|
HC X-RAY-CERVICAL SPINE MIN 4-5 VIEWS
|
Facility
|
IP
|
$640.38
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
1612050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$480.29 |
| Max. Negotiated Rate |
$595.55 |
| Rate for Payer: Aetna Commercial |
$553.29
|
| Rate for Payer: Cash Price |
$384.23
|
| Rate for Payer: Cigna All Commercial |
$552.65
|
| Rate for Payer: CORVEL All Commercial |
$595.55
|
| Rate for Payer: Coventry All Commercial |
$563.53
|
| Rate for Payer: Encore All Commercial |
$589.47
|
| Rate for Payer: Frontpath All Commercial |
$589.15
|
| Rate for Payer: Humana ChoiceCare |
$553.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.34
|
| Rate for Payer: PHCS All Commercial |
$480.29
|
| Rate for Payer: PHP All Commercial |
$485.66
|
| Rate for Payer: Sagamore Health Network All Products |
$494.37
|
| Rate for Payer: Signature Care EPO |
$531.52
|
| Rate for Payer: Signature Care PPO |
$563.53
|
| Rate for Payer: United Healthcare Commercial |
$504.62
|
|
|
HC X-RAY-CERVICAL SPINE MIN 4-5 VIEWS
|
Facility
|
OP
|
$640.38
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
1612050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$595.55 |
| Rate for Payer: Aetna Commercial |
$540.48
|
| Rate for Payer: Aetna Medicare |
$204.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$367.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$400.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$235.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.41
|
| Rate for Payer: Cash Price |
$384.23
|
| Rate for Payer: Cash Price |
$384.23
|
| Rate for Payer: Centivo All Commercial |
$348.37
|
| Rate for Payer: Cigna All Commercial |
$552.65
|
| Rate for Payer: CORVEL All Commercial |
$595.55
|
| Rate for Payer: Coventry All Commercial |
$563.53
|
| Rate for Payer: Encore All Commercial |
$589.47
|
| Rate for Payer: Frontpath All Commercial |
$589.15
|
| Rate for Payer: Humana ChoiceCare |
$553.10
|
| Rate for Payer: Humana Medicare |
$204.92
|
| Rate for Payer: Lucent All Commercial |
$348.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.34
|
| Rate for Payer: Managed Health Services Medicaid |
$22.95
|
| Rate for Payer: MDWise Medicaid |
$22.95
|
| Rate for Payer: PHCS All Commercial |
$480.29
|
| Rate for Payer: PHP All Commercial |
$485.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.75
|
| Rate for Payer: Sagamore Health Network All Products |
$494.37
|
| Rate for Payer: Signature Care EPO |
$531.52
|
| Rate for Payer: Signature Care PPO |
$563.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.32
|
| Rate for Payer: United Healthcare Commercial |
$504.62
|
| Rate for Payer: United Healthcare Medicare |
$204.92
|
|
|
HC X-RAY-CERV SP COMP W FLEX/EXT 6+ VIEWS
|
Facility
|
OP
|
$698.57
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
1612052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$589.59
|
| Rate for Payer: Aetna Medicare |
$223.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$30.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$401.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$436.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.90
|
| Rate for Payer: Cash Price |
$419.14
|
| Rate for Payer: Cash Price |
$419.14
|
| Rate for Payer: Centivo All Commercial |
$380.02
|
| Rate for Payer: Cigna All Commercial |
$602.87
|
| Rate for Payer: CORVEL All Commercial |
$649.67
|
| Rate for Payer: Coventry All Commercial |
$614.74
|
| Rate for Payer: Encore All Commercial |
$643.03
|
| Rate for Payer: Frontpath All Commercial |
$642.68
|
| Rate for Payer: Humana ChoiceCare |
$603.35
|
| Rate for Payer: Humana Medicare |
$223.54
|
| Rate for Payer: Lucent All Commercial |
$380.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.71
|
