|
HC X-RAY-LS SPINE 2 OR 3 VIEWS
|
Facility
|
OP
|
$610.98
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
1612100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$568.21 |
| Rate for Payer: Aetna Commercial |
$515.67
|
| Rate for Payer: Aetna Medicare |
$195.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$189.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$350.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$381.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$224.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.06
|
| Rate for Payer: Cash Price |
$366.59
|
| Rate for Payer: Cash Price |
$366.59
|
| Rate for Payer: Centivo All Commercial |
$332.37
|
| Rate for Payer: Cigna All Commercial |
$527.28
|
| Rate for Payer: CORVEL All Commercial |
$568.21
|
| Rate for Payer: Coventry All Commercial |
$537.66
|
| Rate for Payer: Encore All Commercial |
$562.41
|
| Rate for Payer: Frontpath All Commercial |
$562.10
|
| Rate for Payer: Humana ChoiceCare |
$527.70
|
| Rate for Payer: Humana Medicare |
$195.51
|
| Rate for Payer: Lucent All Commercial |
$332.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$549.88
|
| Rate for Payer: Managed Health Services Medicaid |
$17.01
|
| Rate for Payer: MDWise Medicaid |
$17.01
|
| Rate for Payer: PHCS All Commercial |
$458.24
|
| Rate for Payer: PHP All Commercial |
$463.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$238.28
|
| Rate for Payer: Sagamore Health Network All Products |
$471.68
|
| Rate for Payer: Signature Care EPO |
$507.11
|
| Rate for Payer: Signature Care PPO |
$537.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$519.33
|
| Rate for Payer: United Healthcare Commercial |
$481.45
|
| Rate for Payer: United Healthcare Medicare |
$195.51
|
|
|
HC X-RAY-LS SPINE BENDING 2-3 VIEWS
|
Facility
|
IP
|
$796.49
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
1612120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$597.37 |
| Max. Negotiated Rate |
$740.74 |
| Rate for Payer: Aetna Commercial |
$688.17
|
| Rate for Payer: Cash Price |
$477.89
|
| Rate for Payer: Cigna All Commercial |
$687.37
|
| Rate for Payer: CORVEL All Commercial |
$740.74
|
| Rate for Payer: Coventry All Commercial |
$700.91
|
| Rate for Payer: Encore All Commercial |
$733.17
|
| Rate for Payer: Frontpath All Commercial |
$732.77
|
| Rate for Payer: Humana ChoiceCare |
$687.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.84
|
| Rate for Payer: PHCS All Commercial |
$597.37
|
| Rate for Payer: PHP All Commercial |
$604.06
|
| Rate for Payer: Sagamore Health Network All Products |
$614.89
|
| Rate for Payer: Signature Care EPO |
$661.09
|
| Rate for Payer: Signature Care PPO |
$700.91
|
| Rate for Payer: United Healthcare Commercial |
$627.63
|
|
|
HC X-RAY-LS SPINE BENDING 2-3 VIEWS
|
Facility
|
OP
|
$796.49
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
1612120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$740.74 |
| Rate for Payer: Aetna Commercial |
$672.24
|
| Rate for Payer: Aetna Medicare |
$254.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$246.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$457.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$497.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.36
|
| Rate for Payer: Cash Price |
$477.89
|
| Rate for Payer: Cash Price |
$477.89
|
| Rate for Payer: Centivo All Commercial |
$433.29
|
| Rate for Payer: Cigna All Commercial |
$687.37
|
| Rate for Payer: CORVEL All Commercial |
$740.74
|
| Rate for Payer: Coventry All Commercial |
$700.91
|
| Rate for Payer: Encore All Commercial |
$733.17
|
| Rate for Payer: Frontpath All Commercial |
$732.77
|
| Rate for Payer: Humana ChoiceCare |
$687.93
|
| Rate for Payer: Humana Medicare |
$254.88
|
| Rate for Payer: Lucent All Commercial |
$433.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.84
|
| Rate for Payer: Managed Health Services Medicaid |
$20.23
|
| Rate for Payer: MDWise Medicaid |
