Max. Negotiated Rate $599.99
Rate for Payer: Aetna Commercial $557.41
Rate for Payer: Cash Price $399.99
Rate for Payer: Cigna All Commercial $556.76
Rate for Payer: CORVEL All Commercial $599.99
Rate for Payer: Coventry All Commercial $567.73
Rate for Payer: Encore All Commercial $593.86
Rate for Payer: Frontpath All Commercial $593.54
Rate for Payer: Humana ChoiceCare $557.22
Rate for Payer: Lutheran Preferred All Commercial $580.64
Rate for Payer: PHCS All Commercial $483.86
Rate for Payer: PHP All Commercial $489.28
Rate for Payer: Sagamore Health Network All Products $498.06
Rate for Payer: Signature Care EPO $535.47
Rate for Payer: Signature Care PPO $567.73
Rate for Payer: United Healthcare Commercial $508.38
Service Code CPT 87522
Hospital Charge Code 63002042
Hospital Revenue Code 300
Min. Negotiated Rate $42.84
Max. Negotiated Rate $599.99
Rate for Payer: Aetna Commercial $544.51
Rate for Payer: Aetna Medicare $212.90
Rate for Payer: Anthem Blue Cross of IN Medicare $212.90
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $296.51
Rate for Payer: Anthem Blue Cross of IN Traditional $296.51
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $42.84
Rate for Payer: CareSource Indiana of IN Just 4 Me $244.83
Rate for Payer: CareSource Indiana of IN Medicare $234.19
Rate for Payer: Cash Price $399.99
Rate for Payer: Cash Price $399.99
Rate for Payer: Centivo All Commercial $329.03
Rate for Payer: Cigna All Commercial $556.76
Rate for Payer: CORVEL All Commercial $599.99
Rate for Payer: Coventry All Commercial $567.73
Rate for Payer: Encore All Commercial $593.86
Rate for Payer: Frontpath All Commercial $593.54
Rate for Payer: Humana ChoiceCare $557.22
Rate for Payer: Humana Medicare $329.03
Rate for Payer: Lucent All Commercial $329.03
Rate for Payer: Lutheran Preferred All Commercial $580.64
Rate for Payer: Managed Health Services Medicaid $42.84
Rate for Payer: MDWise Medicaid $42.84
Rate for Payer: PHCS All Commercial $483.86
Rate for Payer: PHP All Commercial $489.28
Rate for Payer: Plain Church Group Ministry All Commercial $251.61
Rate for Payer: Sagamore Health Network All Products $498.06
Rate for Payer: Signature Care EPO $535.47
Rate for Payer: Signature Care PPO $567.73
Rate for Payer: Three Rivers Preferred All Commercial $548.38
Rate for Payer: United Healthcare Commercial $508.38
Rate for Payer: United Healthcare Medicare $212.90
Service Code CPT 88374
Hospital Charge Code 63002136
Hospital Revenue Code 310
Min. Negotiated Rate $973.59
Max. Negotiated Rate $1,207.25
Rate for Payer: Aetna Commercial $1,121.58
Rate for Payer: Cash Price $804.84
Rate for Payer: Cigna All Commercial $1,120.28
Rate for Payer: CORVEL All Commercial $1,207.25
Rate for Payer: Coventry All Commercial $1,142.35
Rate for Payer: Encore All Commercial $1,194.92
Rate for Payer: Frontpath All Commercial $1,194.27
Rate for Payer: Humana ChoiceCare $1,121.19
Rate for Payer: Lutheran Preferred All Commercial $1,168.31
Rate for Payer: PHCS All Commercial $973.59
Rate for Payer: PHP All Commercial $984.50
Rate for Payer: Sagamore Health Network All Products $1,002.15
Rate for Payer: Signature Care EPO $1,077.44
Rate for Payer: Signature Care PPO $1,142.35
Rate for Payer: United Healthcare Commercial $1,022.92