|
HC OT EVAL MOD COMPLEX 45 MIN
|
Facility
IP
|
$483.48
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
01737166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$362.61 |
| Max. Negotiated Rate |
$449.64 |
| Rate for Payer: Aetna Commercial |
$417.73
|
| Rate for Payer: Cash Price |
$299.76
|
| Rate for Payer: Cigna All Commercial |
$417.24
|
| Rate for Payer: CORVEL All Commercial |
$449.64
|
| Rate for Payer: Coventry All Commercial |
$425.46
|
| Rate for Payer: Encore All Commercial |
$445.04
|
| Rate for Payer: Frontpath All Commercial |
$444.80
|
| Rate for Payer: Humana ChoiceCare |
$417.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.13
|
| Rate for Payer: PHCS All Commercial |
$362.61
|
| Rate for Payer: PHP All Commercial |
$366.67
|
| Rate for Payer: Sagamore Health Network All Products |
$373.25
|
| Rate for Payer: Signature Care EPO |
$401.29
|
| Rate for Payer: Signature Care PPO |
$425.46
|
| Rate for Payer: United Healthcare Commercial |
$380.98
|
|
|
HC OT EVAL MOD COMPLEX 45 MIN
|
Facility
OP
|
$483.48
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
01737166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$159.55 |
| Max. Negotiated Rate |
$449.64 |
| Rate for Payer: Aetna Commercial |
$408.06
|
| Rate for Payer: Aetna Medicare |
$159.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.50
|
| Rate for Payer: Cash Price |
$299.76
|
| Rate for Payer: Centivo All Commercial |
$246.57
|
| Rate for Payer: Cigna All Commercial |
$417.24
|
| Rate for Payer: CORVEL All Commercial |
$449.64
|
| Rate for Payer: Coventry All Commercial |
$425.46
|
| Rate for Payer: Encore All Commercial |
$445.04
|
| Rate for Payer: Frontpath All Commercial |
$444.80
|
| Rate for Payer: Humana ChoiceCare |
$417.58
|
| Rate for Payer: Humana Medicare |
$246.57
|
| Rate for Payer: Lucent All Commercial |
$246.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.13
|
| Rate for Payer: PHCS All Commercial |
$362.61
|
| Rate for Payer: PHP All Commercial |
$366.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.56
|
| Rate for Payer: Sagamore Health Network All Products |
$373.25
|
| Rate for Payer: Signature Care EPO |
$401.29
|
| Rate for Payer: Signature Care PPO |
$425.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.96
|
| Rate for Payer: United Healthcare Commercial |
$380.98
|
| Rate for Payer: United Healthcare Medicare |
$159.55
|
|
|
HC OTI DYNAMO SP10 BTE HA MON
|
Facility
IP
|
$4,019.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603683
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,014.55 |
| Max. Negotiated Rate |
$3,738.04 |
| Rate for Payer: Aetna Commercial |
$3,472.76
|
| Rate for Payer: Cash Price |
$2,492.03
|
| Rate for Payer: Cigna All Commercial |
$3,468.74
|
| Rate for Payer: CORVEL All Commercial |
$3,738.04
|
| Rate for Payer: Coventry All Commercial |
$3,537.07
|
| Rate for Payer: Encore All Commercial |
$3,699.86
|
| Rate for Payer: Frontpath All Commercial |
$3,697.85
|
| Rate for Payer: Humana ChoiceCare |
$3,471.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,617.46
|
| Rate for Payer: PHCS All Commercial |
$3,014.55
|
| Rate for Payer: PHP All Commercial |
$3,048.31
|
| Rate for Payer: Sagamore Health Network All Products |
$3,102.98
|
| Rate for Payer: Signature Care EPO |
$3,336.10
|
| Rate for Payer: Signature Care PPO |
$3,537.07
|
| Rate for Payer: United Healthcare Commercial |
$3,167.29
|
|
|
HC OTI DYNAMO SP10 BTE HA MON
|
Facility
OP
|
$4,019.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603683
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,738.04 |
| Rate for Payer: Aetna Commercial |
$3,392.37
|
| Rate for Payer: Aetna Medicare |
$1,326.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,326.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,308.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,512.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,525.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,459.04
|
| Rate for Payer: Cash Price |
$2,492.03
|
| Rate for Payer: Cash Price |
$2,492.03
|
| Rate for Payer: Centivo All Commercial |
$2,049.89
|
| Rate for Payer: Cigna All Commercial |
$3,468.74
|
| Rate for Payer: CORVEL All Commercial |
$3,738.04
|
| Rate for Payer: Coventry All Commercial |
$3,537.07
|
| Rate for Payer: Encore All Commercial |
$3,699.86
|
| Rate for Payer: Frontpath All Commercial |
$3,697.85
|
| Rate for Payer: Humana ChoiceCare |
$3,471.56
|
| Rate for Payer: Humana Medicare |
$2,049.89
|
| Rate for Payer: Lucent All Commercial |
$2,049.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,617.46
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$3,014.55
|
| Rate for Payer: PHP All Commercial |
