|
HC ICD SC FORT ASS VR 40
|
Facility
OP
|
$35,437.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607559
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$32,956.88 |
| Rate for Payer: Aetna Commercial |
$29,909.25
|
| Rate for Payer: Aetna Medicare |
$11,694.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11,694.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20,351.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22,151.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13,448.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12,863.81
|
| Rate for Payer: Cash Price |
$21,971.25
|
| Rate for Payer: Cash Price |
$21,971.25
|
| Rate for Payer: Centivo All Commercial |
$18,073.12
|
| Rate for Payer: Cigna All Commercial |
$30,582.56
|
| Rate for Payer: CORVEL All Commercial |
$32,956.88
|
| Rate for Payer: Coventry All Commercial |
$31,185.00
|
| Rate for Payer: Encore All Commercial |
$32,620.22
|
| Rate for Payer: Frontpath All Commercial |
$32,602.50
|
| Rate for Payer: Humana ChoiceCare |
$30,607.37
|
| Rate for Payer: Humana Medicare |
$18,073.12
|
| Rate for Payer: Lucent All Commercial |
$18,073.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,893.75
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$26,578.12
|
| Rate for Payer: PHP All Commercial |
$26,875.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13,820.62
|
| Rate for Payer: Sagamore Health Network All Products |
$27,357.75
|
| Rate for Payer: Signature Care EPO |
$29,413.12
|
| Rate for Payer: Signature Care PPO |
$31,185.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30,121.88
|
| Rate for Payer: United Healthcare Commercial |
$27,924.75
|
| Rate for Payer: United Healthcare Medicare |
$11,694.38
|
|
|
HC ICD SC FORT ASS VR 40
|
Facility
IP
|
$35,437.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607559
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$26,578.12 |
| Max. Negotiated Rate |
$32,956.88 |
| Rate for Payer: Aetna Commercial |
$30,618.00
|
| Rate for Payer: Cash Price |
$21,971.25
|
| Rate for Payer: Cigna All Commercial |
$30,582.56
|
| Rate for Payer: CORVEL All Commercial |
$32,956.88
|
| Rate for Payer: Coventry All Commercial |
$31,185.00
|
| Rate for Payer: Encore All Commercial |
$32,620.22
|
| Rate for Payer: Frontpath All Commercial |
$32,602.50
|
| Rate for Payer: Humana ChoiceCare |
$30,607.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,893.75
|
| Rate for Payer: PHCS All Commercial |
$26,578.12
|
| Rate for Payer: PHP All Commercial |
$26,875.80
|
| Rate for Payer: Sagamore Health Network All Products |
$27,357.75
|
| Rate for Payer: Signature Care EPO |
$29,413.12
|
| Rate for Payer: Signature Care PPO |
$31,185.00
|
| Rate for Payer: United Healthcare Commercial |
$27,924.75
|
|
|
HC ICDSC FORT ASS VR40DF4 CONNMRI
|
Facility
OP
|
$35,437.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607560
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$32,956.88 |
| Rate for Payer: Aetna Commercial |
$29,909.25
|
| Rate for Payer: Aetna Medicare |
$11,694.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11,694.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20,351.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22,151.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13,448.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12,863.81
|
| Rate for Payer: Cash Price |
$21,971.25
|
| Rate for Payer: Cash Price |
$21,971.25
|
| Rate for Payer: Centivo All Commercial |
$18,073.12
|
| Rate for Payer: Cigna All Commercial |
$30,582.56
|
| Rate for Payer: CORVEL All Commercial |
$32,956.88
|
| Rate for Payer: Coventry All Commercial |
$31,185.00
|
| Rate for Payer: Encore All Commercial |
$32,620.22
|
| Rate for Payer: Frontpath All Commercial |
$32,602.50
|
| Rate for Payer: Humana ChoiceCare |
$30,607.37
|
| Rate for Payer: Humana Medicare |
$18,073.12
|
| Rate for Payer: Lucent All Commercial |
$18,073.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,893.75
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$26,578.12
|
| Rate for Payer: PHP All Commercial |
$26,875.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13,820.62
|
| Rate for Payer: Sagamore Health Network All Products |
$27,357.75
|
| Rate for Payer: Signature Care EPO |
$29,413.12
|
| Rate for Payer: Signature Care PPO |
$31,185.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30,121.88
|
| Rate for Payer: United Healthcare Commercial |
$27,924.75
|
| Rate for Payer: United Healthcare Medicare |
$11,694.38
|
|
|
HC ICDSC FORT ASS VR40DF4 CONNMRI
|
Facility
IP
|
$35,437.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607560
