|
HC SHOULDER ARTHROGRAM RT
|
Facility
|
OP
|
$924.49
|
|
|
Service Code
|
CPT 73040 RT
|
| Hospital Charge Code |
11616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$859.78 |
| Rate for Payer: Aetna Commercial |
$780.27
|
| Rate for Payer: Aetna Medicare |
$295.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$54.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$286.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$530.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.42
|
| Rate for Payer: Cash Price |
$554.69
|
| Rate for Payer: Cash Price |
$554.69
|
| Rate for Payer: Centivo All Commercial |
$502.92
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.78
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Humana Medicare |
$295.84
|
| Rate for Payer: Lucent All Commercial |
$502.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: Managed Health Services Medicaid |
$54.66
|
| Rate for Payer: MDWise Medicaid |
$54.66
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.55
|
| Rate for Payer: Sagamore Health Network All Products |
$713.71
|
| Rate for Payer: Signature Care EPO |
$767.33
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.82
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
| Rate for Payer: United Healthcare Medicare |
$295.84
|
|
|
HC SHOULDER ARTHROGRAM RT
|
Facility
|
IP
|
$924.49
|
|
|
Service Code
|
CPT 73040 RT
|
| Hospital Charge Code |
11616073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$693.37 |
| Max. Negotiated Rate |
$859.78 |
| Rate for Payer: Aetna Commercial |
$798.76
|
| Rate for Payer: Cash Price |
$554.69
|
| Rate for Payer: Cigna All Commercial |
$797.83
|
| Rate for Payer: CORVEL All Commercial |
$859.78
|
| Rate for Payer: Coventry All Commercial |
$813.55
|
| Rate for Payer: Encore All Commercial |
$850.99
|
| Rate for Payer: Frontpath All Commercial |
$850.53
|
| Rate for Payer: Humana ChoiceCare |
$798.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$832.04
|
| Rate for Payer: PHCS All Commercial |
$693.37
|
| Rate for Payer: PHP All Commercial |
$701.13
|
| Rate for Payer: Sagamore Health Network All Products |
$713.71
|
| Rate for Payer: Signature Care EPO |
$767.33
|
| Rate for Payer: Signature Care PPO |
$813.55
|
| Rate for Payer: United Healthcare Commercial |
$728.50
|
|
|
HC SICKLE CELL SCR
|
Facility
|
IP
|
$62.64
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
63001323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cigna All Commercial |
$54.06
|
| Rate for Payer: CORVEL All Commercial |
$58.26
|
| Rate for Payer: Coventry All Commercial |
$55.12
|
| Rate for Payer: Encore All Commercial |
$57.66
|
| Rate for Payer: Frontpath All Commercial |
$57.63
|
| Rate for Payer: Humana ChoiceCare |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.38
|
| Rate for Payer: PHCS All Commercial |
$46.98
|
| Rate for Payer: PHP All Commercial |
$47.51
|
| Rate for Payer: Sagamore Health Network All Products |
$48.36
|
| Rate for Payer: Signature Care EPO |
$51.99
|
| Rate for Payer: Signature Care PPO |
$55.12
|
| Rate for Payer: United Healthcare Commercial |
$49.36
|
|
|
HC SICKLE CELL SCR
|
Facility
|
OP
|
$62.64
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
63001323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.87
|
| Rate for Payer: Aetna Medicare |
$20.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.05
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Centivo All Commercial |
$34.08
|
| Rate for Payer: Cigna All Commercial |
$54.06
|
| Rate for Payer: CORVEL All Commercial |
$58.26
|
| Rate for Payer: Coventry All Commercial |
$55.12
|
| Rate for Payer: Encore All Commercial |
$57.66
|
| Rate for Payer: Frontpath All Commercial |
$57.63
|
| Rate for Payer: Humana ChoiceCare |
$54.10
|
| Rate for Payer: Humana Medicare |
$20.04
|
| Rate for Payer: Lucent All Commercial |
$34.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.51
|
| Rate for Payer: MDWise Medicaid |
$5.51
|
| Rate for Payer: PHCS All Commercial |
$46.98
|
| Rate for Payer: PHP All Commercial |
$47.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.43
|
| Rate for Payer: Sagamore Health Network All Products |