$3,048.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,567.57
|
| Rate for Payer: Sagamore Health Network All Products |
$3,102.98
|
| Rate for Payer: Signature Care EPO |
$3,336.10
|
| Rate for Payer: Signature Care PPO |
$3,537.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,416.49
|
| Rate for Payer: United Healthcare Commercial |
$3,167.29
|
| Rate for Payer: United Healthcare Medicare |
$1,326.40
|
|
|
HC OTI DYNAMO SP4 BTE HA MON
|
Facility
OP
|
$2,380.00
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603685
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,213.40 |
| Rate for Payer: Aetna Commercial |
$2,008.72
|
| Rate for Payer: Aetna Medicare |
$785.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$785.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,366.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,487.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$903.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$863.94
|
| Rate for Payer: Cash Price |
$1,475.60
|
| Rate for Payer: Cash Price |
$1,475.60
|
| Rate for Payer: Centivo All Commercial |
$1,213.80
|
| Rate for Payer: Cigna All Commercial |
$2,053.94
|
| Rate for Payer: CORVEL All Commercial |
$2,213.40
|
| Rate for Payer: Coventry All Commercial |
$2,094.40
|
| Rate for Payer: Encore All Commercial |
$2,190.79
|
| Rate for Payer: Frontpath All Commercial |
$2,189.60
|
| Rate for Payer: Humana ChoiceCare |
$2,055.61
|
| Rate for Payer: Humana Medicare |
$1,213.80
|
| Rate for Payer: Lucent All Commercial |
$1,213.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,142.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,785.00
|
| Rate for Payer: PHP All Commercial |
$1,804.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$928.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,837.36
|
| Rate for Payer: Signature Care EPO |
$1,975.40
|
| Rate for Payer: Signature Care PPO |
$2,094.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,023.00
|
| Rate for Payer: United Healthcare Commercial |
$1,875.44
|
| Rate for Payer: United Healthcare Medicare |
$785.40
|
|
|
HC OTI DYNAMO SP4 BTE HA MON
|
Facility
IP
|
$2,380.00
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603685
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,785.00 |
| Max. Negotiated Rate |
$2,213.40 |
| Rate for Payer: Aetna Commercial |
$2,056.32
|
| Rate for Payer: Cash Price |
$1,475.60
|
| Rate for Payer: Cigna All Commercial |
$2,053.94
|
| Rate for Payer: CORVEL All Commercial |
$2,213.40
|
| Rate for Payer: Coventry All Commercial |
$2,094.40
|
| Rate for Payer: Encore All Commercial |
$2,190.79
|
| Rate for Payer: Frontpath All Commercial |
$2,189.60
|
| Rate for Payer: Humana ChoiceCare |
$2,055.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,142.00
|
| Rate for Payer: PHCS All Commercial |
$1,785.00
|
| Rate for Payer: PHP All Commercial |
$1,804.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,837.36
|
| Rate for Payer: Signature Care EPO |
$1,975.40
|
| Rate for Payer: Signature Care PPO |
$2,094.40
|
| Rate for Payer: United Healthcare Commercial |
$1,875.44
|
|
|
HC OTI DYNAMO SP6 BTE HA MON
|
Facility
IP
|
$2,289.60
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603684
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,717.20 |
| Max. Negotiated Rate |
$2,129.33 |
| Rate for Payer: Aetna Commercial |
$1,978.21
|
| Rate for Payer: Cash Price |
$1,419.55
|
| Rate for Payer: Cigna All Commercial |
$1,975.92
|
| Rate for Payer: CORVEL All Commercial |
$2,129.33
|
| Rate for Payer: Coventry All Commercial |
$2,014.85
|
| Rate for Payer: Encore All Commercial |
$2,107.58
|
| Rate for Payer: Frontpath All Commercial |
$2,106.43
|
| Rate for Payer: Humana ChoiceCare |
$1,977.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,060.64
|
| Rate for Payer: PHCS All Commercial |
$1,717.20
|
| Rate for Payer: PHP All Commercial |
$1,736.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,767.57
|
| Rate for Payer: Signature Care EPO |
$1,900.37
|
| Rate for Payer: Signature Care PPO |
$2,014.85
|
| Rate for Payer: United Healthcare Commercial |
$1,804.20
|
|
|
HC OTI DYNAMO SP6 BTE HA MON
|
Facility
OP
|
$2,289.60
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603684
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,129.33 |
| Rate for Payer: Aetna Commercial |
$1,932.42
|
| Rate for Payer: Aetna Medicare |
$755.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$755.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,314.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,431.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$868.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$831.12
|
| Rate for Payer: Cash Price |