$20.23
|
| Rate for Payer: PHCS All Commercial |
$597.37
|
| Rate for Payer: PHP All Commercial |
$604.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$310.63
|
| Rate for Payer: Sagamore Health Network All Products |
$614.89
|
| Rate for Payer: Signature Care EPO |
$661.09
|
| Rate for Payer: Signature Care PPO |
$700.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$677.02
|
| Rate for Payer: United Healthcare Commercial |
$627.63
|
| Rate for Payer: United Healthcare Medicare |
$254.88
|
|
|
HC X-RAY-LS SPINE MIN 4 VIEWS
|
Facility
|
OP
|
$841.50
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
1612110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$710.23
|
| Rate for Payer: Aetna Medicare |
$269.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$260.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$483.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$526.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.21
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Centivo All Commercial |
$457.78
|
| Rate for Payer: Cigna All Commercial |
$726.21
|
| Rate for Payer: CORVEL All Commercial |
$782.60
|
| Rate for Payer: Coventry All Commercial |
$740.52
|
| Rate for Payer: Encore All Commercial |
$774.60
|
| Rate for Payer: Frontpath All Commercial |
$774.18
|
| Rate for Payer: Humana ChoiceCare |
$726.80
|
| Rate for Payer: Humana Medicare |
$269.28
|
| Rate for Payer: Lucent All Commercial |
$457.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.35
|
| Rate for Payer: Managed Health Services Medicaid |
$23.45
|
| Rate for Payer: MDWise Medicaid |
$23.45
|
| Rate for Payer: PHCS All Commercial |
$631.12
|
| Rate for Payer: PHP All Commercial |
$638.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$328.19
|
| Rate for Payer: Sagamore Health Network All Products |
$649.64
|
| Rate for Payer: Signature Care EPO |
$698.45
|
| Rate for Payer: Signature Care PPO |
$740.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$715.27
|
| Rate for Payer: United Healthcare Commercial |
$663.10
|
| Rate for Payer: United Healthcare Medicare |
$269.28
|
|
|
HC X-RAY-LS SPINE MIN 4 VIEWS
|
Facility
|
IP
|
$841.50
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
1612110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$727.06
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna All Commercial |
$726.21
|
| Rate for Payer: CORVEL All Commercial |
$782.60
|
| Rate for Payer: Coventry All Commercial |
$740.52
|
| Rate for Payer: Encore All Commercial |
$774.60
|
| Rate for Payer: Frontpath All Commercial |
$774.18
|
| Rate for Payer: Humana ChoiceCare |
$726.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.35
|
| Rate for Payer: PHCS All Commercial |
$631.12
|
| Rate for Payer: PHP All Commercial |
$638.19
|
| Rate for Payer: Sagamore Health Network All Products |
$649.64
|
| Rate for Payer: Signature Care EPO |
$698.45
|
| Rate for Payer: Signature Care PPO |
$740.52
|
| Rate for Payer: United Healthcare Commercial |
$663.10
|
|
|
HC X-RAY-LS SPINE W/FLEX & EXT 6+ VIEWS
|
Facility
|
IP
|
$924.25
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
1612105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$693.19 |
| Max. Negotiated Rate |
$859.55 |
| Rate for Payer: Aetna Commercial |
$798.55
|
| Rate for Payer: Cash Price |
$554.55
|
| Rate for Payer: Cigna All Commercial |
$797.63
|
| Rate for Payer: CORVEL All Commercial |
$859.55
|
| Rate for Payer: Coventry All Commercial |
$813.34
|
| Rate for Payer: Encore All Commercial |
$850.77
|
| Rate for Payer: Frontpath All Commercial |
$850.31
|
| Rate for Payer: Humana ChoiceCare |
$798.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.83
|
| Rate for Payer: PHCS All Commercial |
$693.19
|
| Rate for Payer: PHP All Commercial |
$700.95
|
| Rate for Payer: Sagamore Health Network All Products |
$713.52
|
| Rate for Payer: Signature Care EPO |
$767.13
|
| Rate for Payer: Signature Care PPO |