$48.36
|
| Rate for Payer: Signature Care EPO |
$51.99
|
| Rate for Payer: Signature Care PPO |
$55.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.24
|
| Rate for Payer: United Healthcare Commercial |
$49.36
|
| Rate for Payer: United Healthcare Medicare |
$20.04
|
|
|
HC SIMULATION-COMPLEX
|
Facility
|
IP
|
$2,333.76
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
1547290
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,750.32 |
| Max. Negotiated Rate |
$2,170.40 |
| Rate for Payer: Aetna Commercial |
$2,016.37
|
| Rate for Payer: Cash Price |
$1,400.26
|
| Rate for Payer: Cigna All Commercial |
$2,014.03
|
| Rate for Payer: CORVEL All Commercial |
$2,170.40
|
| Rate for Payer: Coventry All Commercial |
$2,053.71
|
| Rate for Payer: Encore All Commercial |
$2,148.23
|
| Rate for Payer: Frontpath All Commercial |
$2,147.06
|
| Rate for Payer: Humana ChoiceCare |
$2,015.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,100.38
|
| Rate for Payer: PHCS All Commercial |
$1,750.32
|
| Rate for Payer: PHP All Commercial |
$1,769.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,801.66
|
| Rate for Payer: Signature Care EPO |
$1,937.02
|
| Rate for Payer: Signature Care PPO |
$2,053.71
|
| Rate for Payer: United Healthcare Commercial |
$1,839.00
|
|
|
HC SIMULATION-COMPLEX
|
Facility
|
OP
|
$2,333.76
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
1547290
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$2,170.40 |
| Rate for Payer: Aetna Commercial |
$1,969.69
|
| Rate for Payer: Aetna Medicare |
$746.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$294.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$723.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,340.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,458.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$294.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$858.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$821.48
|
| Rate for Payer: Cash Price |
$1,400.26
|
| Rate for Payer: Cash Price |
$1,400.26
|
| Rate for Payer: Centivo All Commercial |
$1,269.57
|
| Rate for Payer: Cigna All Commercial |
$2,014.03
|
| Rate for Payer: CORVEL All Commercial |
$2,170.40
|
| Rate for Payer: Coventry All Commercial |
$2,053.71
|
| Rate for Payer: Encore All Commercial |
$2,148.23
|
| Rate for Payer: Frontpath All Commercial |
$2,147.06
|
| Rate for Payer: Humana ChoiceCare |
$2,015.67
|
| Rate for Payer: Humana Medicare |
$746.80
|
| Rate for Payer: Lucent All Commercial |
$1,269.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,100.38
|
| Rate for Payer: Managed Health Services Medicaid |
$294.70
|
| Rate for Payer: MDWise Medicaid |
$294.70
|
| Rate for Payer: PHCS All Commercial |
$1,750.32
|
| Rate for Payer: PHP All Commercial |
$1,769.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$910.17
|
| Rate for Payer: Sagamore Health Network All Products |
$1,801.66
|
| Rate for Payer: Signature Care EPO |
$1,937.02
|
| Rate for Payer: Signature Care PPO |
$2,053.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,983.70
|
| Rate for Payer: United Healthcare Commercial |
$1,839.00
|
| Rate for Payer: United Healthcare Medicare |
$746.80
|
|
|
HC SIMULATION-INTERMEDIATE
|
Facility
|
OP
|
$2,121.60
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
1547285
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$254.82 |
| Max. Negotiated Rate |
$1,973.09 |
| Rate for Payer: Aetna Commercial |
$1,790.63
|
| Rate for Payer: Aetna Medicare |
$678.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$254.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$657.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,218.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,326.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$254.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$780.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$746.80
|
| Rate for Payer: Cash Price |
$1,272.96
|
| Rate for Payer: Cash Price |
$1,272.96
|
| Rate for Payer: Centivo All Commercial |
$1,154.15
|
| Rate for Payer: Cigna All Commercial |
$1,830.94
|
| Rate for Payer: CORVEL All Commercial |