$1,419.55
|
| Rate for Payer: Cash Price |
$1,419.55
|
| Rate for Payer: Centivo All Commercial |
$1,167.70
|
| Rate for Payer: Cigna All Commercial |
$1,975.92
|
| Rate for Payer: CORVEL All Commercial |
$2,129.33
|
| Rate for Payer: Coventry All Commercial |
$2,014.85
|
| Rate for Payer: Encore All Commercial |
$2,107.58
|
| Rate for Payer: Frontpath All Commercial |
$2,106.43
|
| Rate for Payer: Humana ChoiceCare |
$1,977.53
|
| Rate for Payer: Humana Medicare |
$1,167.70
|
| Rate for Payer: Lucent All Commercial |
$1,167.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,060.64
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,717.20
|
| Rate for Payer: PHP All Commercial |
$1,736.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$892.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,767.57
|
| Rate for Payer: Signature Care EPO |
$1,900.37
|
| Rate for Payer: Signature Care PPO |
$2,014.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,946.16
|
| Rate for Payer: United Healthcare Commercial |
$1,804.20
|
| Rate for Payer: United Healthcare Medicare |
$755.57
|
|
|
HC OTI OPN 1 BTE13 PP BTE HA MON
|
Facility
OP
|
$4,309.20
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603679
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$4,007.56 |
| Rate for Payer: Aetna Commercial |
$3,636.96
|
| Rate for Payer: Aetna Medicare |
$1,422.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,422.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,474.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,693.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,635.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,564.24
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Centivo All Commercial |
$2,197.69
|
| Rate for Payer: Cigna All Commercial |
$3,718.84
|
| Rate for Payer: CORVEL All Commercial |
$4,007.56
|
| Rate for Payer: Coventry All Commercial |
$3,792.10
|
| Rate for Payer: Encore All Commercial |
$3,966.62
|
| Rate for Payer: Frontpath All Commercial |
$3,964.46
|
| Rate for Payer: Humana ChoiceCare |
$3,721.86
|
| Rate for Payer: Humana Medicare |
$2,197.69
|
| Rate for Payer: Lucent All Commercial |
$2,197.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,878.28
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$3,231.90
|
| Rate for Payer: PHP All Commercial |
$3,268.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,680.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,326.70
|
| Rate for Payer: Signature Care EPO |
$3,576.64
|
| Rate for Payer: Signature Care PPO |
$3,792.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,662.82
|
| Rate for Payer: United Healthcare Commercial |
$3,395.65
|
| Rate for Payer: United Healthcare Medicare |
$1,422.04
|
|
|
HC OTI OPN 1 BTE13 PP BTE HA MON
|
Facility
IP
|
$4,309.20
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603679
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,231.90 |
| Max. Negotiated Rate |
$4,007.56 |
| Rate for Payer: Aetna Commercial |
$3,723.15
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Cigna All Commercial |
$3,718.84
|
| Rate for Payer: CORVEL All Commercial |
$4,007.56
|
| Rate for Payer: Coventry All Commercial |
$3,792.10
|
| Rate for Payer: Encore All Commercial |
$3,966.62
|
| Rate for Payer: Frontpath All Commercial |
$3,964.46
|
| Rate for Payer: Humana ChoiceCare |
$3,721.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,878.28
|
| Rate for Payer: PHCS All Commercial |
$3,231.90
|
| Rate for Payer: PHP All Commercial |
$3,268.10
|
| Rate for Payer: Sagamore Health Network All Products |
$3,326.70
|
| Rate for Payer: Signature Care EPO |
$3,576.64
|
| Rate for Payer: Signature Care PPO |
$3,792.10
|
| Rate for Payer: United Healthcare Commercial |
$3,395.65
|
|
|
HC OTI OPN 1 MINIR BTE HA MON
|
Facility
IP
|
$4,309.20
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603677
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,231.90 |
| Max. Negotiated Rate |
$4,007.56 |
| Rate for Payer: Aetna Commercial |
$3,723.15
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Cigna All Commercial |
$3,718.84
|
| Rate for Payer: CORVEL All Commercial |
$4,007.56
|
| Rate for Payer: Coventry All Commercial |
$3,792.10
|
| Rate for Payer: Encore All Commercial |
$3,966.62
|
| Rate for Payer: Frontpath All Commercial |
$3,964.46
|
| Rate for Payer: Humana ChoiceCare |
$3,721.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,878.28
|
| Rate for Payer: PHCS All Commercial |
$3,231.90
|
| Rate for Payer: PHP All Commercial |
$3,268.10
|
| Rate for Payer: Sagamore Health Network All Products |
$3,326.70
|
| Rate for Payer: Signature Care EPO |
$3,576.64
|
| Rate for Payer: Signature Care PPO |