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$26,578.12 |
| Max. Negotiated Rate |
$32,956.88 |
| Rate for Payer: Aetna Commercial |
$30,618.00
|
| Rate for Payer: Cash Price |
$21,971.25
|
| Rate for Payer: Cigna All Commercial |
$30,582.56
|
| Rate for Payer: CORVEL All Commercial |
$32,956.88
|
| Rate for Payer: Coventry All Commercial |
$31,185.00
|
| Rate for Payer: Encore All Commercial |
$32,620.22
|
| Rate for Payer: Frontpath All Commercial |
$32,602.50
|
| Rate for Payer: Humana ChoiceCare |
$30,607.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,893.75
|
| Rate for Payer: PHCS All Commercial |
$26,578.12
|
| Rate for Payer: PHP All Commercial |
$26,875.80
|
| Rate for Payer: Sagamore Health Network All Products |
$27,357.75
|
| Rate for Payer: Signature Care EPO |
$29,413.12
|
| Rate for Payer: Signature Care PPO |
$31,185.00
|
| Rate for Payer: United Healthcare Commercial |
$27,924.75
|
|
|
HC ICD SC GALLANT VR
|
Facility
OP
|
$40,635.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607558
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$37,790.55 |
| Rate for Payer: Aetna Commercial |
$34,295.94
|
| Rate for Payer: Aetna Medicare |
$13,409.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13,409.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23,336.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25,400.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15,420.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14,750.50
|
| Rate for Payer: Cash Price |
$25,193.70
|
| Rate for Payer: Cash Price |
$25,193.70
|
| Rate for Payer: Centivo All Commercial |
$20,723.85
|
| Rate for Payer: Cigna All Commercial |
$35,068.00
|
| Rate for Payer: CORVEL All Commercial |
$37,790.55
|
| Rate for Payer: Coventry All Commercial |
$35,758.80
|
| Rate for Payer: Encore All Commercial |
$37,404.52
|
| Rate for Payer: Frontpath All Commercial |
$37,384.20
|
| Rate for Payer: Humana ChoiceCare |
$35,096.45
|
| Rate for Payer: Humana Medicare |
$20,723.85
|
| Rate for Payer: Lucent All Commercial |
$20,723.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36,571.50
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$30,476.25
|
| Rate for Payer: PHP All Commercial |
$30,817.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15,847.65
|
| Rate for Payer: Sagamore Health Network All Products |
$31,370.22
|
| Rate for Payer: Signature Care EPO |
$33,727.05
|
| Rate for Payer: Signature Care PPO |
$35,758.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,539.75
|
| Rate for Payer: United Healthcare Commercial |
$32,020.38
|
| Rate for Payer: United Healthcare Medicare |
$13,409.55
|
|
|
HC ICD SC GALLANT VR
|
Facility
IP
|
$40,635.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607558
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,476.25 |
| Max. Negotiated Rate |
$37,790.55 |
| Rate for Payer: Aetna Commercial |
$35,108.64
|
| Rate for Payer: Cash Price |
$25,193.70
|
| Rate for Payer: Cigna All Commercial |
$35,068.00
|
| Rate for Payer: CORVEL All Commercial |
$37,790.55
|
| Rate for Payer: Coventry All Commercial |
$35,758.80
|
| Rate for Payer: Encore All Commercial |
$37,404.52
|
| Rate for Payer: Frontpath All Commercial |
$37,384.20
|
| Rate for Payer: Humana ChoiceCare |
$35,096.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36,571.50
|
| Rate for Payer: PHCS All Commercial |
$30,476.25
|
| Rate for Payer: PHP All Commercial |
$30,817.58
|
| Rate for Payer: Sagamore Health Network All Products |
$31,370.22
|
| Rate for Payer: Signature Care EPO |
$33,727.05
|
| Rate for Payer: Signature Care PPO |
$35,758.80
|
| Rate for Payer: United Healthcare Commercial |
$32,020.38
|
|
|
HC ICD SC MOMENTUM EL VR
|
Facility
OP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607213
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$40,632.27
|
| Rate for Payer: Aetna Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27,648.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30,093.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18,270.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17,475.73
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Centivo All Commercial |
$24,552.68
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Humana Medicare |
$24,552.68
|
| Rate for Payer: Lucent All Commercial |
$24,552.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18,775.58
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,921.12
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
| Rate for Payer: United Healthcare Medicare |
$15,887.02
|
|
|
HC ICD SC MOMENTUM EL VR
|
Facility
