|
HC MONITORED ANESTH INITIAL 15 MIN
|
Facility
|
OP
|
$196.43
|
|
| Hospital Charge Code |
1246654
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$62.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.14
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Centivo All Commercial |
$106.86
|
| Rate for Payer: Cigna All Commercial |
$169.52
|
| Rate for Payer: CORVEL All Commercial |
$182.68
|
| Rate for Payer: Coventry All Commercial |
$172.86
|
| Rate for Payer: Encore All Commercial |
$180.81
|
| Rate for Payer: Frontpath All Commercial |
$180.72
|
| Rate for Payer: Humana ChoiceCare |
$169.66
|
| Rate for Payer: Humana Medicare |
$62.86
|
| Rate for Payer: Lucent All Commercial |
$106.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.79
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$147.32
|
| Rate for Payer: PHP All Commercial |
$148.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.61
|
| Rate for Payer: Sagamore Health Network All Products |
$151.64
|
| Rate for Payer: Signature Care EPO |
$163.04
|
| Rate for Payer: Signature Care PPO |
$172.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$166.97
|
| Rate for Payer: United Healthcare Commercial |
$154.79
|
| Rate for Payer: United Healthcare Medicare |
$62.86
|
|
|
HC MONO SPOT TEST
|
Facility
|
OP
|
$135.76
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
63001277
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$126.26 |
| Rate for Payer: Aetna Commercial |
$114.58
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.79
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centivo All Commercial |
$73.85
|
| Rate for Payer: Cigna All Commercial |
$117.16
|
| Rate for Payer: CORVEL All Commercial |
$126.26
|
| Rate for Payer: Coventry All Commercial |
$119.47
|
| Rate for Payer: Encore All Commercial |
$124.97
|
| Rate for Payer: Frontpath All Commercial |
$124.90
|
| Rate for Payer: Humana ChoiceCare |
$117.26
|
| Rate for Payer: Humana Medicare |
$43.44
|
| Rate for Payer: Lucent All Commercial |
$73.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$101.82
|
| Rate for Payer: PHP All Commercial |
$102.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.95
|
| Rate for Payer: Sagamore Health Network All Products |
$104.81
|
| Rate for Payer: Signature Care EPO |
$112.68
|
| Rate for Payer: Signature Care PPO |
$119.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.40
|
| Rate for Payer: United Healthcare Commercial |
$106.98
|
| Rate for Payer: United Healthcare Medicare |
$43.44
|
|
|
HC MONO SPOT TEST
|
Facility
|
IP
|
$135.76
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
63001277
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$126.26 |
| Rate for Payer: Aetna Commercial |
$117.30
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cigna All Commercial |
$117.16
|
| Rate for Payer: CORVEL All Commercial |
$126.26
|
| Rate for Payer: Coventry All Commercial |
$119.47
|
| Rate for Payer: Encore All Commercial |
$124.97
|
| Rate for Payer: Frontpath All Commercial |
$124.90
|
| Rate for Payer: Humana ChoiceCare |
$117.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.18
|
| Rate for Payer: PHCS All Commercial |
$101.82
|
| Rate for Payer: PHP All Commercial |
$102.96
|
| Rate for Payer: Sagamore Health Network All Products |
$104.81
|
| Rate for Payer: Signature Care EPO |
$112.68
|
| Rate for Payer: Signature Care PPO |
$119.47
|
| Rate for Payer: United Healthcare Commercial |
$106.98
|
|
|
HC M. PNEUMONIAE, AMPLIFIED PROBE
|
Facility
|
IP
|
$66.66
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
63002045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna All Commercial |
$57.53
|
| Rate for Payer: CORVEL All Commercial |
$61.99
|
| Rate for Payer: Coventry All Commercial |
$58.66
|
| Rate for Payer: Encore All Commercial |
$61.36
|
| Rate for Payer: Frontpath All Commercial |
$61.33
|
| Rate for Payer: Humana ChoiceCare |
$57.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.99
|
| Rate for Payer: PHCS All Commercial |
$49.99
|
| Rate for Payer: PHP All Commercial |
$50.55
|
| Rate for Payer: Sagamore Health Network All Products |
$51.46
|
| Rate for Payer: Signature Care EPO |
$55.33
|
| Rate for Payer: Signature Care PPO |
$58.66
|
| Rate for Payer: United Healthcare Commercial |
$52.53
|
|
|
HC M. PNEUMONIAE, AMPLIFIED PROBE
|
Facility
|
OP
|
$66.66
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
63002045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Aetna Medicare |
$21.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$30.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.46
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Centivo All Commercial |
$36.26
|
| Rate for Payer: Cigna All Commercial |
$57.53
|
| Rate for Payer: CORVEL All Commercial |
$61.99
|
| Rate for Payer: Coventry All Commercial |
$58.66
|
| Rate for Payer: Encore All Commercial |
$61.36
|
| Rate for Payer: Frontpath All Commercial |
$61.33
|
| Rate for Payer: Humana ChoiceCare |
$57.57
|
| Rate for Payer: Humana Medicare |
$21.33
|
| Rate for Payer: Lucent All Commercial |
$36.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.99
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$49.99
|
| Rate for Payer: PHP All Commercial |
$50.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.00
|
| Rate for Payer: Sagamore Health Network All Products |
$51.46
|
| Rate for Payer: Signature Care EPO |
$55.33
|
| Rate for Payer: Signature Care PPO |
$58.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.66
|
| Rate for Payer: United Healthcare Commercial |
$52.53
|
| Rate for Payer: United Healthcare Medicare |
$21.33
|
|
|
HC MPO/PR3(ANCA) ABS
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$41.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$41.88
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.04
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
| Rate for Payer: United Healthcare Medicare |
$41.88
|
|
|
HC MPO/PR3(ANCA) ABS
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
63001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
|
|
HC MRA ABDOMEN W/WO
|
Facility
|
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
1579949
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA ABDOMEN W/WO
|
Facility
|
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
1579949
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$946.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$231.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$916.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$231.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,088.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,041.22
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Centivo All Commercial |
$1,609.15
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$946.56
|
| Rate for Payer: Lucent All Commercial |
$1,609.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$231.04
|
| Rate for Payer: MDWise Medicaid |
$231.04
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$946.56
|
|
|
HC MRA-HEAD W/CONTRAST
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
1570545
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,938.82
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
|
|
HC MRA-HEAD W/CONTRAST
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
1570545
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$236.49 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,893.94
|
| Rate for Payer: Aetna Medicare |
$718.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$236.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$695.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,288.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,402.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$825.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$789.89
