|
HC X-RAY-RIBS UNILAT W/PA CHEST R 3+ VIEWS
|
Facility
|
OP
|
$743.03
|
|
|
Service Code
|
CPT 71101 RT
|
| Hospital Charge Code |
11611101
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$691.02 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Medicare |
$237.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$426.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$464.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$273.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$261.55
|
| Rate for Payer: Cash Price |
$445.82
|
| Rate for Payer: Cash Price |
$445.82
|
| Rate for Payer: Centivo All Commercial |
$404.21
|
| Rate for Payer: Cigna All Commercial |
$641.23
|
| Rate for Payer: CORVEL All Commercial |
$691.02
|
| Rate for Payer: Coventry All Commercial |
$653.87
|
| Rate for Payer: Encore All Commercial |
$683.96
|
| Rate for Payer: Frontpath All Commercial |
$683.59
|
| Rate for Payer: Humana ChoiceCare |
$641.76
|
| Rate for Payer: Humana Medicare |
$237.77
|
| Rate for Payer: Lucent All Commercial |
$404.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$668.73
|
| Rate for Payer: Managed Health Services Medicaid |
$18.74
|
| Rate for Payer: MDWise Medicaid |
$18.74
|
| Rate for Payer: PHCS All Commercial |
$557.27
|
| Rate for Payer: PHP All Commercial |
$563.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.78
|
| Rate for Payer: Sagamore Health Network All Products |
$573.62
|
| Rate for Payer: Signature Care EPO |
$616.71
|
| Rate for Payer: Signature Care PPO |
$653.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$631.58
|
| Rate for Payer: United Healthcare Commercial |
$585.51
|
| Rate for Payer: United Healthcare Medicare |
$237.77
|
|
|
HC X-RAY-SACROILIAC JOINTS 3+ VIEWS
|
Facility
|
OP
|
$421.47
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
1612202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$391.97 |
| Rate for Payer: Aetna Commercial |
$355.72
|
| Rate for Payer: Aetna Medicare |
$134.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$242.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$263.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.36
|
| Rate for Payer: Cash Price |
$252.88
|
| Rate for Payer: Cash Price |
$252.88
|
| Rate for Payer: Centivo All Commercial |
$229.28
|
| Rate for Payer: Cigna All Commercial |
$363.73
|
| Rate for Payer: CORVEL All Commercial |
$391.97
|
| Rate for Payer: Coventry All Commercial |
$370.89
|
| Rate for Payer: Encore All Commercial |
$387.96
|
| Rate for Payer: Frontpath All Commercial |
$387.75
|
| Rate for Payer: Humana ChoiceCare |
$364.02
|
| Rate for Payer: Humana Medicare |
$134.87
|
| Rate for Payer: Lucent All Commercial |
$229.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18.00
|
| Rate for Payer: MDWise Medicaid |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$316.10
|
| Rate for Payer: PHP All Commercial |
$319.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.37
|
| Rate for Payer: Sagamore Health Network All Products |
$325.37
|
| Rate for Payer: Signature Care EPO |
$349.82
|
| Rate for Payer: Signature Care PPO |
$370.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$358.25
|
| Rate for Payer: United Healthcare Commercial |
$332.12
|
| Rate for Payer: United Healthcare Medicare |
$134.87
|
|
|
HC X-RAY-SACROILIAC JOINTS 3+ VIEWS
|
Facility
|
IP
|
$421.47
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
1612202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.10 |
| Max. Negotiated Rate |
$391.97 |
| Rate for Payer: Aetna Commercial |
$364.15
|
| Rate for Payer: Cash Price |
$252.88
|
| Rate for Payer: Cigna All Commercial |
$363.73
|
| Rate for Payer: CORVEL All Commercial |
$391.97
|
| Rate for Payer: Coventry All Commercial |
$370.89
|
| Rate for Payer: Encore All Commercial |
$387.96
|
