|
HC X-RAY-SKULL 3 OR LESS VIEWS
|
Facility
|
OP
|
$329.04
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
1610261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$306.01 |
| Rate for Payer: Aetna Commercial |
$277.71
|
| Rate for Payer: Aetna Medicare |
$105.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$188.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.82
|
| Rate for Payer: Cash Price |
$197.42
|
| Rate for Payer: Cash Price |
$197.42
|
| Rate for Payer: Centivo All Commercial |
$179.00
|
| Rate for Payer: Cigna All Commercial |
$283.96
|
| Rate for Payer: CORVEL All Commercial |
$306.01
|
| Rate for Payer: Coventry All Commercial |
$289.56
|
| Rate for Payer: Encore All Commercial |
$302.88
|
| Rate for Payer: Frontpath All Commercial |
$302.72
|
| Rate for Payer: Humana ChoiceCare |
$284.19
|
| Rate for Payer: Humana Medicare |
$105.29
|
| Rate for Payer: Lucent All Commercial |
$179.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.14
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$246.78
|
| Rate for Payer: PHP All Commercial |
$249.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.33
|
| Rate for Payer: Sagamore Health Network All Products |
$254.02
|
| Rate for Payer: Signature Care EPO |
$273.10
|
| Rate for Payer: Signature Care PPO |
$289.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$279.68
|
| Rate for Payer: United Healthcare Commercial |
$259.28
|
| Rate for Payer: United Healthcare Medicare |
$105.29
|
|
|
HC X-RAY-SKULL 3 OR LESS VIEWS
|
Facility
|
IP
|
$329.04
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
1610261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.78 |
| Max. Negotiated Rate |
$306.01 |
| Rate for Payer: Aetna Commercial |
$284.29
|
| Rate for Payer: Cash Price |
$197.42
|
| Rate for Payer: Cigna All Commercial |
$283.96
|
| Rate for Payer: CORVEL All Commercial |
$306.01
|
| Rate for Payer: Coventry All Commercial |
$289.56
|
| Rate for Payer: Encore All Commercial |
$302.88
|
| Rate for Payer: Frontpath All Commercial |
$302.72
|
| Rate for Payer: Humana ChoiceCare |
$284.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.14
|
| Rate for Payer: PHCS All Commercial |
$246.78
|
| Rate for Payer: PHP All Commercial |
$249.54
|
| Rate for Payer: Sagamore Health Network All Products |
$254.02
|
| Rate for Payer: Signature Care EPO |
$273.10
|
| Rate for Payer: Signature Care PPO |
$289.56
|
| Rate for Payer: United Healthcare Commercial |
$259.28
|
|
|
HC X-RAY-SKULL 4 OR MORE VIEWS
|
Facility
|
OP
|
$823.84
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
1610260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$766.17 |
| Rate for Payer: Aetna Commercial |
$695.32
|
| Rate for Payer: Aetna Medicare |
$263.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$473.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$514.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$289.99
|
| Rate for Payer: Cash Price |
$494.30
|
| Rate for Payer: Cash Price |
$494.30
|
| Rate for Payer: Centivo All Commercial |
$448.17
|
| Rate for Payer: Cigna All Commercial |
$710.97
|
| Rate for Payer: CORVEL All Commercial |
$766.17
|
| Rate for Payer: Coventry All Commercial |
$724.98
|
| Rate for Payer: Encore All Commercial |
$758.34
|
| Rate for Payer: Frontpath All Commercial |
$757.93
|
| Rate for Payer: Humana ChoiceCare |
$711.55
|
| Rate for Payer: Humana Medicare |
$263.63
|
| Rate for Payer: Lucent All Commercial |
$448.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$741.46
|
| Rate for Payer: Managed Health Services Medicaid |
$21.47
|
| Rate for Payer: MDWise Medicaid |
$21.47
|
| Rate for Payer: PHCS All Commercial |
$617.88
|
| Rate for Payer: PHP All Commercial |
$624.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.30
|
| Rate for Payer: Sagamore Health Network All Products |
$636.00
|
| Rate for Payer: Signature Care EPO |
$683.79
|
| Rate for Payer: Signature Care PPO |
$724.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$700.26