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Centivo All Commercial |
$1,220.74
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Humana Medicare |
$718.08
|
| Rate for Payer: Lucent All Commercial |
$1,220.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: Managed Health Services Medicaid |
$236.49
|
| Rate for Payer: MDWise Medicaid |
$236.49
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$875.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,907.40
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
| Rate for Payer: United Healthcare Medicare |
$718.08
|
|
|
HC MRA-HEAD W/O CONTRAST
|
Facility
|
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
1570544
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$240.45 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$946.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$240.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$916.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$240.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,088.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,041.22
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Centivo All Commercial |
$1,609.15
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$946.56
|
| Rate for Payer: Lucent All Commercial |
$1,609.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$240.45
|
| Rate for Payer: MDWise Medicaid |
$240.45
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$946.56
|
|
|
HC MRA-HEAD W/O CONTRAST
|
Facility
|
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
1570544
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA-HEAD W/WO CONTRAST
|
Facility
|
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
1570546
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$361.58 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$946.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$361.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$916.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$361.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,088.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,041.22
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Centivo All Commercial |
$1,609.15
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$946.56
|
| Rate for Payer: Lucent All Commercial |
$1,609.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$361.58
|
| Rate for Payer: MDWise Medicaid |
$361.58
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$946.56
|
|
|
HC MRA-HEAD W/WO CONTRAST
|
Facility
|
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
1570546
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA-NECK W/CONTRAST
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
1570548
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,893.94
|
| Rate for Payer: Aetna Medicare |
$718.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$255.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$695.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,288.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,402.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$255.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$825.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$789.89
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Centivo All Commercial |
$1,220.74
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Humana Medicare |
$718.08
|
| Rate for Payer: Lucent All Commercial |
$1,220.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: Managed Health Services Medicaid |
$255.31
|
| Rate for Payer: MDWise Medicaid |
$255.31
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$875.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,907.40
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
| Rate for Payer: United Healthcare Medicare |
$718.08
|
|
|
HC MRA-NECK W/CONTRAST
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
1570548
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,938.82
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
|
|
HC MRA-NECK W/O CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
1570547
|
|
Hospital Revenue Code
|
615
|
| 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 MRA-NECK W/O CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
1570547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$241.19 |
| 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 |
$241.19
|
| 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 |
$241.19
|
| 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 |
$241.19
|
| Rate for Payer: MDWise Medicaid |
$241.19
|
| 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 MRA-NECK W/WO CONTRAST
|
Facility
|
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1570549
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA-NECK W/WO CONTRAST
|
Facility
|
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
1570549
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$364.55 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$946.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$364.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$916.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$364.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,088.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,041.22
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Centivo All Commercial |
$1,609.15
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$946.56
|
| Rate for Payer: Lucent All Commercial |
$1,609.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$364.55
|
| Rate for Payer: MDWise Medicaid |
$364.55
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$946.56
|
|
|
HC MRI-ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
1575182
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,938.82
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
|
|
HC MRI-ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
1575182
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$263.24 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,893.94
|
| Rate for Payer: Aetna Medicare |
$718.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$263.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$695.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,288.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,402.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$263.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$825.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$789.89
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Centivo All Commercial |
$1,220.74
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Humana Medicare |
$718.08
|
| Rate for Payer: Lucent All Commercial |
$1,220.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: Managed Health Services Medicaid |
$263.24
|
| Rate for Payer: MDWise Medicaid |
$263.24
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$875.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,907.40
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
| Rate for Payer: United Healthcare Medicare |
$718.08
|
|
|
HC MRI-ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
1574181
|
|
Hospital Revenue Code
|
610
|
| 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 MRI-ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
1574181
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$183.97 |
| 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 |
$183.97
|
| 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 |
$183.97
|
| 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 |
$183.97
|
| Rate for Payer: MDWise Medicaid |
$183.97
|
| 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
|
|