| Rate for Payer: Frontpath All Commercial |
$387.75
|
| Rate for Payer: Humana ChoiceCare |
$364.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$379.32
|
| Rate for Payer: PHCS All Commercial |
$316.10
|
| Rate for Payer: PHP All Commercial |
$319.64
|
| Rate for Payer: Sagamore Health Network All Products |
$325.37
|
| Rate for Payer: Signature Care EPO |
$349.82
|
| Rate for Payer: Signature Care PPO |
$370.89
|
| Rate for Payer: United Healthcare Commercial |
$332.12
|
|
|
HC X-RAY-SACRUM / COCCYX 2+ VIEWS
|
Facility
|
IP
|
$507.77
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
1612221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$472.23 |
| Rate for Payer: Aetna Commercial |
$438.71
|
| Rate for Payer: Cash Price |
$304.66
|
| 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: Lutheran Preferred All Commercial |
$456.99
|
| Rate for Payer: PHCS All Commercial |
$380.83
|
| Rate for Payer: PHP All Commercial |
$385.09
|
| 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: United Healthcare Commercial |
$400.12
|
|
|
HC X-RAY-SACRUM / COCCYX 2+ VIEWS
|
Facility
|
OP
|
$507.77
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
1612221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| 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 |
$14.28
|
| 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 |
$14.28
|
| 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 |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| 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
|
|
|
HC X-RAY-SCAPULA BI
|
Facility
|
OP
|
$719.85
|
|
|
Service Code
|
CPT 73010 50
|
| Hospital Charge Code |
21613010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$669.46 |
| Rate for Payer: Aetna Commercial |
$607.55
|
| Rate for Payer: Aetna Medicare |
$230.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$223.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$413.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$449.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$264.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.39
|
| Rate for Payer: Cash Price |
$431.91
|
| Rate for Payer: Cash Price |
$431.91
|
| Rate for Payer: Centivo All Commercial |
$391.60
|
| Rate for Payer: Cigna All Commercial |
$621.23
|
| Rate for Payer: CORVEL All Commercial |
$669.46
|
| Rate for Payer: Coventry All Commercial |
$633.47
|
| Rate for Payer: Encore All Commercial |
$662.62
|
| Rate for Payer: Frontpath All Commercial |
$662.26
|
| Rate for Payer: Humana ChoiceCare |
$621.73
|
| Rate for Payer: Humana Medicare |
$230.35
|
| Rate for Payer: Lucent All Commercial |
$391.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$647.87
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$539.89
|
| Rate for Payer: PHP All Commercial |
$545.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$280.74
|
| Rate for Payer: Sagamore Health Network All Products |
$555.72
|
| Rate for Payer: Signature Care EPO |
$597.48
|
| Rate for Payer: Signature Care PPO |
$633.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$611.87
|
| Rate for Payer: United Healthcare Commercial |
$567.24
|
| Rate for Payer: United Healthcare Medicare |
$230.35
|
|
|
HC X-RAY-SCAPULA BI
|
Facility
|
IP
|
$719.85
|
|
|
Service Code
|
CPT 73010 50
|
| Hospital Charge Code |
21613010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$539.89 |
| Max. Negotiated Rate |
$669.46 |
| Rate for Payer: Aetna Commercial |
$621.95
|
| Rate for Payer: Cash Price |
$431.91
|
| Rate for Payer: Cigna All Commercial |
$621.23
|
| Rate for Payer: CORVEL All Commercial |
$669.46
|
| Rate for Payer: Coventry All Commercial |
$633.47
|
| Rate for Payer: Encore All Commercial |
$662.62
|
| Rate for Payer: Frontpath All Commercial |
$662.26
|
| Rate for Payer: Humana ChoiceCare |