| Rate for Payer: Managed Health Services Medicaid |
$30.88
|
| Rate for Payer: MDWise Medicaid |
$30.88
|
| Rate for Payer: PHCS All Commercial |
$523.93
|
| Rate for Payer: PHP All Commercial |
$529.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.44
|
| Rate for Payer: Sagamore Health Network All Products |
$539.30
|
| Rate for Payer: Signature Care EPO |
$579.81
|
| Rate for Payer: Signature Care PPO |
$614.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$593.78
|
| Rate for Payer: United Healthcare Commercial |
$550.47
|
| Rate for Payer: United Healthcare Medicare |
$223.54
|
|
|
HC X-RAY-CERV SP COMP W FLEX/EXT 6+ VIEWS
|
Facility
|
IP
|
$698.57
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
1612052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$523.93 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$603.56
|
| Rate for Payer: Cash Price |
$419.14
|
| Rate for Payer: Cigna All Commercial |
$602.87
|
| Rate for Payer: CORVEL All Commercial |
$649.67
|
| Rate for Payer: Coventry All Commercial |
$614.74
|
| Rate for Payer: Encore All Commercial |
$643.03
|
| Rate for Payer: Frontpath All Commercial |
$642.68
|
| Rate for Payer: Humana ChoiceCare |
$603.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.71
|
| Rate for Payer: PHCS All Commercial |
$523.93
|
| Rate for Payer: PHP All Commercial |
$529.80
|
| Rate for Payer: Sagamore Health Network All Products |
$539.30
|
| Rate for Payer: Signature Care EPO |
$579.81
|
| Rate for Payer: Signature Care PPO |
$614.74
|
| Rate for Payer: United Healthcare Commercial |
$550.47
|
|
|
HC X-RAY-CERV SPINE 2 OR 3 VIEWS
|
Facility
|
IP
|
$442.43
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
1612040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.82 |
| Max. Negotiated Rate |
$411.46 |
| Rate for Payer: Aetna Commercial |
$382.26
|
| Rate for Payer: Cash Price |
$265.46
|
| Rate for Payer: Cigna All Commercial |
$381.82
|
| Rate for Payer: CORVEL All Commercial |
$411.46
|
| Rate for Payer: Coventry All Commercial |
$389.34
|
| Rate for Payer: Encore All Commercial |
$407.26
|
| Rate for Payer: Frontpath All Commercial |
$407.04
|
| Rate for Payer: Humana ChoiceCare |
$382.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.19
|
| Rate for Payer: PHCS All Commercial |
$331.82
|
| Rate for Payer: PHP All Commercial |
$335.54
|
| Rate for Payer: Sagamore Health Network All Products |
$341.56
|
| Rate for Payer: Signature Care EPO |
$367.22
|
| Rate for Payer: Signature Care PPO |
$389.34
|
| Rate for Payer: United Healthcare Commercial |
$348.63
|
|
|
HC X-RAY-CERV SPINE 2 OR 3 VIEWS
|
Facility
|
OP
|
$442.43
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
1612040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$411.46 |
| Rate for Payer: Aetna Commercial |
$373.41
|
| Rate for Payer: Aetna Medicare |
$141.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$254.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.74
|
| Rate for Payer: Cash Price |
$265.46
|
| Rate for Payer: Cash Price |
$265.46
|
| Rate for Payer: Centivo All Commercial |
$240.68
|
| Rate for Payer: Cigna All Commercial |
$381.82
|
| Rate for Payer: CORVEL All Commercial |
$411.46
|
| Rate for Payer: Coventry All Commercial |
$389.34
|
| Rate for Payer: Encore All Commercial |
$407.26
|
| Rate for Payer: Frontpath All Commercial |
$407.04
|
| Rate for Payer: Humana ChoiceCare |
$382.13
|
| Rate for Payer: Humana Medicare |
$141.58
|
| Rate for Payer: Lucent All Commercial |
$240.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.19
|
| Rate for Payer: Managed Health Services Medicaid |
$17.01
|
| Rate for Payer: MDWise Medicaid |
$17.01
|
| Rate for Payer: PHCS All Commercial |
$331.82
|
| Rate for Payer: PHP All Commercial |
$335.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.55