$1,973.09
|
| Rate for Payer: Coventry All Commercial |
$1,867.01
|
| Rate for Payer: Encore All Commercial |
$1,952.93
|
| Rate for Payer: Frontpath All Commercial |
$1,951.87
|
| Rate for Payer: Humana ChoiceCare |
$1,832.43
|
| Rate for Payer: Humana Medicare |
$678.91
|
| Rate for Payer: Lucent All Commercial |
$1,154.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,909.44
|
| Rate for Payer: Managed Health Services Medicaid |
$254.82
|
| Rate for Payer: MDWise Medicaid |
$254.82
|
| Rate for Payer: PHCS All Commercial |
$1,591.20
|
| Rate for Payer: PHP All Commercial |
$1,609.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$827.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,637.88
|
| Rate for Payer: Signature Care EPO |
$1,760.93
|
| Rate for Payer: Signature Care PPO |
$1,867.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare Commercial |
$1,671.82
|
| Rate for Payer: United Healthcare Medicare |
$678.91
|
|
|
HC SIMULATION-INTERMEDIATE
|
Facility
|
IP
|
$2,121.60
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
1547285
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,591.20 |
| Max. Negotiated Rate |
$1,973.09 |
| Rate for Payer: Aetna Commercial |
$1,833.06
|
| Rate for Payer: Cash Price |
$1,272.96
|
| Rate for Payer: Cigna All Commercial |
$1,830.94
|
| Rate for Payer: CORVEL All Commercial |
$1,973.09
|
| Rate for Payer: Coventry All Commercial |
$1,867.01
|
| Rate for Payer: Encore All Commercial |
$1,952.93
|
| Rate for Payer: Frontpath All Commercial |
$1,951.87
|
| Rate for Payer: Humana ChoiceCare |
$1,832.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,909.44
|
| Rate for Payer: PHCS All Commercial |
$1,591.20
|
| Rate for Payer: PHP All Commercial |
$1,609.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,637.88
|
| Rate for Payer: Signature Care EPO |
$1,760.93
|
| Rate for Payer: Signature Care PPO |
$1,867.01
|
| Rate for Payer: United Healthcare Commercial |
$1,671.82
|
|
|
HC SIMULATION-SIMPLE
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
1547280
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,338.75 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna All Commercial |
$1,540.45
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
|
|
HC SIMULATION-SIMPLE
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
1547280
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$162.67 |
| Max. Negotiated Rate |
$1,660.05 |
| Rate for Payer: Aetna Commercial |
$1,506.54
|
| Rate for Payer: Aetna Medicare |
$571.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$162.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$553.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,025.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,115.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$162.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$656.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$628.32
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Centivo All Commercial |
$971.04
|
| Rate for Payer: Cigna All Commercial |
$1,540.45
|
| Rate for Payer: CORVEL All Commercial |
$1,660.05
|
| Rate for Payer: Coventry All Commercial |
$1,570.80
|
| Rate for Payer: Encore All Commercial |
$1,643.09
|
| Rate for Payer: Frontpath All Commercial |
$1,642.20
|
| Rate for Payer: Humana ChoiceCare |
$1,541.70
|
| Rate for Payer: Humana Medicare |
$571.20
|
| Rate for Payer: Lucent All Commercial |
$971.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,606.50
|
| Rate for Payer: Managed Health Services Medicaid |
$162.67
|
| Rate for Payer: MDWise Medicaid |
$162.67
|
| Rate for Payer: PHCS All Commercial |
$1,338.75
|
| Rate for Payer: PHP All Commercial |
$1,353.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$696.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,378.02
|
| Rate for Payer: Signature Care EPO |
$1,481.55
|
| Rate for Payer: Signature Care PPO |
$1,570.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,517.25
|
| Rate for Payer: United Healthcare Commercial |
$1,406.58
|
| Rate for Payer: United Healthcare Medicare |
$571.20
|
|
|
HC SION INSTRUMENT