$621.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$647.87
|
| Rate for Payer: PHCS All Commercial |
$539.89
|
| Rate for Payer: PHP All Commercial |
$545.93
|
| Rate for Payer: Sagamore Health Network All Products |
$555.72
|
| Rate for Payer: Signature Care EPO |
$597.48
|
| Rate for Payer: Signature Care PPO |
$633.47
|
| Rate for Payer: United Healthcare Commercial |
$567.24
|
|
|
HC X-RAY-SCAPULA LT
|
Facility
|
OP
|
$479.90
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
1613010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$446.31 |
| Rate for Payer: Aetna Commercial |
$405.04
|
| Rate for Payer: Aetna Medicare |
$153.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.92
|
| Rate for Payer: Cash Price |
$287.94
|
| Rate for Payer: Cash Price |
$287.94
|
| Rate for Payer: Centivo All Commercial |
$261.07
|
| Rate for Payer: Cigna All Commercial |
$414.15
|
| Rate for Payer: CORVEL All Commercial |
$446.31
|
| Rate for Payer: Coventry All Commercial |
$422.31
|
| Rate for Payer: Encore All Commercial |
$441.75
|
| Rate for Payer: Frontpath All Commercial |
$441.51
|
| Rate for Payer: Humana ChoiceCare |
$414.49
|
| Rate for Payer: Humana Medicare |
$153.57
|
| Rate for Payer: Lucent All Commercial |
$261.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$359.93
|
| Rate for Payer: PHP All Commercial |
$363.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.16
|
| Rate for Payer: Sagamore Health Network All Products |
$370.48
|
| Rate for Payer: Signature Care EPO |
$398.32
|
| Rate for Payer: Signature Care PPO |
$422.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.92
|
| Rate for Payer: United Healthcare Commercial |
$378.16
|
| Rate for Payer: United Healthcare Medicare |
$153.57
|
|
|
HC X-RAY-SCAPULA LT
|
Facility
|
IP
|
$479.90
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
1613010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.93 |
| Max. Negotiated Rate |
$446.31 |
| Rate for Payer: Aetna Commercial |
$414.63
|
| Rate for Payer: Cash Price |
$287.94
|
| Rate for Payer: Cigna All Commercial |
$414.15
|
| Rate for Payer: CORVEL All Commercial |
$446.31
|
| Rate for Payer: Coventry All Commercial |
$422.31
|
| Rate for Payer: Encore All Commercial |
$441.75
|
| Rate for Payer: Frontpath All Commercial |
$441.51
|
| Rate for Payer: Humana ChoiceCare |
$414.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.91
|
| Rate for Payer: PHCS All Commercial |
$359.93
|
| Rate for Payer: PHP All Commercial |
$363.96
|
| Rate for Payer: Sagamore Health Network All Products |
$370.48
|
| Rate for Payer: Signature Care EPO |
$398.32
|
| Rate for Payer: Signature Care PPO |
$422.31
|
| Rate for Payer: United Healthcare Commercial |
$378.16
|
|
|
HC X-RAY-SCAPULA RT
|
Facility
|
OP
|
$479.90
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
11613010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$446.31 |
| Rate for Payer: Aetna Commercial |
$405.04
|
| Rate for Payer: Aetna Medicare |
$153.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.92
|
| Rate for Payer: Cash Price |
$287.94
|
| Rate for Payer: Cash Price |
$287.94
|
| Rate for Payer: Centivo All Commercial |
$261.07
|
| Rate for Payer: Cigna All Commercial |
$414.15
|
| Rate for Payer: CORVEL All Commercial |
$446.31
|
| Rate for Payer: Coventry All Commercial |
$422.31
|
| Rate for Payer: Encore All Commercial |
$441.75
|
| Rate for Payer: Frontpath All Commercial |
$441.51
|
| Rate for Payer: Humana ChoiceCare |
$414.49
|
| Rate for Payer: Humana Medicare |
$153.57
|
| Rate for Payer: Lucent All Commercial |
$261.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$359.93
|
| Rate for Payer: PHP All Commercial |
$363.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.16
|
| Rate for Payer: Sagamore Health Network All Products |
$370.48
|