|
| Rate for Payer: Sagamore Health Network All Products |
$341.56
|
| Rate for Payer: Signature Care EPO |
$367.22
|
| Rate for Payer: Signature Care PPO |
$389.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$376.07
|
| Rate for Payer: United Healthcare Commercial |
$348.63
|
| Rate for Payer: United Healthcare Medicare |
$141.58
|
|
|
HC X-RAY-CLAVICLE BI
|
Facility
|
IP
|
$625.77
|
|
|
Service Code
|
CPT 73000 50
|
| Hospital Charge Code |
21613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$469.33 |
| Max. Negotiated Rate |
$581.97 |
| Rate for Payer: Aetna Commercial |
$540.67
|
| Rate for Payer: Cash Price |
$375.46
|
| Rate for Payer: Cigna All Commercial |
$540.04
|
| Rate for Payer: CORVEL All Commercial |
$581.97
|
| Rate for Payer: Coventry All Commercial |
$550.68
|
| Rate for Payer: Encore All Commercial |
$576.02
|
| Rate for Payer: Frontpath All Commercial |
$575.71
|
| Rate for Payer: Humana ChoiceCare |
$540.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.19
|
| Rate for Payer: PHCS All Commercial |
$469.33
|
| Rate for Payer: PHP All Commercial |
$474.58
|
| Rate for Payer: Sagamore Health Network All Products |
$483.09
|
| Rate for Payer: Signature Care EPO |
$519.39
|
| Rate for Payer: Signature Care PPO |
$550.68
|
| Rate for Payer: United Healthcare Commercial |
$493.11
|
|
|
HC X-RAY-CLAVICLE BI
|
Facility
|
OP
|
$625.77
|
|
|
Service Code
|
CPT 73000 50
|
| Hospital Charge Code |
21613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$581.97 |
| Rate for Payer: Aetna Commercial |
$528.15
|
| Rate for Payer: Aetna Medicare |
$200.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$359.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.27
|
| Rate for Payer: Cash Price |
$375.46
|
| Rate for Payer: Cash Price |
$375.46
|
| Rate for Payer: Centivo All Commercial |
$340.42
|
| Rate for Payer: Cigna All Commercial |
$540.04
|
| Rate for Payer: CORVEL All Commercial |
$581.97
|
| Rate for Payer: Coventry All Commercial |
$550.68
|
| Rate for Payer: Encore All Commercial |
$576.02
|
| Rate for Payer: Frontpath All Commercial |
$575.71
|
| Rate for Payer: Humana ChoiceCare |
$540.48
|
| Rate for Payer: Humana Medicare |
$200.25
|
| Rate for Payer: Lucent All Commercial |
$340.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.19
|
| Rate for Payer: Managed Health Services Medicaid |
$14.53
|
| Rate for Payer: MDWise Medicaid |
$14.53
|
| Rate for Payer: PHCS All Commercial |
$469.33
|
| Rate for Payer: PHP All Commercial |
$474.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.05
|
| Rate for Payer: Sagamore Health Network All Products |
$483.09
|
| Rate for Payer: Signature Care EPO |
$519.39
|
| Rate for Payer: Signature Care PPO |
$550.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$531.90
|
| Rate for Payer: United Healthcare Commercial |
$493.11
|
| Rate for Payer: United Healthcare Medicare |
$200.25
|
|
|
HC X-RAY-CLAVICLE LT
|
Facility
|
OP
|
$417.18
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
1613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$352.10
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.85
|
| Rate for Payer: Cash Price |
$250.31
|
| Rate for Payer: Cash Price |
$250.31
|
| Rate for Payer: Centivo All Commercial |
$226.95
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Humana Medicare |
$133.50
|
| Rate for Payer: Lucent All Commercial |
$226.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: Managed Health Services Medicaid |
$14.53
|
| Rate for Payer: MDWise Medicaid |
$14.53
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.70
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
| Rate for Payer: United Healthcare Medicare |
$133.50
|
|
|
HC X-RAY-CLAVICLE LT
|
Facility
|
IP
|