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
41608385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Aetna Commercial |
$1,899.00
|
| Rate for Payer: Aetna Medicare |
$720.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$697.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,292.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,406.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$828.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$792.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Centivo All Commercial |
$1,224.00
|
| Rate for Payer: Cigna All Commercial |
$1,941.75
|
| Rate for Payer: CORVEL All Commercial |
$2,092.50
|
| Rate for Payer: Coventry All Commercial |
$1,980.00
|
| Rate for Payer: Encore All Commercial |
$2,071.12
|
| Rate for Payer: Frontpath All Commercial |
$2,070.00
|
| Rate for Payer: Humana ChoiceCare |
$1,943.33
|
| Rate for Payer: Humana Medicare |
$720.00
|
| Rate for Payer: Lucent All Commercial |
$1,224.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,025.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,687.50
|
| Rate for Payer: PHP All Commercial |
$1,706.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$877.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,737.00
|
| Rate for Payer: Signature Care EPO |
$1,867.50
|
| Rate for Payer: Signature Care PPO |
$1,980.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,912.50
|
| Rate for Payer: United Healthcare Commercial |
$1,773.00
|
| Rate for Payer: United Healthcare Medicare |
$720.00
|
|
|
HC SION INSTRUMENT
|
Facility
|
IP
|
$2,250.00
|
|
| Hospital Charge Code |
41608385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Aetna Commercial |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna All Commercial |
$1,941.75
|
| Rate for Payer: CORVEL All Commercial |
$2,092.50
|
| Rate for Payer: Coventry All Commercial |
$1,980.00
|
| Rate for Payer: Encore All Commercial |
$2,071.12
|
| Rate for Payer: Frontpath All Commercial |
$2,070.00
|
| Rate for Payer: Humana ChoiceCare |
$1,943.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,025.00
|
| Rate for Payer: PHCS All Commercial |
$1,687.50
|
| Rate for Payer: PHP All Commercial |
$1,706.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,737.00
|
| Rate for Payer: Signature Care EPO |
$1,867.50
|
| Rate for Payer: Signature Care PPO |
$1,980.00
|
| Rate for Payer: United Healthcare Commercial |
$1,773.00
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$284.29
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
63001379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$264.39 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Cash Price |
$170.57
|
| Rate for Payer: Cigna All Commercial |
$245.34
|
| Rate for Payer: CORVEL All Commercial |
$264.39
|
| Rate for Payer: Coventry All Commercial |
$250.18
|
| Rate for Payer: Encore All Commercial |
$261.69
|
| Rate for Payer: Frontpath All Commercial |
$261.55
|
| Rate for Payer: Humana ChoiceCare |
$245.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.86
|
| Rate for Payer: PHCS All Commercial |
$213.22
|
| Rate for Payer: PHP All Commercial |
$215.61
|
| Rate for Payer: Sagamore Health Network All Products |
$219.47
|
| Rate for Payer: Signature Care EPO |
$235.96
|
| Rate for Payer: Signature Care PPO |
$250.18
|
| Rate for Payer: United Healthcare Commercial |
$224.02
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$284.29
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
63001379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$264.39 |
| Rate for Payer: Aetna Commercial |
$239.94
|
| Rate for Payer: Aetna Medicare |
$90.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$88.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$130.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$130.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.07
|
| Rate for Payer: Cash Price |
$170.57
|
| Rate for Payer: Cash Price |
$170.57
|
| Rate for Payer: Centivo All Commercial |
$154.65
|
| Rate for Payer: Cigna All Commercial |
$245.34
|
| Rate for Payer: CORVEL All Commercial |
$264.39
|
| Rate for Payer: Coventry All Commercial |