| Rate for Payer: Signature Care EPO |
$398.32
|
| Rate for Payer: Signature Care PPO |
$422.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.92
|
| Rate for Payer: United Healthcare Commercial |
$378.16
|
| Rate for Payer: United Healthcare Medicare |
$153.57
|
|
|
HC X-RAY-SCAPULA RT
|
Facility
|
IP
|
$479.90
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
11613010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.93 |
| Max. Negotiated Rate |
$446.31 |
| Rate for Payer: Aetna Commercial |
$414.63
|
| Rate for Payer: Cash Price |
$287.94
|
| Rate for Payer: Cigna All Commercial |
$414.15
|
| Rate for Payer: CORVEL All Commercial |
$446.31
|
| Rate for Payer: Coventry All Commercial |
$422.31
|
| Rate for Payer: Encore All Commercial |
$441.75
|
| Rate for Payer: Frontpath All Commercial |
$441.51
|
| Rate for Payer: Humana ChoiceCare |
$414.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.91
|
| Rate for Payer: PHCS All Commercial |
$359.93
|
| Rate for Payer: PHP All Commercial |
$363.96
|
| Rate for Payer: Sagamore Health Network All Products |
$370.48
|
| Rate for Payer: Signature Care EPO |
$398.32
|
| Rate for Payer: Signature Care PPO |
$422.31
|
| Rate for Payer: United Healthcare Commercial |
$378.16
|
|
|
HC X-RAY-SHOULDER MIN 2 VIEWS BI
|
Facility
|
IP
|
$779.65
|
|
|
Service Code
|
CPT 73030 50
|
| Hospital Charge Code |
21613031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$584.74 |
| Max. Negotiated Rate |
$725.07 |
| Rate for Payer: Aetna Commercial |
$673.62
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Cigna All Commercial |
$672.84
|
| Rate for Payer: CORVEL All Commercial |
$725.07
|
| Rate for Payer: Coventry All Commercial |
$686.09
|
| Rate for Payer: Encore All Commercial |
$717.67
|
| Rate for Payer: Frontpath All Commercial |
$717.28
|
| Rate for Payer: Humana ChoiceCare |
$673.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$701.68
|
| Rate for Payer: PHCS All Commercial |
$584.74
|
| Rate for Payer: PHP All Commercial |
$591.29
|
| Rate for Payer: Sagamore Health Network All Products |
$601.89
|
| Rate for Payer: Signature Care EPO |
$647.11
|
| Rate for Payer: Signature Care PPO |
$686.09
|
| Rate for Payer: United Healthcare Commercial |
$614.36
|
|
|
HC X-RAY-SHOULDER MIN 2 VIEWS BI
|
Facility
|
OP
|
$779.65
|
|
|
Service Code
|
CPT 73030 50
|
| Hospital Charge Code |
21613031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$725.07 |
| Rate for Payer: Aetna Commercial |
$658.02
|
| Rate for Payer: Aetna Medicare |
$249.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$241.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$447.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$487.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$286.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.44
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Centivo All Commercial |
$424.13
|
| Rate for Payer: Cigna All Commercial |
$672.84
|
| Rate for Payer: CORVEL All Commercial |
$725.07
|
| Rate for Payer: Coventry All Commercial |
$686.09
|
| Rate for Payer: Encore All Commercial |
$717.67
|
| Rate for Payer: Frontpath All Commercial |
$717.28
|
| Rate for Payer: Humana ChoiceCare |
$673.38
|
| Rate for Payer: Humana Medicare |
$249.49
|
| Rate for Payer: Lucent All Commercial |
$424.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$701.68
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$584.74
|
| Rate for Payer: PHP All Commercial |
$591.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$304.06
|
| Rate for Payer: Sagamore Health Network All Products |
$601.89
|
| Rate for Payer: Signature Care EPO |
$647.11
|
| Rate for Payer: Signature Care PPO |
$686.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$662.70
|
| Rate for Payer: United Healthcare Commercial |
$614.36
|