IP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607213
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$36,106.88 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$41,595.12
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
|
|
HC ICD SC PERC1VA VR DF4
|
Facility
IP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607214
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$36,106.88 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$41,595.12
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
|
|
HC ICD SC PERC1VA VR DF4
|
Facility
OP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607214
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$40,632.27
|
| Rate for Payer: Aetna Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27,648.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30,093.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18,270.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17,475.73
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Centivo All Commercial |
$24,552.68
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Humana Medicare |
$24,552.68
|
| Rate for Payer: Lucent All Commercial |
$24,552.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18,775.58
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,921.12
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
| Rate for Payer: United Healthcare Medicare |
$15,887.02
|
|
|
HC ICD SC PERCIVA VR
|
Facility
OP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607215
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$40,632.27
|
| Rate for Payer: Aetna Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27,648.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30,093.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18,270.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17,475.73
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Centivo All Commercial |
$24,552.68
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Humana Medicare |
$24,552.68
|
| Rate for Payer: Lucent All Commercial |
$24,552.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18,775.58
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,921.12
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
| Rate for Payer: United Healthcare Medicare |
$15,887.02
|
|
|
HC ICD SC PERCIVA VR
|
Facility
IP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607215
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$36,106.88 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$41,595.12
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
|
|
HC ICD SC VIGILANT EL VR DF4
|
Facility
OP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607212
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$40,632.27
|
| Rate for Payer: Aetna Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15,887.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27,648.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30,093.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18,270.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17,475.73
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Centivo All Commercial |
$24,552.68
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Humana Medicare |
$24,552.68
|
| Rate for Payer: Lucent All Commercial |
$24,552.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18,775.58
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,921.12
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
| Rate for Payer: United Healthcare Medicare |
$15,887.02
|
|
|
HC ICD SC VIGILANT EL VR DF4
|
Facility
IP
|
$48,142.50
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607212
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$36,106.88 |
| Max. Negotiated Rate |
$44,772.52 |
| Rate for Payer: Aetna Commercial |
$41,595.12
|
| Rate for Payer: Cash Price |
$29,848.35
|
| Rate for Payer: Cigna All Commercial |
$41,546.98
|
| Rate for Payer: CORVEL All Commercial |
$44,772.52
|
| Rate for Payer: Coventry All Commercial |
$42,365.40
|
| Rate for Payer: Encore All Commercial |
$44,315.17
|
| Rate for Payer: Frontpath All Commercial |
$44,291.10
|
| Rate for Payer: Humana ChoiceCare |
$41,580.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43,328.25
|
| Rate for Payer: PHCS All Commercial |
$36,106.88
|
| Rate for Payer: PHP All Commercial |
$36,511.27
|
| Rate for Payer: Sagamore Health Network All Products |
$37,166.01
|
| Rate for Payer: Signature Care EPO |
$39,958.28
|
| Rate for Payer: Signature Care PPO |
$42,365.40
|
| Rate for Payer: United Healthcare Commercial |
$37,936.29
|
|
|
HC ICD SC VISIA AF MRI S VR D1
|
Facility
OP
|