$3,792.10
|
| Rate for Payer: United Healthcare Commercial |
$3,395.65
|
|
|
HC OTI OPN 1 MINIR BTE HA MON
|
Facility
OP
|
$4,309.20
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603677
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$4,007.56 |
| Rate for Payer: Aetna Commercial |
$3,636.96
|
| Rate for Payer: Aetna Medicare |
$1,422.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,422.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,474.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,693.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,635.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,564.24
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Centivo All Commercial |
$2,197.69
|
| Rate for Payer: Cigna All Commercial |
$3,718.84
|
| Rate for Payer: CORVEL All Commercial |
$4,007.56
|
| Rate for Payer: Coventry All Commercial |
$3,792.10
|
| Rate for Payer: Encore All Commercial |
$3,966.62
|
| Rate for Payer: Frontpath All Commercial |
$3,964.46
|
| Rate for Payer: Humana ChoiceCare |
$3,721.86
|
| Rate for Payer: Humana Medicare |
$2,197.69
|
| Rate for Payer: Lucent All Commercial |
$2,197.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,878.28
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$3,231.90
|
| Rate for Payer: PHP All Commercial |
$3,268.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,680.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,326.70
|
| Rate for Payer: Signature Care EPO |
$3,576.64
|
| Rate for Payer: Signature Care PPO |
$3,792.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,662.82
|
| Rate for Payer: United Healthcare Commercial |
$3,395.65
|
| Rate for Payer: United Healthcare Medicare |
$1,422.04
|
|
|
HC OTI OPN 1 MINIR T BTE HA MON
|
Facility
IP
|
$4,309.20
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603678
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,231.90 |
| Max. Negotiated Rate |
$4,007.56 |
| Rate for Payer: Aetna Commercial |
$3,723.15
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Cigna All Commercial |
$3,718.84
|
| Rate for Payer: CORVEL All Commercial |
$4,007.56
|
| Rate for Payer: Coventry All Commercial |
$3,792.10
|
| Rate for Payer: Encore All Commercial |
$3,966.62
|
| Rate for Payer: Frontpath All Commercial |
$3,964.46
|
| Rate for Payer: Humana ChoiceCare |
$3,721.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,878.28
|
| Rate for Payer: PHCS All Commercial |
$3,231.90
|
| Rate for Payer: PHP All Commercial |
$3,268.10
|
| Rate for Payer: Sagamore Health Network All Products |
$3,326.70
|
| Rate for Payer: Signature Care EPO |
$3,576.64
|
| Rate for Payer: Signature Care PPO |
$3,792.10
|
| Rate for Payer: United Healthcare Commercial |
$3,395.65
|
|
|
HC OTI OPN 1 MINIR T BTE HA MON
|
Facility
OP
|
$4,309.20
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603678
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$4,007.56 |
| Rate for Payer: Aetna Commercial |
$3,636.96
|
| Rate for Payer: Aetna Medicare |
$1,422.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,422.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,474.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,693.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,635.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,564.24
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Cash Price |
$2,671.70
|
| Rate for Payer: Centivo All Commercial |
$2,197.69
|
| Rate for Payer: Cigna All Commercial |
$3,718.84
|
| Rate for Payer: CORVEL All Commercial |
$4,007.56
|
| Rate for Payer: Coventry All Commercial |
$3,792.10
|
| Rate for Payer: Encore All Commercial |
$3,966.62
|
| Rate for Payer: Frontpath All Commercial |
$3,964.46
|
| Rate for Payer: Humana ChoiceCare |
$3,721.86
|
| Rate for Payer: Humana Medicare |
$2,197.69
|
| Rate for Payer: Lucent All Commercial |
$2,197.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,878.28
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$3,231.90
|
| Rate for Payer: PHP All Commercial |
$3,268.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,680.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,326.70
|
| Rate for Payer: Signature Care EPO |
$3,576.64
|
| Rate for Payer: Signature Care PPO |
$3,792.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,662.82
|
| Rate for Payer: United Healthcare Commercial |
$3,395.65
|
| Rate for Payer: United Healthcare Medicare |
$1,422.04
|
|
|
HC OTI OPN3 BTE13 PP BTE HA MON
|
Facility
OP
|
$2,151.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603682
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,000.43 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Aetna Medicare |