| Rate for Payer: United Healthcare Medicare |
$249.49
|
|
|
HC X-RAY-SHOULDER MIN 2 VIEWS LT
|
Facility
|
IP
|
$519.75
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
1613031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$389.81 |
| Max. Negotiated Rate |
$483.37 |
| Rate for Payer: Aetna Commercial |
$449.06
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cigna All Commercial |
$448.54
|
| Rate for Payer: CORVEL All Commercial |
$483.37
|
| Rate for Payer: Coventry All Commercial |
$457.38
|
| Rate for Payer: Encore All Commercial |
$478.43
|
| Rate for Payer: Frontpath All Commercial |
$478.17
|
| Rate for Payer: Humana ChoiceCare |
$448.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.77
|
| Rate for Payer: PHCS All Commercial |
$389.81
|
| Rate for Payer: PHP All Commercial |
$394.18
|
| Rate for Payer: Sagamore Health Network All Products |
$401.25
|
| Rate for Payer: Signature Care EPO |
$431.39
|
| Rate for Payer: Signature Care PPO |
$457.38
|
| Rate for Payer: United Healthcare Commercial |
$409.56
|
|
|
HC X-RAY-SHOULDER MIN 2 VIEWS LT
|
Facility
|
OP
|
$519.75
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
1613031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$483.37 |
| Rate for Payer: Aetna Commercial |
$438.67
|
| Rate for Payer: Aetna Medicare |
$166.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$298.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$324.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.95
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Centivo All Commercial |
$282.74
|
| Rate for Payer: Cigna All Commercial |
$448.54
|
| Rate for Payer: CORVEL All Commercial |
$483.37
|
| Rate for Payer: Coventry All Commercial |
$457.38
|
| Rate for Payer: Encore All Commercial |
$478.43
|
| Rate for Payer: Frontpath All Commercial |
$478.17
|
| Rate for Payer: Humana ChoiceCare |
$448.91
|
| Rate for Payer: Humana Medicare |
$166.32
|
| Rate for Payer: Lucent All Commercial |
$282.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.77
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$389.81
|
| Rate for Payer: PHP All Commercial |
$394.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.70
|
| Rate for Payer: Sagamore Health Network All Products |
$401.25
|
| Rate for Payer: Signature Care EPO |
$431.39
|
| Rate for Payer: Signature Care PPO |
$457.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.79
|
| Rate for Payer: United Healthcare Commercial |
$409.56
|
| Rate for Payer: United Healthcare Medicare |
$166.32
|
|
|
HC X-RAY-SHOULDER MIN 2 VIEWS RT
|
Facility
|
IP
|
$519.75
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
11613031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$389.81 |
| Max. Negotiated Rate |
$483.37 |
| Rate for Payer: Aetna Commercial |
$449.06
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cigna All Commercial |
$448.54
|
| Rate for Payer: CORVEL All Commercial |
$483.37
|
| Rate for Payer: Coventry All Commercial |
$457.38
|
| Rate for Payer: Encore All Commercial |
$478.43
|
| Rate for Payer: Frontpath All Commercial |
$478.17
|
| Rate for Payer: Humana ChoiceCare |
$448.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.77
|
| Rate for Payer: PHCS All Commercial |
$389.81
|
| Rate for Payer: PHP All Commercial |
$394.18
|
| Rate for Payer: Sagamore Health Network All Products |
$401.25
|
| Rate for Payer: Signature Care EPO |
$431.39
|
| Rate for Payer: Signature Care PPO |
$457.38
|
| Rate for Payer: United Healthcare Commercial |
$409.56
|
|
|
HC X-RAY-SHOULDER MIN 2 VIEWS RT
|
Facility
|
OP
|
$519.75
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
11613031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$483.37 |
| Rate for Payer: Aetna Commercial |
$438.67
|
| Rate for Payer: Aetna Medicare |