$41,097.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607344
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$38,220.21 |
| Rate for Payer: Aetna Commercial |
$34,685.87
|
| Rate for Payer: Aetna Medicare |
$13,562.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13,562.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23,602.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25,689.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15,596.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14,918.21
|
| Rate for Payer: Cash Price |
$25,480.14
|
| Rate for Payer: Cash Price |
$25,480.14
|
| Rate for Payer: Centivo All Commercial |
$20,959.47
|
| Rate for Payer: Cigna All Commercial |
$35,466.71
|
| Rate for Payer: CORVEL All Commercial |
$38,220.21
|
| Rate for Payer: Coventry All Commercial |
$36,165.36
|
| Rate for Payer: Encore All Commercial |
$37,829.79
|
| Rate for Payer: Frontpath All Commercial |
$37,809.24
|
| Rate for Payer: Humana ChoiceCare |
$35,495.48
|
| Rate for Payer: Humana Medicare |
$20,959.47
|
| Rate for Payer: Lucent All Commercial |
$20,959.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36,987.30
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$30,822.75
|
| Rate for Payer: PHP All Commercial |
$31,167.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16,027.83
|
| Rate for Payer: Sagamore Health Network All Products |
$31,726.88
|
| Rate for Payer: Signature Care EPO |
$34,110.51
|
| Rate for Payer: Signature Care PPO |
$36,165.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,932.45
|
| Rate for Payer: United Healthcare Commercial |
$32,384.44
|
| Rate for Payer: United Healthcare Medicare |
$13,562.01
|
|
|
HC ICD SC VISIA AF MRI S VR D1
|
Facility
IP
|
$41,097.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607344
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,822.75 |
| Max. Negotiated Rate |
$38,220.21 |
| Rate for Payer: Aetna Commercial |
$35,507.81
|
| Rate for Payer: Cash Price |
$25,480.14
|
| Rate for Payer: Cigna All Commercial |
$35,466.71
|
| Rate for Payer: CORVEL All Commercial |
$38,220.21
|
| Rate for Payer: Coventry All Commercial |
$36,165.36
|
| Rate for Payer: Encore All Commercial |
$37,829.79
|
| Rate for Payer: Frontpath All Commercial |
$37,809.24
|
| Rate for Payer: Humana ChoiceCare |
$35,495.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36,987.30
|
| Rate for Payer: PHCS All Commercial |
$30,822.75
|
| Rate for Payer: PHP All Commercial |
$31,167.96
|
| Rate for Payer: Sagamore Health Network All Products |
$31,726.88
|
| Rate for Payer: Signature Care EPO |
$34,110.51
|
| Rate for Payer: Signature Care PPO |
$36,165.36
|
| Rate for Payer: United Healthcare Commercial |
$32,384.44
|
|
|
HC ICD SC VISIA AF MRI S VR D4
|
Facility
IP
|
$41,097.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607345
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,822.75 |
| Max. Negotiated Rate |
$38,220.21 |
| Rate for Payer: Aetna Commercial |
$35,507.81
|
| Rate for Payer: Cash Price |
$25,480.14
|
| Rate for Payer: Cigna All Commercial |
$35,466.71
|
| Rate for Payer: CORVEL All Commercial |
$38,220.21
|
| Rate for Payer: Coventry All Commercial |
$36,165.36
|
| Rate for Payer: Encore All Commercial |
$37,829.79
|
| Rate for Payer: Frontpath All Commercial |
$37,809.24
|
| Rate for Payer: Humana ChoiceCare |
$35,495.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36,987.30
|
| Rate for Payer: PHCS All Commercial |
$30,822.75
|
| Rate for Payer: PHP All Commercial |
$31,167.96
|
| Rate for Payer: Sagamore Health Network All Products |
$31,726.88
|
| Rate for Payer: Signature Care EPO |
$34,110.51
|
| Rate for Payer: Signature Care PPO |
$36,165.36
|
| Rate for Payer: United Healthcare Commercial |
$32,384.44
|
|
|
HC ICD SC VISIA AF MRI S VR D4
|
Facility
OP
|
$41,097.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607345
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$38,220.21 |
| Rate for Payer: Aetna Commercial |
$34,685.87
|
| Rate for Payer: Aetna Medicare |
$13,562.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13,562.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23,602.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25,689.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15,596.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14,918.21
|
| Rate for Payer: Cash Price |
$25,480.14
|
| Rate for Payer: Cash Price |
$25,480.14
|
| Rate for Payer: Centivo All Commercial |
$20,959.47
|
| Rate for Payer: Cigna All Commercial |
$35,466.71
|
| Rate for Payer: CORVEL All Commercial |
$38,220.21
|
| Rate for Payer: Coventry All Commercial |