$813.34
|
| Rate for Payer: United Healthcare Commercial |
$728.31
|
|
|
HC X-RAY-LS SPINE W/FLEX & EXT 6+ VIEWS
|
Facility
|
OP
|
$924.25
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
1612105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$859.55 |
| Rate for Payer: Aetna Commercial |
$780.07
|
| Rate for Payer: Aetna Medicare |
$295.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$286.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$530.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$33.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.34
|
| Rate for Payer: Cash Price |
$554.55
|
| Rate for Payer: Cash Price |
$554.55
|
| Rate for Payer: Centivo All Commercial |
$502.79
|
| Rate for Payer: Cigna All Commercial |
$797.63
|
| Rate for Payer: CORVEL All Commercial |
$859.55
|
| Rate for Payer: Coventry All Commercial |
$813.34
|
| Rate for Payer: Encore All Commercial |
$850.77
|
| Rate for Payer: Frontpath All Commercial |
$850.31
|
| Rate for Payer: Humana ChoiceCare |
$798.27
|
| Rate for Payer: Humana Medicare |
$295.76
|
| Rate for Payer: Lucent All Commercial |
$502.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.83
|
| Rate for Payer: Managed Health Services Medicaid |
$33.36
|
| Rate for Payer: MDWise Medicaid |
$33.36
|
| Rate for Payer: PHCS All Commercial |
$693.19
|
| Rate for Payer: PHP All Commercial |
$700.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.46
|
| Rate for Payer: Sagamore Health Network All Products |
$713.52
|
| Rate for Payer: Signature Care EPO |
$767.13
|
| Rate for Payer: Signature Care PPO |
$813.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.61
|
| Rate for Payer: United Healthcare Commercial |
$728.31
|
| Rate for Payer: United Healthcare Medicare |
$295.76
|
|
|
HC X-RAY-MANDIBLE MIN 4 VIEWS
|
Facility
|
IP
|
$655.62
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
1610110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.71 |
| Max. Negotiated Rate |
$609.73 |
| Rate for Payer: Aetna Commercial |
$566.46
|
| Rate for Payer: Cash Price |
$393.37
|
| Rate for Payer: Cigna All Commercial |
$565.80
|
| Rate for Payer: CORVEL All Commercial |
$609.73
|
| Rate for Payer: Coventry All Commercial |
$576.95
|
| Rate for Payer: Encore All Commercial |
$603.50
|
| Rate for Payer: Frontpath All Commercial |
$603.17
|
| Rate for Payer: Humana ChoiceCare |
$566.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$590.06
|
| Rate for Payer: PHCS All Commercial |
$491.71
|
| Rate for Payer: PHP All Commercial |
$497.22
|
| Rate for Payer: Sagamore Health Network All Products |
$506.14
|
| Rate for Payer: Signature Care EPO |
$544.16
|
| Rate for Payer: Signature Care PPO |
$576.95
|
| Rate for Payer: United Healthcare Commercial |
$516.63
|
|
|
HC X-RAY-MANDIBLE MIN 4 VIEWS
|
Facility
|
OP
|
$655.62
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
1610110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$609.73 |
| Rate for Payer: Aetna Commercial |
$553.34
|
| Rate for Payer: Aetna Medicare |
$209.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$376.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.78
|
| Rate for Payer: Cash Price |
$393.37
|
| Rate for Payer: Cash Price |
$393.37
|
| Rate for Payer: Centivo All Commercial |
$356.66
|
| Rate for Payer: Cigna All Commercial |
$565.80
|
| Rate for Payer: CORVEL All Commercial |
$609.73
|
| Rate for Payer: Coventry All Commercial |
$576.95
|
| Rate for Payer: Encore All Commercial |
$603.50
|
| Rate for Payer: Frontpath All Commercial |
$603.17
|
| Rate for Payer: Humana ChoiceCare |
$566.26
|
| Rate for Payer: Humana Medicare |
$209.80
|
| Rate for Payer: Lucent All Commercial |
$356.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$590.06
|
| Rate for Payer: Managed Health Services Medicaid |
$19.24
|
| Rate for Payer: MDWise Medicaid |
$19.24
|
| Rate for Payer: PHCS All Commercial |
$491.71
|
| Rate for Payer: PHP All Commercial |