$709.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$709.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,235.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,344.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$816.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.81
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Centivo All Commercial |
$1,097.01
|
| Rate for Payer: Cigna All Commercial |
$1,856.31
|
| Rate for Payer: CORVEL All Commercial |
$2,000.43
|
| Rate for Payer: Coventry All Commercial |
$1,892.88
|
| Rate for Payer: Encore All Commercial |
$1,980.00
|
| Rate for Payer: Frontpath All Commercial |
$1,978.92
|
| Rate for Payer: Humana ChoiceCare |
$1,857.82
|
| Rate for Payer: Humana Medicare |
$1,097.01
|
| Rate for Payer: Lucent All Commercial |
$1,097.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,935.90
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,613.25
|
| Rate for Payer: PHP All Commercial |
$1,631.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$838.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,660.57
|
| Rate for Payer: Signature Care EPO |
$1,785.33
|
| Rate for Payer: Signature Care PPO |
$1,892.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,828.35
|
| Rate for Payer: United Healthcare Commercial |
$1,694.99
|
| Rate for Payer: United Healthcare Medicare |
$709.83
|
|
|
HC OTI OPN3 BTE13 PP BTE HA MON
|
Facility
IP
|
$2,151.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603682
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,613.25 |
| Max. Negotiated Rate |
$2,000.43 |
| Rate for Payer: Aetna Commercial |
$1,858.46
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Cigna All Commercial |
$1,856.31
|
| Rate for Payer: CORVEL All Commercial |
$2,000.43
|
| Rate for Payer: Coventry All Commercial |
$1,892.88
|
| Rate for Payer: Encore All Commercial |
$1,980.00
|
| Rate for Payer: Frontpath All Commercial |
$1,978.92
|
| Rate for Payer: Humana ChoiceCare |
$1,857.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,935.90
|
| Rate for Payer: PHCS All Commercial |
$1,613.25
|
| Rate for Payer: PHP All Commercial |
$1,631.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,660.57
|
| Rate for Payer: Signature Care EPO |
$1,785.33
|
| Rate for Payer: Signature Care PPO |
$1,892.88
|
| Rate for Payer: United Healthcare Commercial |
$1,694.99
|
|
|
HC OTI OPN3 MINIR BTE HA MON
|
Facility
OP
|
$2,151.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603680
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,000.43 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Aetna Medicare |
$709.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$709.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,235.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,344.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$816.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.81
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Centivo All Commercial |
$1,097.01
|
| Rate for Payer: Cigna All Commercial |
$1,856.31
|
| Rate for Payer: CORVEL All Commercial |
$2,000.43
|
| Rate for Payer: Coventry All Commercial |
$1,892.88
|
| Rate for Payer: Encore All Commercial |
$1,980.00
|
| Rate for Payer: Frontpath All Commercial |
$1,978.92
|
| Rate for Payer: Humana ChoiceCare |
$1,857.82
|
| Rate for Payer: Humana Medicare |
$1,097.01
|
| Rate for Payer: Lucent All Commercial |
$1,097.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,935.90
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,613.25
|
| Rate for Payer: PHP All Commercial |
$1,631.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$838.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,660.57
|
| Rate for Payer: Signature Care EPO |
$1,785.33
|
| Rate for Payer: Signature Care PPO |
$1,892.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,828.35
|
| Rate for Payer: United Healthcare Commercial |
$1,694.99
|
| Rate for Payer: United Healthcare Medicare |
$709.83
|
|
|
HC OTI OPN3 MINIR BTE HA MON
|
Facility
IP
|
$2,151.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603680
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,613.25 |
| Max. Negotiated Rate |
$2,000.43 |
| Rate for Payer: Aetna Commercial |
$1,858.46
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Cigna All Commercial |
$1,856.31
|
| Rate for Payer: CORVEL All Commercial |
$2,000.43
|
| Rate for Payer: Coventry All Commercial |
$1,892.88
|
| Rate for Payer: Encore All Commercial |
$1,980.00
|
| Rate for Payer: Frontpath All Commercial |
$1,978.92
|
| Rate for Payer: Humana ChoiceCare |
$1,857.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,935.90
|
| Rate for Payer: PHCS All Commercial |
$1,613.25
|
| Rate for Payer: PHP All Commercial |