$417.18
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
1613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.88 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$360.44
|
| Rate for Payer: Cash Price |
$250.31
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
|
|
HC X-RAY-CLAVICLE RT
|
Facility
|
IP
|
$417.18
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
11613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.88 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$360.44
|
| Rate for Payer: Cash Price |
$250.31
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
|
|
HC X-RAY-CLAVICLE RT
|
Facility
|
OP
|
$417.18
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
11613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$352.10
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.85
|
| Rate for Payer: Cash Price |
$250.31
|
| Rate for Payer: Cash Price |
$250.31
|
| Rate for Payer: Centivo All Commercial |
$226.95
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Humana Medicare |
$133.50
|
| Rate for Payer: Lucent All Commercial |
$226.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: Managed Health Services Medicaid |
$14.53
|
| Rate for Payer: MDWise Medicaid |
$14.53
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.70
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
| Rate for Payer: United Healthcare Medicare |
$133.50
|
|
|
HC X-RAY-COLON(BE)
|
Facility
|
OP
|
$1,265.08
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1614270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,176.52 |
| Rate for Payer: Aetna Commercial |
$1,067.73
|
| Rate for Payer: Aetna Medicare |
$404.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$87.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$392.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$726.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$790.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$87.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$465.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$445.31
|
| Rate for Payer: Cash Price |
$759.05
|
| Rate for Payer: Cash Price |
$759.05
|
| Rate for Payer: Centivo All Commercial |
$688.20
|
| Rate for Payer: Cigna All Commercial |
$1,091.76
|
| Rate for Payer: CORVEL All Commercial |
$1,176.52
|
| Rate for Payer: Coventry All Commercial |
$1,113.27
|
| Rate for Payer: Encore All Commercial |
$1,164.51
|
| Rate for Payer: Frontpath All Commercial |
$1,163.87
|
| Rate for Payer: Humana ChoiceCare |
$1,092.65
|
| Rate for Payer: Humana Medicare |
$404.83
|
| Rate for Payer: Lucent All Commercial |
$688.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,138.57
|
| Rate for Payer: Managed Health Services Medicaid |
$87.36
|
| Rate for Payer: MDWise Medicaid |
$87.36
|
| Rate for Payer: PHCS All Commercial |
$948.81
|
| Rate for Payer: PHP All Commercial |
$959.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$493.38
|
| Rate for Payer: Sagamore Health Network All Products |
$976.64
|
| Rate for Payer: Signature Care EPO |
$1,050.02
|
| Rate for Payer: Signature Care PPO |
$1,113.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,075.32
|
| Rate for Payer: United Healthcare Commercial |
$996.88
|
| Rate for Payer: United Healthcare Medicare |
$404.83
|
|
|
HC X-RAY-COLON(BE)
|
Facility
|
IP
|
$1,265.08
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1614270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$948.81 |
| Max. Negotiated Rate |
$1,176.52 |
| Rate for Payer: Aetna Commercial |
$1,093.03
|
| Rate for Payer: Cash Price |
$759.05
|
| Rate for Payer: Cigna All Commercial |
$1,091.76
|
| Rate for Payer: CORVEL All Commercial |
$1,176.52
|
| Rate for Payer: Coventry All Commercial |
$1,113.27
|
| Rate for Payer: Encore All Commercial |