$497.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.69
|
| Rate for Payer: Sagamore Health Network All Products |
$506.14
|
| Rate for Payer: Signature Care EPO |
$544.16
|
| Rate for Payer: Signature Care PPO |
$576.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$557.28
|
| Rate for Payer: United Healthcare Commercial |
$516.63
|
| Rate for Payer: United Healthcare Medicare |
$209.80
|
|
|
HC X-RAY-NASAL BONES 3+ VIEWS
|
Facility
|
IP
|
$545.49
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
1610160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$409.12 |
| Max. Negotiated Rate |
$507.31 |
| Rate for Payer: Aetna Commercial |
$471.30
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Cigna All Commercial |
$470.76
|
| Rate for Payer: CORVEL All Commercial |
$507.31
|
| Rate for Payer: Coventry All Commercial |
$480.03
|
| Rate for Payer: Encore All Commercial |
$502.12
|
| Rate for Payer: Frontpath All Commercial |
$501.85
|
| Rate for Payer: Humana ChoiceCare |
$471.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.94
|
| Rate for Payer: PHCS All Commercial |
$409.12
|
| Rate for Payer: PHP All Commercial |
$413.70
|
| Rate for Payer: Sagamore Health Network All Products |
$421.12
|
| Rate for Payer: Signature Care EPO |
$452.76
|
| Rate for Payer: Signature Care PPO |
$480.03
|
| Rate for Payer: United Healthcare Commercial |
$429.85
|
|
|
HC X-RAY-NASAL BONES 3+ VIEWS
|
Facility
|
OP
|
$545.49
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
1610160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$507.31 |
| Rate for Payer: Aetna Commercial |
$460.39
|
| Rate for Payer: Aetna Medicare |
$174.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$313.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.01
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Centivo All Commercial |
$296.75
|
| Rate for Payer: Cigna All Commercial |
$470.76
|
| Rate for Payer: CORVEL All Commercial |
$507.31
|
| Rate for Payer: Coventry All Commercial |
$480.03
|
| Rate for Payer: Encore All Commercial |
$502.12
|
| Rate for Payer: Frontpath All Commercial |
$501.85
|
| Rate for Payer: Humana ChoiceCare |
$471.14
|
| Rate for Payer: Humana Medicare |
$174.56
|
| Rate for Payer: Lucent All Commercial |
$296.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.94
|
| Rate for Payer: Managed Health Services Medicaid |
$17.75
|
| Rate for Payer: MDWise Medicaid |
$17.75
|
| Rate for Payer: PHCS All Commercial |
$409.12
|
| Rate for Payer: PHP All Commercial |
$413.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.74
|
| Rate for Payer: Sagamore Health Network All Products |
$421.12
|
| Rate for Payer: Signature Care EPO |
$452.76
|
| Rate for Payer: Signature Care PPO |
$480.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$463.67
|
| Rate for Payer: United Healthcare Commercial |
$429.85
|
| Rate for Payer: United Healthcare Medicare |
$174.56
|
|
|
HC X-RAY-NECK (SOFT TISSUE)
|
Facility
|
OP
|
$384.95
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
1610360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Medicare |
$123.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$221.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.50
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Centivo All Commercial |
$209.41
|
| Rate for Payer: Cigna All Commercial |
$332.21
|
| Rate for Payer: CORVEL All Commercial |
$358.00
|
| Rate for Payer: Coventry All Commercial |
$338.76
|
| Rate for Payer: Encore All Commercial |
$354.35
|
| Rate for Payer: Frontpath All Commercial |
$354.15
|
| Rate for Payer: Humana ChoiceCare |
$332.48
|
| Rate for Payer: Humana Medicare |
$123.18
|
| Rate for Payer: Lucent All Commercial |
$209.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.45
|
| Rate for Payer: Managed Health Services Medicaid |
$14.53
|
| Rate for Payer: MDWise Medicaid |
$14.53
|
| Rate for Payer: PHCS All Commercial |
$288.71
|
| Rate for Payer: PHP All Commercial |