|
| Rate for Payer: United Healthcare Commercial |
$649.19
|
| Rate for Payer: United Healthcare Medicare |
$263.63
|
|
|
HC X-RAY-SKULL 4 OR MORE VIEWS
|
Facility
|
IP
|
$823.84
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
1610260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$617.88 |
| Max. Negotiated Rate |
$766.17 |
| Rate for Payer: Aetna Commercial |
$711.80
|
| Rate for Payer: Cash Price |
$494.30
|
| Rate for Payer: Cigna All Commercial |
$710.97
|
| Rate for Payer: CORVEL All Commercial |
$766.17
|
| Rate for Payer: Coventry All Commercial |
$724.98
|
| Rate for Payer: Encore All Commercial |
$758.34
|
| Rate for Payer: Frontpath All Commercial |
$757.93
|
| Rate for Payer: Humana ChoiceCare |
$711.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$741.46
|
| Rate for Payer: PHCS All Commercial |
$617.88
|
| Rate for Payer: PHP All Commercial |
$624.80
|
| Rate for Payer: Sagamore Health Network All Products |
$636.00
|
| Rate for Payer: Signature Care EPO |
$683.79
|
| Rate for Payer: Signature Care PPO |
$724.98
|
| Rate for Payer: United Healthcare Commercial |
$649.19
|
|
|
HC X-RAY-SMALL BOWEL ONLY
|
Facility
|
IP
|
$1,077.49
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1614250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$808.12 |
| Max. Negotiated Rate |
$1,002.07 |
| Rate for Payer: Aetna Commercial |
$930.95
|
| Rate for Payer: Cash Price |
$646.49
|
| Rate for Payer: Cigna All Commercial |
$929.87
|
| Rate for Payer: CORVEL All Commercial |
$1,002.07
|
| Rate for Payer: Coventry All Commercial |
$948.19
|
| Rate for Payer: Encore All Commercial |
$991.83
|
| Rate for Payer: Frontpath All Commercial |
$991.29
|
| Rate for Payer: Humana ChoiceCare |
$930.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$969.74
|
| Rate for Payer: PHCS All Commercial |
$808.12
|
| Rate for Payer: PHP All Commercial |
$817.17
|
| Rate for Payer: Sagamore Health Network All Products |
$831.82
|
| Rate for Payer: Signature Care EPO |
$894.32
|
| Rate for Payer: Signature Care PPO |
$948.19
|
| Rate for Payer: United Healthcare Commercial |
$849.06
|
|
|
HC X-RAY-SMALL BOWEL ONLY
|
Facility
|
OP
|
$1,077.49
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1614250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$1,002.07 |
| Rate for Payer: Aetna Commercial |
$909.40
|
| Rate for Payer: Aetna Medicare |
$344.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$334.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$618.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$673.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.28
|
| Rate for Payer: Cash Price |
$646.49
|
| Rate for Payer: Cash Price |
$646.49
|
| Rate for Payer: Centivo All Commercial |
$586.15
|
| Rate for Payer: Cigna All Commercial |
$929.87
|
| Rate for Payer: CORVEL All Commercial |
$1,002.07
|
| Rate for Payer: Coventry All Commercial |
$948.19
|
| Rate for Payer: Encore All Commercial |
$991.83
|
| Rate for Payer: Frontpath All Commercial |
$991.29
|
| Rate for Payer: Humana ChoiceCare |
$930.63
|
| Rate for Payer: Humana Medicare |
$344.80
|
| Rate for Payer: Lucent All Commercial |
$586.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$969.74
|
| Rate for Payer: Managed Health Services Medicaid |
$60.11
|
| Rate for Payer: MDWise Medicaid |
$60.11
|
| Rate for Payer: PHCS All Commercial |
$808.12
|
| Rate for Payer: PHP All Commercial |
$817.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$420.22
|
| Rate for Payer: Sagamore Health Network All Products |
$831.82
|
| Rate for Payer: Signature Care EPO |
$894.32
|
| Rate for Payer: Signature Care PPO |
$948.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$915.87
|
| Rate for Payer: United Healthcare Commercial |
$849.06
|
| Rate for Payer: United Healthcare Medicare |
$344.80
|
|
|
HC X-RAY SM INT FOLLOW-THRU STUDY
|
Facility
|
IP
|
$808.12
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