$166.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$298.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$324.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.95
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Centivo All Commercial |
$282.74
|
| Rate for Payer: Cigna All Commercial |
$448.54
|
| Rate for Payer: CORVEL All Commercial |
$483.37
|
| Rate for Payer: Coventry All Commercial |
$457.38
|
| Rate for Payer: Encore All Commercial |
$478.43
|
| Rate for Payer: Frontpath All Commercial |
$478.17
|
| Rate for Payer: Humana ChoiceCare |
$448.91
|
| Rate for Payer: Humana Medicare |
$166.32
|
| Rate for Payer: Lucent All Commercial |
$282.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.77
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$389.81
|
| Rate for Payer: PHP All Commercial |
$394.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.70
|
| Rate for Payer: Sagamore Health Network All Products |
$401.25
|
| Rate for Payer: Signature Care EPO |
$431.39
|
| Rate for Payer: Signature Care PPO |
$457.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.79
|
| Rate for Payer: United Healthcare Commercial |
$409.56
|
| Rate for Payer: United Healthcare Medicare |
$166.32
|
|
|
HC X-RAY-SHOULDER SINGLE VIEW BI
|
Facility
|
IP
|
$516.78
|
|
|
Service Code
|
CPT 73020 50
|
| Hospital Charge Code |
21613020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$387.58 |
| Max. Negotiated Rate |
$480.61 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Cash Price |
$310.07
|
| Rate for Payer: Cigna All Commercial |
$445.98
|
| Rate for Payer: CORVEL All Commercial |
$480.61
|
| Rate for Payer: Coventry All Commercial |
$454.77
|
| Rate for Payer: Encore All Commercial |
$475.70
|
| Rate for Payer: Frontpath All Commercial |
$475.44
|
| Rate for Payer: Humana ChoiceCare |
$446.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.10
|
| Rate for Payer: PHCS All Commercial |
$387.58
|
| Rate for Payer: PHP All Commercial |
$391.93
|
| Rate for Payer: Sagamore Health Network All Products |
$398.95
|
| Rate for Payer: Signature Care EPO |
$428.93
|
| Rate for Payer: Signature Care PPO |
$454.77
|
| Rate for Payer: United Healthcare Commercial |
$407.22
|
|
|
HC X-RAY-SHOULDER SINGLE VIEW BI
|
Facility
|
OP
|
$516.78
|
|
|
Service Code
|
CPT 73020 50
|
| Hospital Charge Code |
21613020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$480.61 |
| Rate for Payer: Aetna Commercial |
$436.16
|
| Rate for Payer: Aetna Medicare |
$165.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$296.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$323.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.91
|
| Rate for Payer: Cash Price |
$310.07
|
| Rate for Payer: Cash Price |
$310.07
|
| Rate for Payer: Centivo All Commercial |
$281.13
|
| Rate for Payer: Cigna All Commercial |
$445.98
|
| Rate for Payer: CORVEL All Commercial |
$480.61
|
| Rate for Payer: Coventry All Commercial |
$454.77
|
| Rate for Payer: Encore All Commercial |
$475.70
|
| Rate for Payer: Frontpath All Commercial |
$475.44
|
| Rate for Payer: Humana ChoiceCare |
$446.34
|
| Rate for Payer: Humana Medicare |
$165.37
|
| Rate for Payer: Lucent All Commercial |
$281.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.10
|
| Rate for Payer: Managed Health Services Medicaid |
$11.31
|
| Rate for Payer: MDWise Medicaid |
$11.31
|
| Rate for Payer: PHCS All Commercial |
$387.58
|
| Rate for Payer: PHP All Commercial |
$391.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.54
|
| Rate for Payer: Sagamore Health Network All Products |
$398.95
|
| Rate for Payer: Signature Care EPO |
$428.93
|
| Rate for Payer: Signature Care PPO |
$454.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.26
|
| Rate for Payer: United Healthcare Commercial |
$407.22
|
| Rate for Payer: United Healthcare Medicare |