$291.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.13
|
| Rate for Payer: Sagamore Health Network All Products |
$297.18
|
| Rate for Payer: Signature Care EPO |
$319.51
|
| Rate for Payer: Signature Care PPO |
$338.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.21
|
| Rate for Payer: United Healthcare Commercial |
$303.34
|
| Rate for Payer: United Healthcare Medicare |
$123.18
|
|
|
HC X-RAY-NECK (SOFT TISSUE)
|
Facility
|
IP
|
$384.95
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
1610360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.71 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Cigna All Commercial |
$332.21
|
| Rate for Payer: CORVEL All Commercial |
$358.00
|
| Rate for Payer: Coventry All Commercial |
$338.76
|
| Rate for Payer: Encore All Commercial |
$354.35
|
| Rate for Payer: Frontpath All Commercial |
$354.15
|
| Rate for Payer: Humana ChoiceCare |
$332.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.45
|
| Rate for Payer: PHCS All Commercial |
$288.71
|
| Rate for Payer: PHP All Commercial |
$291.95
|
| Rate for Payer: Sagamore Health Network All Products |
$297.18
|
| Rate for Payer: Signature Care EPO |
$319.51
|
| Rate for Payer: Signature Care PPO |
$338.76
|
| Rate for Payer: United Healthcare Commercial |
$303.34
|
|
|
HC X-RAY -NOSE-RECTUM FB CHILD
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
1619010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$238.01
|
| Rate for Payer: Aetna Medicare |
$90.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.26
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Centivo All Commercial |
$153.41
|
| Rate for Payer: Cigna All Commercial |
$243.37
|
| Rate for Payer: CORVEL All Commercial |
$262.26
|
| Rate for Payer: Coventry All Commercial |
$248.16
|
| Rate for Payer: Encore All Commercial |
$259.58
|
| Rate for Payer: Frontpath All Commercial |
$259.44
|
| Rate for Payer: Humana ChoiceCare |
$243.56
|
| Rate for Payer: Humana Medicare |
$90.24
|
| Rate for Payer: Lucent All Commercial |
$153.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.80
|
| Rate for Payer: Managed Health Services Medicaid |
$12.80
|
| Rate for Payer: MDWise Medicaid |
$12.80
|
| Rate for Payer: PHCS All Commercial |
$211.50
|
| Rate for Payer: PHP All Commercial |
$213.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.98
|
| Rate for Payer: Sagamore Health Network All Products |
$217.70
|
| Rate for Payer: Signature Care EPO |
$234.06
|
| Rate for Payer: Signature Care PPO |
$248.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.70
|
| Rate for Payer: United Healthcare Commercial |
$222.22
|
| Rate for Payer: United Healthcare Medicare |
$90.24
|
|
|
HC X-RAY -NOSE-RECTUM FB CHILD
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
1619010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna All Commercial |
$243.37
|
| Rate for Payer: CORVEL All Commercial |
$262.26
|
| Rate for Payer: Coventry All Commercial |
$248.16
|
| Rate for Payer: Encore All Commercial |
$259.58
|
| Rate for Payer: Frontpath All Commercial |
$259.44
|
| Rate for Payer: Humana ChoiceCare |
$243.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.80
|
| Rate for Payer: PHCS All Commercial |
$211.50
|
| Rate for Payer: PHP All Commercial |
$213.87
|
| Rate for Payer: Sagamore Health Network All Products |
$217.70
|
| Rate for Payer: Signature Care EPO |
$234.06
|
| Rate for Payer: Signature Care PPO |
$248.16
|
| Rate for Payer: United Healthcare Commercial |
$222.22
|
|
|
HC X-RAY-ORBITS 2 VIEW PRE-MRI FB
|
Facility
|
IP
|
$392.19
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
1610190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$364.74 |
| Rate for Payer: Aetna Commercial |
$338.85
|
| Rate for Payer: Cash Price |
$235.31
|
| Rate for Payer: Cigna All Commercial |
$338.46
|
| Rate for Payer: CORVEL All Commercial |
$364.74
|
| Rate for Payer: Coventry All Commercial |
$345.13