$1,164.51
|
| Rate for Payer: Frontpath All Commercial |
$1,163.87
|
| Rate for Payer: Humana ChoiceCare |
$1,092.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,138.57
|
| Rate for Payer: PHCS All Commercial |
$948.81
|
| Rate for Payer: PHP All Commercial |
$959.44
|
| Rate for Payer: Sagamore Health Network All Products |
$976.64
|
| Rate for Payer: Signature Care EPO |
$1,050.02
|
| Rate for Payer: Signature Care PPO |
$1,113.27
|
| Rate for Payer: United Healthcare Commercial |
$996.88
|
|
|
HC X-RAY-COLON DOUBLE CONTRAST
|
Facility
|
IP
|
$1,469.59
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1614275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,102.19 |
| Max. Negotiated Rate |
$1,366.72 |
| Rate for Payer: Aetna Commercial |
$1,269.73
|
| Rate for Payer: Cash Price |
$881.75
|
| Rate for Payer: Cigna All Commercial |
$1,268.26
|
| Rate for Payer: CORVEL All Commercial |
$1,366.72
|
| Rate for Payer: Coventry All Commercial |
$1,293.24
|
| Rate for Payer: Encore All Commercial |
$1,352.76
|
| Rate for Payer: Frontpath All Commercial |
$1,352.02
|
| Rate for Payer: Humana ChoiceCare |
$1,269.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,322.63
|
| Rate for Payer: PHCS All Commercial |
$1,102.19
|
| Rate for Payer: PHP All Commercial |
$1,114.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,134.52
|
| Rate for Payer: Signature Care EPO |
$1,219.76
|
| Rate for Payer: Signature Care PPO |
$1,293.24
|
| Rate for Payer: United Healthcare Commercial |
$1,158.04
|
|
|
HC X-RAY-COLON DOUBLE CONTRAST
|
Facility
|
OP
|
$1,469.59
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1614275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.30 |
| Max. Negotiated Rate |
$1,366.72 |
| Rate for Payer: Aetna Commercial |
$1,240.33
|
| Rate for Payer: Aetna Medicare |
$470.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$121.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$455.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$843.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$918.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$121.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$540.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$517.30
|
| Rate for Payer: Cash Price |
$881.75
|
| Rate for Payer: Cash Price |
$881.75
|
| Rate for Payer: Centivo All Commercial |
$799.46
|
| Rate for Payer: Cigna All Commercial |
$1,268.26
|
| Rate for Payer: CORVEL All Commercial |
$1,366.72
|
| Rate for Payer: Coventry All Commercial |
$1,293.24
|
| Rate for Payer: Encore All Commercial |
$1,352.76
|
| Rate for Payer: Frontpath All Commercial |
$1,352.02
|
| Rate for Payer: Humana ChoiceCare |
$1,269.28
|
| Rate for Payer: Humana Medicare |
$470.27
|
| Rate for Payer: Lucent All Commercial |
$799.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,322.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.30
|
| Rate for Payer: MDWise Medicaid |
$121.30
|
| Rate for Payer: PHCS All Commercial |
$1,102.19
|
| Rate for Payer: PHP All Commercial |
$1,114.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$573.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,134.52
|
| Rate for Payer: Signature Care EPO |
$1,219.76
|
| Rate for Payer: Signature Care PPO |
$1,293.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,249.15
|
| Rate for Payer: United Healthcare Commercial |
$1,158.04
|
| Rate for Payer: United Healthcare Medicare |
$470.27
|
|
|
HC X-RAY-ELBOW 2 VIEWS BI
|
Facility
|
OP
|
$703.21
|
|
|
Service Code
|
CPT 73070 50
|
| Hospital Charge Code |
21619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$653.99 |
| Rate for Payer: Aetna Commercial |
$593.51
|
| Rate for Payer: Aetna Medicare |