$36,165.36
|
| Rate for Payer: Encore All Commercial |
$37,829.79
|
| Rate for Payer: Frontpath All Commercial |
$37,809.24
|
| Rate for Payer: Humana ChoiceCare |
$35,495.48
|
| Rate for Payer: Humana Medicare |
$20,959.47
|
| Rate for Payer: Lucent All Commercial |
$20,959.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36,987.30
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$30,822.75
|
| Rate for Payer: PHP All Commercial |
$31,167.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16,027.83
|
| Rate for Payer: Sagamore Health Network All Products |
$31,726.88
|
| Rate for Payer: Signature Care EPO |
$34,110.51
|
| Rate for Payer: Signature Care PPO |
$36,165.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34,932.45
|
| Rate for Payer: United Healthcare Commercial |
$32,384.44
|
| Rate for Payer: United Healthcare Medicare |
$13,562.01
|
|
|
HC ICD SQ EMBLEM MRI PULSE GEN
|
Facility
OP
|
$71,750.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607240
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$66,727.50 |
| Rate for Payer: Aetna Commercial |
$60,557.00
|
| Rate for Payer: Aetna Medicare |
$23,677.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23,677.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41,206.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44,850.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$82.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27,229.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26,045.25
|
| Rate for Payer: Cash Price |
$44,485.00
|
| Rate for Payer: Cash Price |
$44,485.00
|
| Rate for Payer: Centivo All Commercial |
$36,592.50
|
| Rate for Payer: Cigna All Commercial |
$61,920.25
|
| Rate for Payer: CORVEL All Commercial |
$66,727.50
|
| Rate for Payer: Coventry All Commercial |
$63,140.00
|
| Rate for Payer: Encore All Commercial |
$66,045.88
|
| Rate for Payer: Frontpath All Commercial |
$66,010.00
|
| Rate for Payer: Humana ChoiceCare |
$61,970.48
|
| Rate for Payer: Humana Medicare |
$36,592.50
|
| Rate for Payer: Lucent All Commercial |
$36,592.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64,575.00
|
| Rate for Payer: Managed Health Services Medicaid |
$82.84
|
| Rate for Payer: MDWise Medicaid |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$53,812.50
|
| Rate for Payer: PHP All Commercial |
$54,415.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27,982.50
|
| Rate for Payer: Sagamore Health Network All Products |
$55,391.00
|
| Rate for Payer: Signature Care EPO |
$59,552.50
|
| Rate for Payer: Signature Care PPO |
$63,140.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60,987.50
|
| Rate for Payer: United Healthcare Commercial |
$56,539.00
|
| Rate for Payer: United Healthcare Medicare |
$23,677.50
|
|
|
HC ICD SQ EMBLEM MRI PULSE GEN
|
Facility
IP
|
$71,750.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
41607240
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$53,812.50 |
| Max. Negotiated Rate |
$66,727.50 |
| Rate for Payer: Aetna Commercial |
$61,992.00
|
| Rate for Payer: Cash Price |
$44,485.00
|
| Rate for Payer: Cigna All Commercial |
$61,920.25
|
| Rate for Payer: CORVEL All Commercial |
$66,727.50
|
| Rate for Payer: Coventry All Commercial |
$63,140.00
|
| Rate for Payer: Encore All Commercial |
$66,045.88
|
| Rate for Payer: Frontpath All Commercial |
$66,010.00
|
| Rate for Payer: Humana ChoiceCare |
$61,970.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64,575.00
|
| Rate for Payer: PHCS All Commercial |
$53,812.50
|
| Rate for Payer: PHP All Commercial |
$54,415.20
|
| Rate for Payer: Sagamore Health Network All Products |
$55,391.00
|
| Rate for Payer: Signature Care EPO |
$59,552.50
|
| Rate for Payer: Signature Care PPO |
$63,140.00
|
| Rate for Payer: United Healthcare Commercial |
$56,539.00
|
|
|
HC IFE SERUM
|
Facility
IP
|
$233.89
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
63001310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$202.08
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Cigna All Commercial |
$201.84
|
| Rate for Payer: CORVEL All Commercial |
$217.51
|
| Rate for Payer: Coventry All Commercial |
$205.82
|
| Rate for Payer: Encore All Commercial |
$215.29
|
| Rate for Payer: Frontpath All Commercial |
$215.18
|
| Rate for Payer: Humana ChoiceCare |
$202.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.50
|
| Rate for Payer: PHCS All Commercial |
$175.41
|
| Rate for Payer: PHP All Commercial |
$177.38
|
| Rate for Payer: Sagamore Health Network All Products |
$180.56
|
| Rate for Payer: Signature Care EPO |
$194.13
|
| Rate for Payer: Signature Care PPO |
$205.82