|
| Rate for Payer: Encore All Commercial |
$361.01
|
| Rate for Payer: Frontpath All Commercial |
$360.81
|
| Rate for Payer: Humana ChoiceCare |
$338.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$352.97
|
| Rate for Payer: PHCS All Commercial |
$294.14
|
| Rate for Payer: PHP All Commercial |
$297.44
|
| Rate for Payer: Sagamore Health Network All Products |
$302.77
|
| Rate for Payer: Signature Care EPO |
$325.52
|
| Rate for Payer: Signature Care PPO |
$345.13
|
| Rate for Payer: United Healthcare Commercial |
$309.05
|
|
|
HC X-RAY-ORBITS 2 VIEW PRE-MRI FB
|
Facility
|
OP
|
$392.19
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
1610190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$364.74 |
| Rate for Payer: Aetna Commercial |
$331.01
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$225.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$245.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.05
|
| Rate for Payer: Cash Price |
$235.31
|
| Rate for Payer: Cash Price |
$235.31
|
| Rate for Payer: Centivo All Commercial |
$213.35
|
| Rate for Payer: Cigna All Commercial |
$338.46
|
| Rate for Payer: CORVEL All Commercial |
$364.74
|
| Rate for Payer: Coventry All Commercial |
$345.13
|
| Rate for Payer: Encore All Commercial |
$361.01
|
| Rate for Payer: Frontpath All Commercial |
$360.81
|
| Rate for Payer: Humana ChoiceCare |
$338.73
|
| Rate for Payer: Humana Medicare |
$125.50
|
| Rate for Payer: Lucent All Commercial |
$213.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$352.97
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$294.14
|
| Rate for Payer: PHP All Commercial |
$297.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.95
|
| Rate for Payer: Sagamore Health Network All Products |
$302.77
|
| Rate for Payer: Signature Care EPO |
$325.52
|
| Rate for Payer: Signature Care PPO |
$345.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$333.36
|
| Rate for Payer: United Healthcare Commercial |
$309.05
|
| Rate for Payer: United Healthcare Medicare |
$125.50
|
|
|
HC X-RAY-ORBITS MIN 4 VIEWS
|
Facility
|
IP
|
$446.57
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
1617020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$334.93 |
| Max. Negotiated Rate |
$415.31 |
| Rate for Payer: Aetna Commercial |
$385.84
|
| Rate for Payer: Cash Price |
$267.94
|
| Rate for Payer: Cigna All Commercial |
$385.39
|
| Rate for Payer: CORVEL All Commercial |
$415.31
|
| Rate for Payer: Coventry All Commercial |
$392.98
|
| Rate for Payer: Encore All Commercial |
$411.07
|
| Rate for Payer: Frontpath All Commercial |
$410.84
|
| Rate for Payer: Humana ChoiceCare |
$385.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$401.91
|
| Rate for Payer: PHCS All Commercial |
$334.93
|
| Rate for Payer: PHP All Commercial |
$338.68
|
| Rate for Payer: Sagamore Health Network All Products |
$344.75
|
| Rate for Payer: Signature Care EPO |
$370.65
|
| Rate for Payer: Signature Care PPO |
$392.98
|
| Rate for Payer: United Healthcare Commercial |
$351.90
|
|
|
HC X-RAY-ORBITS MIN 4 VIEWS
|
Facility
|
OP
|
$446.57
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
1617020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$415.31 |
| Rate for Payer: Aetna Commercial |
$376.91
|
| Rate for Payer: Aetna Medicare |
$142.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$256.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$279.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.19
|
| Rate for Payer: Cash Price |
$267.94
|
| Rate for Payer: Cash Price |
$267.94
|
| Rate for Payer: Centivo All Commercial |
$242.93
|
| Rate for Payer: Cigna All Commercial |
$385.39
|
| Rate for Payer: CORVEL All Commercial |
$415.31
|
| Rate for Payer: Coventry All Commercial |
$392.98
|
| Rate for Payer: Encore All Commercial |
$411.07
|
| Rate for Payer: Frontpath All Commercial |
$410.84
|
| Rate for Payer: Humana ChoiceCare |
$385.70
|
| Rate for Payer: Humana Medicare |