$225.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$218.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$403.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$439.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$258.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$247.53
|
| Rate for Payer: Cash Price |
$421.93
|
| Rate for Payer: Cash Price |
$421.93
|
| Rate for Payer: Centivo All Commercial |
$382.55
|
| Rate for Payer: Cigna All Commercial |
$606.87
|
| Rate for Payer: CORVEL All Commercial |
$653.99
|
| Rate for Payer: Coventry All Commercial |
$618.82
|
| Rate for Payer: Encore All Commercial |
$647.30
|
| Rate for Payer: Frontpath All Commercial |
$646.95
|
| Rate for Payer: Humana ChoiceCare |
$607.36
|
| Rate for Payer: Humana Medicare |
$225.03
|
| Rate for Payer: Lucent All Commercial |
$382.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$632.89
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$527.41
|
| Rate for Payer: PHP All Commercial |
$533.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.25
|
| Rate for Payer: Sagamore Health Network All Products |
$542.88
|
| Rate for Payer: Signature Care EPO |
$583.66
|
| Rate for Payer: Signature Care PPO |
$618.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$597.73
|
| Rate for Payer: United Healthcare Commercial |
$554.13
|
| Rate for Payer: United Healthcare Medicare |
$225.03
|
|
|
HC X-RAY-ELBOW 2 VIEWS BI
|
Facility
|
IP
|
$703.21
|
|
|
Service Code
|
CPT 73070 50
|
| Hospital Charge Code |
21619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$527.41 |
| Max. Negotiated Rate |
$653.99 |
| Rate for Payer: Aetna Commercial |
$607.57
|
| Rate for Payer: Cash Price |
$421.93
|
| Rate for Payer: Cigna All Commercial |
$606.87
|
| Rate for Payer: CORVEL All Commercial |
$653.99
|
| Rate for Payer: Coventry All Commercial |
$618.82
|
| Rate for Payer: Encore All Commercial |
$647.30
|
| Rate for Payer: Frontpath All Commercial |
$646.95
|
| Rate for Payer: Humana ChoiceCare |
$607.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$632.89
|
| Rate for Payer: PHCS All Commercial |
$527.41
|
| Rate for Payer: PHP All Commercial |
$533.31
|
| Rate for Payer: Sagamore Health Network All Products |
$542.88
|
| Rate for Payer: Signature Care EPO |
$583.66
|
| Rate for Payer: Signature Care PPO |
$618.82
|
| Rate for Payer: United Healthcare Commercial |
$554.13
|
|
|
HC X-RAY-ELBOW 2 VIEWS LT
|
Facility
|
IP
|
$468.81
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
1619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.61 |
| Max. Negotiated Rate |
$435.99 |
| Rate for Payer: Aetna Commercial |
$405.05
|
| Rate for Payer: Cash Price |
$281.29
|
| Rate for Payer: Cigna All Commercial |
$404.58
|
| Rate for Payer: CORVEL All Commercial |
$435.99
|
| Rate for Payer: Coventry All Commercial |
$412.55
|
| Rate for Payer: Encore All Commercial |
$431.54
|
| Rate for Payer: Frontpath All Commercial |
$431.31
|
| Rate for Payer: Humana ChoiceCare |
$404.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.93
|
| Rate for Payer: PHCS All Commercial |
$351.61
|
| Rate for Payer: PHP All Commercial |
$355.55
|
| Rate for Payer: Sagamore Health Network All Products |
$361.92
|
| Rate for Payer: Signature Care EPO |
$389.11
|
| Rate for Payer: Signature Care PPO |
$412.55
|
| Rate for Payer: United Healthcare Commercial |
$369.42
|
|
|
HC X-RAY-ELBOW 2 VIEWS LT
|
Facility
|
OP
|
$468.81
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
1619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$435.99 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$150.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$293.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.02
|
| Rate for Payer: Cash Price |
$281.29
|
| Rate for Payer: Cash Price |
$281.29
|