$250.18
|
| Rate for Payer: Encore All Commercial |
$261.69
|
| Rate for Payer: Frontpath All Commercial |
$261.55
|
| Rate for Payer: Humana ChoiceCare |
$245.54
|
| Rate for Payer: Humana Medicare |
$90.97
|
| Rate for Payer: Lucent All Commercial |
$154.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.86
|
| Rate for Payer: Managed Health Services Medicaid |
$13.73
|
| Rate for Payer: MDWise Medicaid |
$13.73
|
| Rate for Payer: PHCS All Commercial |
$213.22
|
| Rate for Payer: PHP All Commercial |
$215.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.87
|
| Rate for Payer: Sagamore Health Network All Products |
$219.47
|
| Rate for Payer: Signature Care EPO |
$235.96
|
| Rate for Payer: Signature Care PPO |
$250.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$241.65
|
| Rate for Payer: United Healthcare Commercial |
$224.02
|
| Rate for Payer: United Healthcare Medicare |
$90.97
|
|
|
HC SJORGRENS ANTI
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63002197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$72.57 |
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Medicare |
$24.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.47
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Centivo All Commercial |
$42.45
|
| Rate for Payer: Cigna All Commercial |
$67.34
|
| Rate for Payer: CORVEL All Commercial |
$72.57
|
| Rate for Payer: Coventry All Commercial |
$68.67
|
| Rate for Payer: Encore All Commercial |
$71.83
|
| Rate for Payer: Frontpath All Commercial |
$71.79
|
| Rate for Payer: Humana ChoiceCare |
$67.39
|
| Rate for Payer: Humana Medicare |
$24.97
|
| Rate for Payer: Lucent All Commercial |
$42.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.23
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$58.52
|
| Rate for Payer: PHP All Commercial |
$59.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.43
|
| Rate for Payer: Sagamore Health Network All Products |
$60.24
|
| Rate for Payer: Signature Care EPO |
$64.76
|
| Rate for Payer: Signature Care PPO |
$68.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.33
|
| Rate for Payer: United Healthcare Commercial |
$61.49
|
| Rate for Payer: United Healthcare Medicare |
$24.97
|
|
|
HC SJORGRENS ANTI
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63002197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.52 |
| Max. Negotiated Rate |
$72.57 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cigna All Commercial |
$67.34
|
| Rate for Payer: CORVEL All Commercial |
$72.57
|
| Rate for Payer: Coventry All Commercial |
$68.67
|
| Rate for Payer: Encore All Commercial |
$71.83
|
| Rate for Payer: Frontpath All Commercial |
$71.79
|
| Rate for Payer: Humana ChoiceCare |
$67.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.23
|
| Rate for Payer: PHCS All Commercial |
$58.52
|
| Rate for Payer: PHP All Commercial |
$59.18
|
| Rate for Payer: Sagamore Health Network All Products |
$60.24
|
| Rate for Payer: Signature Care EPO |
$64.76
|
| Rate for Payer: Signature Care PPO |
$68.67
|
| Rate for Payer: United Healthcare Commercial |
$61.49
|
|
|
HC SKIN STAPLER 35W
|
Facility
|
IP
|
$63.74
|
|
| Hospital Charge Code |
41601099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$55.07
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Cigna All Commercial |
$55.01
|
| Rate for Payer: CORVEL All Commercial |
$59.28
|
| Rate for Payer: Coventry All Commercial |
$56.09
|
| Rate for Payer: Encore All Commercial |
$58.67
|
| Rate for Payer: Frontpath All Commercial |
$58.64
|
| Rate for Payer: Humana ChoiceCare |
$55.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.37
|
| Rate for Payer: PHCS All Commercial |
$47.80
|
| Rate for Payer: PHP All Commercial |
$48.34
|
| Rate for Payer: Sagamore Health Network All Products |
$49.21
|
| Rate for Payer: Signature Care EPO |
$52.90
|
| Rate for Payer: Signature Care PPO |
$56.09
|
| Rate for Payer: United Healthcare Commercial |
$50.23
|
|
|
HC SKIN STAPLER 35W
|
Facility
|
OP
|
$63.74
|
|
| Hospital Charge Code |
41601099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$53.80
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.44