$142.90
|
| Rate for Payer: Lucent All Commercial |
$242.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$401.91
|
| Rate for Payer: Managed Health Services Medicaid |
$20.97
|
| Rate for Payer: MDWise Medicaid |
$20.97
|
| Rate for Payer: PHCS All Commercial |
$334.93
|
| Rate for Payer: PHP All Commercial |
$338.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.16
|
| Rate for Payer: Sagamore Health Network All Products |
$344.75
|
| Rate for Payer: Signature Care EPO |
$370.65
|
| Rate for Payer: Signature Care PPO |
$392.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$379.58
|
| Rate for Payer: United Healthcare Commercial |
$351.90
|
| Rate for Payer: United Healthcare Medicare |
$142.90
|
|
|
HC X-RAY-OSCALCIS (HEEL) 2+ VIEWS BI
|
Facility
|
OP
|
$462.93
|
|
|
Service Code
|
CPT 73650 50
|
| Hospital Charge Code |
21613650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$430.52 |
| Rate for Payer: Aetna Commercial |
$390.71
|
| Rate for Payer: Aetna Medicare |
$148.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$265.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.95
|
| Rate for Payer: Cash Price |
$277.76
|
| Rate for Payer: Cash Price |
$277.76
|
| Rate for Payer: Centivo All Commercial |
$251.83
|
| Rate for Payer: Cigna All Commercial |
$399.51
|
| Rate for Payer: CORVEL All Commercial |
$430.52
|
| Rate for Payer: Coventry All Commercial |
$407.38
|
| Rate for Payer: Encore All Commercial |
$426.13
|
| Rate for Payer: Frontpath All Commercial |
$425.90
|
| Rate for Payer: Humana ChoiceCare |
$399.83
|
| Rate for Payer: Humana Medicare |
$148.14
|
| Rate for Payer: Lucent All Commercial |
$251.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.64
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$347.20
|
| Rate for Payer: PHP All Commercial |
$351.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.54
|
| Rate for Payer: Sagamore Health Network All Products |
$357.38
|
| Rate for Payer: Signature Care EPO |
$384.23
|
| Rate for Payer: Signature Care PPO |
$407.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$393.49
|
| Rate for Payer: United Healthcare Commercial |
$364.79
|
| Rate for Payer: United Healthcare Medicare |
$148.14
|
|
|
HC X-RAY-OSCALCIS (HEEL) 2+ VIEWS BI
|
Facility
|
IP
|
$462.93
|
|
|
Service Code
|
CPT 73650 50
|
| Hospital Charge Code |
21613650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$430.52 |
| Rate for Payer: Aetna Commercial |
$399.97
|
| Rate for Payer: Cash Price |
$277.76
|
| Rate for Payer: Cigna All Commercial |
$399.51
|
| Rate for Payer: CORVEL All Commercial |
$430.52
|
| Rate for Payer: Coventry All Commercial |
$407.38
|
| Rate for Payer: Encore All Commercial |
$426.13
|
| Rate for Payer: Frontpath All Commercial |
$425.90
|
| Rate for Payer: Humana ChoiceCare |
$399.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$416.64
|
| Rate for Payer: PHCS All Commercial |
$347.20
|
| Rate for Payer: PHP All Commercial |
$351.09
|
| Rate for Payer: Sagamore Health Network All Products |
$357.38
|
| Rate for Payer: Signature Care EPO |
$384.23
|
| Rate for Payer: Signature Care PPO |
$407.38
|
| Rate for Payer: United Healthcare Commercial |
$364.79
|
|
|
HC X-RAY-OSCALCIS (HEEL) 2+ VIEWS LT
|
Facility
|
IP
|
$362.07
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
1613650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.55 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$312.83
|
| Rate for Payer: Cash Price |
$217.24
|
| Rate for Payer: Cigna All Commercial |
$312.47
|
| Rate for Payer: CORVEL All Commercial |
$336.73
|
| Rate for Payer: Coventry All Commercial |
$318.62
|
| Rate for Payer: Encore All Commercial |
$333.29
|
| Rate for Payer: Frontpath All Commercial |
$333.10
|
| Rate for Payer: Humana ChoiceCare |
$312.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.86
|
| Rate for Payer: PHCS All Commercial |
$271.55
|
| Rate for Payer: PHP All Commercial |