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
HC IFE SERUM
|
Facility
OP
|
$233.89
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
63001310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$217.51 |
| Rate for Payer: Aetna Commercial |
$197.40
|
| Rate for Payer: Aetna Medicare |
$77.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.90
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Cash Price |
$145.01
|
| Rate for Payer: Centivo All Commercial |
$119.28
|
| Rate for Payer: Cigna All Commercial |
$201.84
|
| Rate for Payer: CORVEL All Commercial |
$217.51
|
| Rate for Payer: Coventry All Commercial |
$205.82
|
| Rate for Payer: Encore All Commercial |
$215.29
|
| Rate for Payer: Frontpath All Commercial |
$215.18
|
| Rate for Payer: Humana ChoiceCare |
$202.01
|
| Rate for Payer: Humana Medicare |
$119.28
|
| Rate for Payer: Lucent All Commercial |
$119.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.34
|
| Rate for Payer: MDWise Medicaid |
$22.34
|
| Rate for Payer: PHCS All Commercial |
$175.41
|
| Rate for Payer: PHP All Commercial |
$177.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.22
|
| Rate for Payer: Sagamore Health Network All Products |
$180.56
|
| Rate for Payer: Signature Care EPO |
$194.13
|
| Rate for Payer: Signature Care PPO |
$205.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.80
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
| Rate for Payer: United Healthcare Medicare |
$77.18
|
|
|
HC IGA
|
Facility
OP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$97.93
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.12
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Centivo All Commercial |
$59.18
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.91
|
| Rate for Payer: Coventry All Commercial |
$102.11
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.75
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Humana Medicare |
$59.18
|
| Rate for Payer: Lucent All Commercial |
$59.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.43
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: MDWise Medicaid |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.25
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.63
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
| Rate for Payer: United Healthcare Medicare |
$38.29
|
|
|
HC IGA
|
Facility
IP
|
$116.04
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
63001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.03 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$100.25
|
| Rate for Payer: Cash Price |
$71.94
|
| Rate for Payer: Cigna All Commercial |
$100.14
|
| Rate for Payer: CORVEL All Commercial |
$107.91
|
| Rate for Payer: Coventry All Commercial |
$102.11
|
| Rate for Payer: Encore All Commercial |
$106.81
|
| Rate for Payer: Frontpath All Commercial |
$106.75
|
| Rate for Payer: Humana ChoiceCare |
$100.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.43
|
| Rate for Payer: PHCS All Commercial |
$87.03
|
| Rate for Payer: PHP All Commercial |
$88.00
|
| Rate for Payer: Sagamore Health Network All Products |
$89.58
|
| Rate for Payer: Signature Care EPO |
$96.31
|
| Rate for Payer: Signature Care PPO |
$102.11
|
| Rate for Payer: United Healthcare Commercial |
$91.44
|
|
|
HC IGE
|
Facility
OP
|
$179.52
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
63001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$166.95 |
| Rate for Payer: Aetna Commercial |
$151.51
|
| Rate for Payer: Aetna Medicare |
$59.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.17
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Centivo All Commercial |
$91.56
|
| Rate for Payer: Cigna All Commercial |
$154.93
|
| Rate for Payer: CORVEL All Commercial |
$166.95
|
| Rate for Payer: Coventry All Commercial |
$157.98
|
| Rate for Payer: Encore All Commercial |
$165.25
|
| Rate for Payer: Frontpath All Commercial |
$165.16
|
| Rate for Payer: Humana ChoiceCare |
$155.05
|
| Rate for Payer: Humana Medicare |
$91.56
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.57
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: MDWise Medicaid |
$16.46
|
| Rate for Payer: PHCS All Commercial |
$134.64
|
| Rate for Payer: PHP All Commercial |
$136.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.01
|
| Rate for Payer: Sagamore Health Network All Products |
$138.59
|
| Rate for Payer: Signature Care EPO |
$149.00
|
| Rate for Payer: Signature Care PPO |
$157.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.59
|
| Rate for Payer: United Healthcare Commercial |
$141.46
|
| Rate for Payer: United Healthcare Medicare |
$59.24
|
|