$1,631.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,660.57
|
| Rate for Payer: Signature Care EPO |
$1,785.33
|
| Rate for Payer: Signature Care PPO |
$1,892.88
|
| Rate for Payer: United Healthcare Commercial |
$1,694.99
|
|
|
HC OTI OPN3 MINIR T BTE HA MON
|
Facility
IP
|
$2,151.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603681
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,613.25 |
| Max. Negotiated Rate |
$2,000.43 |
| Rate for Payer: Aetna Commercial |
$1,858.46
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Cigna All Commercial |
$1,856.31
|
| Rate for Payer: CORVEL All Commercial |
$2,000.43
|
| Rate for Payer: Coventry All Commercial |
$1,892.88
|
| Rate for Payer: Encore All Commercial |
$1,980.00
|
| Rate for Payer: Frontpath All Commercial |
$1,978.92
|
| Rate for Payer: Humana ChoiceCare |
$1,857.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,935.90
|
| Rate for Payer: PHCS All Commercial |
$1,613.25
|
| Rate for Payer: PHP All Commercial |
$1,631.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,660.57
|
| Rate for Payer: Signature Care EPO |
$1,785.33
|
| Rate for Payer: Signature Care PPO |
$1,892.88
|
| Rate for Payer: United Healthcare Commercial |
$1,694.99
|
|
|
HC OTI OPN3 MINIR T BTE HA MON
|
Facility
OP
|
$2,151.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603681
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,000.43 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Aetna Medicare |
$709.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$709.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,235.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,344.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$816.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.81
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Cash Price |
$1,333.62
|
| Rate for Payer: Centivo All Commercial |
$1,097.01
|
| Rate for Payer: Cigna All Commercial |
$1,856.31
|
| Rate for Payer: CORVEL All Commercial |
$2,000.43
|
| Rate for Payer: Coventry All Commercial |
$1,892.88
|
| Rate for Payer: Encore All Commercial |
$1,980.00
|
| Rate for Payer: Frontpath All Commercial |
$1,978.92
|
| Rate for Payer: Humana ChoiceCare |
$1,857.82
|
| Rate for Payer: Humana Medicare |
$1,097.01
|
| Rate for Payer: Lucent All Commercial |
$1,097.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,935.90
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,613.25
|
| Rate for Payer: PHP All Commercial |
$1,631.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$838.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,660.57
|
| Rate for Payer: Signature Care EPO |
$1,785.33
|
| Rate for Payer: Signature Care PPO |
$1,892.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,828.35
|
| Rate for Payer: United Healthcare Commercial |
$1,694.99
|
| Rate for Payer: United Healthcare Medicare |
$709.83
|
|
|
HC OTI RIA PRO2 CIC HA MON
|
Facility
IP
|
$2,500.00
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603688
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
|
|
HC OTI RIA PRO2 CIC HA MON
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603688
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$948.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$907.50
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Centivo All Commercial |
$1,275.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$1,275.00
|
| Rate for Payer: Lucent All Commercial |
$1,275.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$825.00
|
|
|
HC OTI RIA PRO2 ITE HA MON
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603687
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$948.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$907.50
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Centivo All Commercial |
$1,275.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$1,275.00
|
| Rate for Payer: Lucent All Commercial |
$1,275.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$825.00
|
|
|
HC OTI RIA PRO2 ITE HA MON
|
Facility
IP
|
$2,500.00
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603687
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
|
|
HC OTI RIA PRO2 MINIR BTE HA MON
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603686
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$825.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$948.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$907.50
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Centivo All Commercial |
$1,275.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$1,275.00
|
| Rate for Payer: Lucent All Commercial |
$1,275.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$825.00
|
|