$274.59
|
| Rate for Payer: Sagamore Health Network All Products |
$279.52
|
| Rate for Payer: Signature Care EPO |
$300.52
|
| Rate for Payer: Signature Care PPO |
$318.62
|
| Rate for Payer: United Healthcare Commercial |
$285.31
|
|
|
HC X-RAY-OSCALCIS (HEEL) 2+ VIEWS LT
|
Facility
|
OP
|
$362.07
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
1613650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$207.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.45
|
| Rate for Payer: Cash Price |
$217.24
|
| Rate for Payer: Cash Price |
$217.24
|
| Rate for Payer: Centivo All Commercial |
$196.97
|
| Rate for Payer: Cigna All Commercial |
$312.47
|
| Rate for Payer: CORVEL All Commercial |
$336.73
|
| Rate for Payer: Coventry All Commercial |
$318.62
|
| Rate for Payer: Encore All Commercial |
$333.29
|
| Rate for Payer: Frontpath All Commercial |
$333.10
|
| Rate for Payer: Humana ChoiceCare |
$312.72
|
| Rate for Payer: Humana Medicare |
$115.86
|
| Rate for Payer: Lucent All Commercial |
$196.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.86
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$271.55
|
| Rate for Payer: PHP All Commercial |
$274.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.21
|
| Rate for Payer: Sagamore Health Network All Products |
$279.52
|
| Rate for Payer: Signature Care EPO |
$300.52
|
| Rate for Payer: Signature Care PPO |
$318.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.76
|
| Rate for Payer: United Healthcare Commercial |
$285.31
|
| Rate for Payer: United Healthcare Medicare |
$115.86
|
|
|
HC X-RAY-OSCALCIS (HEEL) 2+ VIEWS RT
|
Facility
|
IP
|
$362.07
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
11613650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.55 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$312.83
|
| Rate for Payer: Cash Price |
$217.24
|
| Rate for Payer: Cigna All Commercial |
$312.47
|
| Rate for Payer: CORVEL All Commercial |
$336.73
|
| Rate for Payer: Coventry All Commercial |
$318.62
|
| Rate for Payer: Encore All Commercial |
$333.29
|
| Rate for Payer: Frontpath All Commercial |
$333.10
|
| Rate for Payer: Humana ChoiceCare |
$312.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.86
|
| Rate for Payer: PHCS All Commercial |
$271.55
|
| Rate for Payer: PHP All Commercial |
$274.59
|
| Rate for Payer: Sagamore Health Network All Products |
$279.52
|
| Rate for Payer: Signature Care EPO |
$300.52
|
| Rate for Payer: Signature Care PPO |
$318.62
|
| Rate for Payer: United Healthcare Commercial |
$285.31
|
|
|
HC X-RAY-OSCALCIS (HEEL) 2+ VIEWS RT
|
Facility
|
OP
|
$362.07
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
11613650
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$305.59
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$207.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.45
|
| Rate for Payer: Cash Price |
$217.24
|
| Rate for Payer: Cash Price |
$217.24
|
| Rate for Payer: Centivo All Commercial |
$196.97
|
| Rate for Payer: Cigna All Commercial |
$312.47
|
| Rate for Payer: CORVEL All Commercial |
$336.73
|
| Rate for Payer: Coventry All Commercial |
$318.62
|
| Rate for Payer: Encore All Commercial |
$333.29
|
| Rate for Payer: Frontpath All Commercial |
$333.10
|
| Rate for Payer: Humana ChoiceCare |
$312.72
|
| Rate for Payer: Humana Medicare |
$115.86
|
| Rate for Payer: Lucent All Commercial |
$196.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.86
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$271.55
|
| Rate for Payer: PHP All Commercial |
$274.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.21
|
| Rate for Payer: Sagamore Health Network All Products |
$279.52
|
| Rate for Payer: Signature Care EPO |
$300.52
|
| Rate for Payer: Signature Care PPO |
$318.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.76
|
| Rate for Payer: United Healthcare Commercial |
$285.31
|
| Rate for Payer: United Healthcare Medicare |
$115.86
|
|