| Rate for Payer: Centivo All Commercial |
$255.03
|
| Rate for Payer: Cigna All Commercial |
$404.58
|
| Rate for Payer: CORVEL All Commercial |
$435.99
|
| Rate for Payer: Coventry All Commercial |
$412.55
|
| Rate for Payer: Encore All Commercial |
$431.54
|
| Rate for Payer: Frontpath All Commercial |
$431.31
|
| Rate for Payer: Humana ChoiceCare |
$404.91
|
| Rate for Payer: Humana Medicare |
$150.02
|
| Rate for Payer: Lucent All Commercial |
$255.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.93
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$351.61
|
| Rate for Payer: PHP All Commercial |
$355.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.84
|
| Rate for Payer: Sagamore Health Network All Products |
$361.92
|
| Rate for Payer: Signature Care EPO |
$389.11
|
| Rate for Payer: Signature Care PPO |
$412.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.49
|
| Rate for Payer: United Healthcare Commercial |
$369.42
|
| Rate for Payer: United Healthcare Medicare |
$150.02
|
|
|
HC X-RAY-ELBOW 2 VIEWS RT
|
Facility
|
OP
|
$468.81
|
|
|
Service Code
|
CPT 73070 RT
|
| Hospital Charge Code |
11619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$435.99 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$150.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$293.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.02
|
| Rate for Payer: Cash Price |
$281.29
|
| Rate for Payer: Cash Price |
$281.29
|
| Rate for Payer: Centivo All Commercial |
$255.03
|
| Rate for Payer: Cigna All Commercial |
$404.58
|
| Rate for Payer: CORVEL All Commercial |
$435.99
|
| Rate for Payer: Coventry All Commercial |
$412.55
|
| Rate for Payer: Encore All Commercial |
$431.54
|
| Rate for Payer: Frontpath All Commercial |
$431.31
|
| Rate for Payer: Humana ChoiceCare |
$404.91
|
| Rate for Payer: Humana Medicare |
$150.02
|
| Rate for Payer: Lucent All Commercial |
$255.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.93
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$351.61
|
| Rate for Payer: PHP All Commercial |
$355.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.84
|
| Rate for Payer: Sagamore Health Network All Products |
$361.92
|
| Rate for Payer: Signature Care EPO |
$389.11
|
| Rate for Payer: Signature Care PPO |
$412.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.49
|
| Rate for Payer: United Healthcare Commercial |
$369.42
|
| Rate for Payer: United Healthcare Medicare |
$150.02
|
|
|
HC X-RAY-ELBOW 2 VIEWS RT
|
Facility
|
IP
|
$468.81
|
|
|
Service Code
|
CPT 73070 RT
|
| Hospital Charge Code |
11619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.61 |
| Max. Negotiated Rate |
$435.99 |
| Rate for Payer: Aetna Commercial |
$405.05
|
| Rate for Payer: Cash Price |
$281.29
|
| Rate for Payer: Cigna All Commercial |
$404.58
|
| Rate for Payer: CORVEL All Commercial |
$435.99
|
| Rate for Payer: Coventry All Commercial |
$412.55
|
| Rate for Payer: Encore All Commercial |
$431.54
|
| Rate for Payer: Frontpath All Commercial |
$431.31
|
| Rate for Payer: Humana ChoiceCare |
$404.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.93
|
| Rate for Payer: PHCS All Commercial |
$351.61
|
| Rate for Payer: PHP All Commercial |
$355.55
|
| Rate for Payer: Sagamore Health Network All Products |
$361.92
|
| Rate for Payer: Signature Care EPO |
$389.11
|
| Rate for Payer: Signature Care PPO |
$412.55
|
| Rate for Payer: United Healthcare Commercial |
$369.42
|
|
|
HC X-RAY-ELBOW MIN 3 VIEWS BI
|
Facility
|
IP
|
$761.65
|
|
|
Service Code
|
CPT 73080 50
|
| Hospital Charge Code |
21613070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$571.24 |
| Max. Negotiated Rate |
$708.33 |
| Rate for Payer: Aetna Commercial |
$658.07
|
| Rate for Payer: Cash Price |
$456.99
|
| Rate for Payer: Cigna All Commercial |