$165.37
|
|
|
HC X-RAY-SHOULDER SINGLE VIEW LT
|
Facility
|
IP
|
$344.53
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
1613020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$320.41 |
| Rate for Payer: Aetna Commercial |
$297.67
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cigna All Commercial |
$297.33
|
| Rate for Payer: CORVEL All Commercial |
$320.41
|
| Rate for Payer: Coventry All Commercial |
$303.19
|
| Rate for Payer: Encore All Commercial |
$317.14
|
| Rate for Payer: Frontpath All Commercial |
$316.97
|
| Rate for Payer: Humana ChoiceCare |
$297.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$310.08
|
| Rate for Payer: PHCS All Commercial |
$258.40
|
| Rate for Payer: PHP All Commercial |
$261.29
|
| Rate for Payer: Sagamore Health Network All Products |
$265.98
|
| Rate for Payer: Signature Care EPO |
$285.96
|
| Rate for Payer: Signature Care PPO |
$303.19
|
| Rate for Payer: United Healthcare Commercial |
$271.49
|
|
|
HC X-RAY-SHOULDER SINGLE VIEW LT
|
Facility
|
OP
|
$344.53
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
1613020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$320.41 |
| Rate for Payer: Aetna Commercial |
$290.78
|
| Rate for Payer: Aetna Medicare |
$110.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$197.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.27
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Centivo All Commercial |
$187.42
|
| Rate for Payer: Cigna All Commercial |
$297.33
|
| Rate for Payer: CORVEL All Commercial |
$320.41
|
| Rate for Payer: Coventry All Commercial |
$303.19
|
| Rate for Payer: Encore All Commercial |
$317.14
|
| Rate for Payer: Frontpath All Commercial |
$316.97
|
| Rate for Payer: Humana ChoiceCare |
$297.57
|
| Rate for Payer: Humana Medicare |
$110.25
|
| Rate for Payer: Lucent All Commercial |
$187.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$310.08
|
| Rate for Payer: Managed Health Services Medicaid |
$11.31
|
| Rate for Payer: MDWise Medicaid |
$11.31
|
| Rate for Payer: PHCS All Commercial |
$258.40
|
| Rate for Payer: PHP All Commercial |
$261.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.37
|
| Rate for Payer: Sagamore Health Network All Products |
$265.98
|
| Rate for Payer: Signature Care EPO |
$285.96
|
| Rate for Payer: Signature Care PPO |
$303.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.85
|
| Rate for Payer: United Healthcare Commercial |
$271.49
|
| Rate for Payer: United Healthcare Medicare |
$110.25
|
|
|
HC X-RAY-SHOULDER SINGLE VIEW RT
|
Facility
|
IP
|
$344.53
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
11613020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$320.41 |
| Rate for Payer: Aetna Commercial |
$297.67
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cigna All Commercial |
$297.33
|
| Rate for Payer: CORVEL All Commercial |
$320.41
|
| Rate for Payer: Coventry All Commercial |
$303.19
|
| Rate for Payer: Encore All Commercial |
$317.14
|
| Rate for Payer: Frontpath All Commercial |
$316.97
|
| Rate for Payer: Humana ChoiceCare |
$297.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$310.08
|
| Rate for Payer: PHCS All Commercial |
$258.40
|
| Rate for Payer: PHP All Commercial |
$261.29
|
| Rate for Payer: Sagamore Health Network All Products |
$265.98
|
| Rate for Payer: Signature Care EPO |
$285.96
|
| Rate for Payer: Signature Care PPO |
$303.19
|
| Rate for Payer: United Healthcare Commercial |
$271.49
|
|
|
HC X-RAY-SHOULDER SINGLE VIEW RT
|
Facility
|
OP
|
$344.53
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
11613020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$320.41 |
| Rate for Payer: Aetna Commercial |
$290.78
|
| Rate for Payer: Aetna Medicare |
$110.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$197.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.27