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Centivo All Commercial |
$34.67
|
| Rate for Payer: Cigna All Commercial |
$55.01
|
| Rate for Payer: CORVEL All Commercial |
$59.28
|
| Rate for Payer: Coventry All Commercial |
$56.09
|
| Rate for Payer: Encore All Commercial |
$58.67
|
| Rate for Payer: Frontpath All Commercial |
$58.64
|
| Rate for Payer: Humana ChoiceCare |
$55.05
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Lucent All Commercial |
$34.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$47.80
|
| Rate for Payer: PHP All Commercial |
$48.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.86
|
| Rate for Payer: Sagamore Health Network All Products |
$49.21
|
| Rate for Payer: Signature Care EPO |
$52.90
|
| Rate for Payer: Signature Care PPO |
$56.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.18
|
| Rate for Payer: United Healthcare Commercial |
$50.23
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
|
|
HC S K-WIRE .045
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$286.44 |
| Rate for Payer: Aetna Commercial |
$259.95
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$176.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.42
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Centivo All Commercial |
$167.55
|
| Rate for Payer: Cigna All Commercial |
$265.80
|
| Rate for Payer: CORVEL All Commercial |
$286.44
|
| Rate for Payer: Coventry All Commercial |
$271.04
|
| Rate for Payer: Encore All Commercial |
$283.51
|
| Rate for Payer: Frontpath All Commercial |
$283.36
|
| Rate for Payer: Humana ChoiceCare |
$266.02
|
| Rate for Payer: Humana Medicare |
$98.56
|
| Rate for Payer: Lucent All Commercial |
$167.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.20
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$231.00
|
| Rate for Payer: PHP All Commercial |
$233.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.12
|
| Rate for Payer: Sagamore Health Network All Products |
$237.78
|
| Rate for Payer: Signature Care EPO |
$255.64
|
| Rate for Payer: Signature Care PPO |
$271.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$261.80
|
| Rate for Payer: United Healthcare Commercial |
$242.70
|
| Rate for Payer: United Healthcare Medicare |
$98.56
|
|
|
HC S K-WIRE .045
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$286.44 |
| Rate for Payer: Aetna Commercial |
$266.11
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna All Commercial |
$265.80
|
| Rate for Payer: CORVEL All Commercial |
$286.44
|
| Rate for Payer: Coventry All Commercial |
$271.04
|
| Rate for Payer: Encore All Commercial |
$283.51
|
| Rate for Payer: Frontpath All Commercial |
$283.36
|
| Rate for Payer: Humana ChoiceCare |
$266.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.20
|
| Rate for Payer: PHCS All Commercial |
$231.00
|
| Rate for Payer: PHP All Commercial |
$233.59
|
| Rate for Payer: Sagamore Health Network All Products |
$237.78
|
| Rate for Payer: Signature Care EPO |
$255.64
|
| Rate for Payer: Signature Care PPO |
$271.04
|
| Rate for Payer: United Healthcare Commercial |
$242.70
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM <6 HRS RECORDING
|
Facility
|
OP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810 52
|
| Hospital Charge Code |
1369810
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,000.51
|
| Rate for Payer: Aetna Medicare |
$1,895.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,836.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,402.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,703.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,180.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,085.52
|
| Rate for Payer: Cash Price |
$3,554.86
|
| Rate for Payer: Cash Price |
$3,554.86
|
| Rate for Payer: Centivo All Commercial |
$3,223.07
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.22
|
| Rate for Payer: Humana Medicare |
$1,895.93
|
| Rate for Payer: Lucent All Commercial |
$3,223.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: Managed Health Services Medicaid |
$200.10
|
| Rate for Payer: MDWise Medicaid |
$200.10