$657.30
|
| Rate for Payer: CORVEL All Commercial |
$708.33
|
| Rate for Payer: Coventry All Commercial |
$670.25
|
| Rate for Payer: Encore All Commercial |
$701.10
|
| Rate for Payer: Frontpath All Commercial |
$700.72
|
| Rate for Payer: Humana ChoiceCare |
$657.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.49
|
| Rate for Payer: PHCS All Commercial |
$571.24
|
| Rate for Payer: PHP All Commercial |
$577.64
|
| Rate for Payer: Sagamore Health Network All Products |
$587.99
|
| Rate for Payer: Signature Care EPO |
$632.17
|
| Rate for Payer: Signature Care PPO |
$670.25
|
| Rate for Payer: United Healthcare Commercial |
$600.18
|
|
|
HC X-RAY-ELBOW MIN 3 VIEWS BI
|
Facility
|
OP
|
$761.65
|
|
|
Service Code
|
CPT 73080 50
|
| Hospital Charge Code |
21613070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$708.33 |
| Rate for Payer: Aetna Commercial |
$642.83
|
| Rate for Payer: Aetna Medicare |
$243.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$236.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$437.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$476.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$280.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$268.10
|
| Rate for Payer: Cash Price |
$456.99
|
| Rate for Payer: Cash Price |
$456.99
|
| Rate for Payer: Centivo All Commercial |
$414.34
|
| Rate for Payer: Cigna All Commercial |
$657.30
|
| Rate for Payer: CORVEL All Commercial |
$708.33
|
| Rate for Payer: Coventry All Commercial |
$670.25
|
| Rate for Payer: Encore All Commercial |
$701.10
|
| Rate for Payer: Frontpath All Commercial |
$700.72
|
| Rate for Payer: Humana ChoiceCare |
$657.84
|
| Rate for Payer: Humana Medicare |
$243.73
|
| Rate for Payer: Lucent All Commercial |
$414.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.49
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$571.24
|
| Rate for Payer: PHP All Commercial |
$577.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$297.04
|
| Rate for Payer: Sagamore Health Network All Products |
$587.99
|
| Rate for Payer: Signature Care EPO |
$632.17
|
| Rate for Payer: Signature Care PPO |
$670.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$647.40
|
| Rate for Payer: United Healthcare Commercial |
$600.18
|
| Rate for Payer: United Healthcare Medicare |
$243.73
|
|
|
HC X-RAY-ELBOW MIN 3 VIEWS LT
|
Facility
|
OP
|
$507.77
|
|
|
Service Code
|
CPT 73080 LT
|
| Hospital Charge Code |
1613070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$472.23 |
| Rate for Payer: Aetna Commercial |
$428.56
|
| Rate for Payer: Aetna Medicare |
$162.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$291.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.74
|
| Rate for Payer: Cash Price |
$304.66
|
| Rate for Payer: Cash Price |
$304.66
|
| Rate for Payer: Centivo All Commercial |
$276.23
|
| Rate for Payer: Cigna All Commercial |
$438.21
|
| Rate for Payer: CORVEL All Commercial |
$472.23
|
| Rate for Payer: Coventry All Commercial |
$446.84
|
| Rate for Payer: Encore All Commercial |
$467.40
|
| Rate for Payer: Frontpath All Commercial |
$467.15
|
| Rate for Payer: Humana ChoiceCare |
$438.56
|
| Rate for Payer: Humana Medicare |
$162.49
|
| Rate for Payer: Lucent All Commercial |
$276.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$380.83
|
| Rate for Payer: PHP All Commercial |
$385.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.03
|
| Rate for Payer: Sagamore Health Network All Products |
$392.00
|
| Rate for Payer: Signature Care EPO |
$421.45
|
| Rate for Payer: Signature Care PPO |
$446.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$431.60
|
| Rate for Payer: United Healthcare Commercial |
$400.12
|
| Rate for Payer: United Healthcare Medicare |
$162.49
|
|