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Centivo All Commercial |
$187.42
|
| Rate for Payer: Cigna All Commercial |
$297.33
|
| Rate for Payer: CORVEL All Commercial |
$320.41
|
| Rate for Payer: Coventry All Commercial |
$303.19
|
| Rate for Payer: Encore All Commercial |
$317.14
|
| Rate for Payer: Frontpath All Commercial |
$316.97
|
| Rate for Payer: Humana ChoiceCare |
$297.57
|
| Rate for Payer: Humana Medicare |
$110.25
|
| Rate for Payer: Lucent All Commercial |
$187.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$310.08
|
| Rate for Payer: Managed Health Services Medicaid |
$11.31
|
| Rate for Payer: MDWise Medicaid |
$11.31
|
| Rate for Payer: PHCS All Commercial |
$258.40
|
| Rate for Payer: PHP All Commercial |
$261.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.37
|
| Rate for Payer: Sagamore Health Network All Products |
$265.98
|
| Rate for Payer: Signature Care EPO |
$285.96
|
| Rate for Payer: Signature Care PPO |
$303.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.85
|
| Rate for Payer: United Healthcare Commercial |
$271.49
|
| Rate for Payer: United Healthcare Medicare |
$110.25
|
|
|
HC X-RAY-SINUSES(2 VIEWS OR LESS)
|
Facility
|
IP
|
$586.29
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
1610210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$439.72 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Aetna Commercial |
$506.55
|
| Rate for Payer: Cash Price |
$351.77
|
| Rate for Payer: Cigna All Commercial |
$505.97
|
| Rate for Payer: CORVEL All Commercial |
$545.25
|
| Rate for Payer: Coventry All Commercial |
$515.94
|
| Rate for Payer: Encore All Commercial |
$539.68
|
| Rate for Payer: Frontpath All Commercial |
$539.39
|
| Rate for Payer: Humana ChoiceCare |
$506.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$527.66
|
| Rate for Payer: PHCS All Commercial |
$439.72
|
| Rate for Payer: PHP All Commercial |
$444.64
|
| Rate for Payer: Sagamore Health Network All Products |
$452.62
|
| Rate for Payer: Signature Care EPO |
$486.62
|
| Rate for Payer: Signature Care PPO |
$515.94
|
| Rate for Payer: United Healthcare Commercial |
$462.00
|
|
|
HC X-RAY-SINUSES(2 VIEWS OR LESS)
|
Facility
|
OP
|
$586.29
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
1610210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Aetna Commercial |
$494.83
|
| Rate for Payer: Aetna Medicare |
$187.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$336.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$366.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.37
|
| Rate for Payer: Cash Price |
$351.77
|
| Rate for Payer: Cash Price |
$351.77
|
| Rate for Payer: Centivo All Commercial |
$318.94
|
| Rate for Payer: Cigna All Commercial |
$505.97
|
| Rate for Payer: CORVEL All Commercial |
$545.25
|
| Rate for Payer: Coventry All Commercial |
$515.94
|
| Rate for Payer: Encore All Commercial |
$539.68
|
| Rate for Payer: Frontpath All Commercial |
$539.39
|
| Rate for Payer: Humana ChoiceCare |
$506.38
|
| Rate for Payer: Humana Medicare |
$187.61
|
| Rate for Payer: Lucent All Commercial |
$318.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$527.66
|
| Rate for Payer: Managed Health Services Medicaid |
$15.52
|
| Rate for Payer: MDWise Medicaid |
$15.52
|
| Rate for Payer: PHCS All Commercial |
$439.72
|
| Rate for Payer: PHP All Commercial |
$444.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.65
|
| Rate for Payer: Sagamore Health Network All Products |
$452.62
|
| Rate for Payer: Signature Care EPO |
$486.62
|
| Rate for Payer: Signature Care PPO |
$515.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$498.35
|
| Rate for Payer: United Healthcare Commercial |
$462.00
|
| Rate for Payer: United Healthcare Medicare |
$187.61
|
|