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,310.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,036.05
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
| Rate for Payer: United Healthcare Medicare |
$1,895.93
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM <6 HRS RECORDING
|
Facility
|
IP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810 52
|
| Hospital Charge Code |
1369810
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,443.58 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,119.00
|
| Rate for Payer: Cash Price |
$3,554.86
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM 6+ HRS RECORDING
|
Facility
|
IP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
1520010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,443.58 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,119.00
|
| Rate for Payer: Cash Price |
$3,554.86
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
|
|
HC SLEEP STUDY 6/> YRS 4/> PARAM 6+ HRS RECORDING
|
Facility
|
OP
|
$5,924.77
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
1520010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$5,510.04 |
| Rate for Payer: Aetna Commercial |
$5,000.51
|
| Rate for Payer: Aetna Medicare |
$1,895.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,836.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,402.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,703.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,180.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,085.52
|
| Rate for Payer: Cash Price |
$3,554.86
|
| Rate for Payer: Cash Price |
$3,554.86
|
| Rate for Payer: Centivo All Commercial |
$3,223.07
|
| Rate for Payer: Cigna All Commercial |
$5,113.08
|
| Rate for Payer: CORVEL All Commercial |
$5,510.04
|
| Rate for Payer: Coventry All Commercial |
$5,213.80
|
| Rate for Payer: Encore All Commercial |
$5,453.75
|
| Rate for Payer: Frontpath All Commercial |
$5,450.79
|
| Rate for Payer: Humana ChoiceCare |
$5,117.22
|
| Rate for Payer: Humana Medicare |
$1,895.93
|
| Rate for Payer: Lucent All Commercial |
$3,223.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,332.29
|
| Rate for Payer: Managed Health Services Medicaid |
$200.10
|
| Rate for Payer: MDWise Medicaid |
$200.10
|
| Rate for Payer: PHCS All Commercial |
$4,443.58
|
| Rate for Payer: PHP All Commercial |
$4,493.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,310.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,573.92
|
| Rate for Payer: Signature Care EPO |
$4,917.56
|
| Rate for Payer: Signature Care PPO |
$5,213.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,036.05
|
| Rate for Payer: United Healthcare Commercial |
$4,668.72
|
| Rate for Payer: United Healthcare Medicare |
$1,895.93
|
|
|
HC SLEEVE ICED KNEE LARGE
|
Facility
|
OP
|
$259.14
|
|
| Hospital Charge Code |
41602162
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna Commercial |
$218.71
|
| Rate for Payer: Aetna Medicare |
$82.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$148.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.22
|
| Rate for Payer: Cash Price |
$155.48
|
| Rate for Payer: Cash Price |
$155.48
|
| Rate for Payer: Centivo All Commercial |
$140.97
|
| Rate for Payer: Cigna All Commercial |
$223.64
|
| Rate for Payer: CORVEL All Commercial |
$241.00
|
| Rate for Payer: Coventry All Commercial |
$228.04
|
| Rate for Payer: Encore All Commercial |
$238.54
|
| Rate for Payer: Frontpath All Commercial |
$238.41
|
| Rate for Payer: Humana ChoiceCare |
$223.82
|
| Rate for Payer: Humana Medicare |
$82.92
|
| Rate for Payer: Lucent All Commercial |
$140.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.23
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$194.35
|
| Rate for Payer: PHP All Commercial |
$196.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.06
|
| Rate for Payer: Sagamore Health Network All Products |
$200.06
|
| Rate for Payer: Signature Care EPO |
$215.09
|
| Rate for Payer: Signature Care PPO |
$228.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.27
|
| Rate for Payer: United Healthcare Commercial |
$204.20
|
| Rate for Payer: United Healthcare Medicare |
$82.92
|
|