1614248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$606.09 |
| Max. Negotiated Rate |
$751.55 |
| Rate for Payer: Aetna Commercial |
$698.22
|
| Rate for Payer: Cash Price |
$484.87
|
| Rate for Payer: Cigna All Commercial |
$697.41
|
| Rate for Payer: CORVEL All Commercial |
$751.55
|
| Rate for Payer: Coventry All Commercial |
$711.15
|
| Rate for Payer: Encore All Commercial |
$743.87
|
| Rate for Payer: Frontpath All Commercial |
$743.47
|
| Rate for Payer: Humana ChoiceCare |
$697.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$727.31
|
| Rate for Payer: PHCS All Commercial |
$606.09
|
| Rate for Payer: PHP All Commercial |
$612.88
|
| Rate for Payer: Sagamore Health Network All Products |
$623.87
|
| Rate for Payer: Signature Care EPO |
$670.74
|
| Rate for Payer: Signature Care PPO |
$711.15
|
| Rate for Payer: United Healthcare Commercial |
$636.80
|
|
|
HC X-RAY SM INT FOLLOW-THRU STUDY
|
Facility
|
OP
|
$808.12
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
1614248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$751.55 |
| Rate for Payer: Aetna Commercial |
$682.05
|
| Rate for Payer: Aetna Medicare |
$258.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$32.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$250.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$464.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$505.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$32.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$297.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$284.46
|
| Rate for Payer: Cash Price |
$484.87
|
| Rate for Payer: Cash Price |
$484.87
|
| Rate for Payer: Centivo All Commercial |
$439.62
|
| Rate for Payer: Cigna All Commercial |
$697.41
|
| Rate for Payer: CORVEL All Commercial |
$751.55
|
| Rate for Payer: Coventry All Commercial |
$711.15
|
| Rate for Payer: Encore All Commercial |
$743.87
|
| Rate for Payer: Frontpath All Commercial |
$743.47
|
| Rate for Payer: Humana ChoiceCare |
$697.97
|
| Rate for Payer: Humana Medicare |
$258.60
|
| Rate for Payer: Lucent All Commercial |
$439.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$727.31
|
| Rate for Payer: Managed Health Services Medicaid |
$32.95
|
| Rate for Payer: MDWise Medicaid |
$32.95
|
| Rate for Payer: PHCS All Commercial |
$606.09
|
| Rate for Payer: PHP All Commercial |
$612.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.17
|
| Rate for Payer: Sagamore Health Network All Products |
$623.87
|
| Rate for Payer: Signature Care EPO |
$670.74
|
| Rate for Payer: Signature Care PPO |
$711.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$686.90
|
| Rate for Payer: United Healthcare Commercial |
$636.80
|
| Rate for Payer: United Healthcare Medicare |
$258.60
|
|
|
HC X-RAY-SPINE ENTIRE 1 VIEW
|
Facility
|
OP
|
$452.56
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
1612015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$381.96
|
| Rate for Payer: Aetna Medicare |
$144.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$259.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$282.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.30
|
| Rate for Payer: Cash Price |
$271.54
|
| Rate for Payer: Cash Price |
$271.54
|
| Rate for Payer: Centivo All Commercial |
$246.19
|
| Rate for Payer: Cigna All Commercial |
$390.56
|
| Rate for Payer: CORVEL All Commercial |
$420.88
|
| Rate for Payer: Coventry All Commercial |
$398.25
|
| Rate for Payer: Encore All Commercial |
$416.58
|
| Rate for Payer: Frontpath All Commercial |
$416.36
|
| Rate for Payer: Humana ChoiceCare |
$390.88
|
| Rate for Payer: Humana Medicare |
$144.82
|
| Rate for Payer: Lucent All Commercial |
$246.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$339.42
|
| Rate for Payer: PHP All Commercial |
$343.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$176.50
|
| Rate for Payer: Sagamore Health Network All Products |
$349.38
|
| Rate for Payer: Signature Care EPO |
$375.62
|
| Rate for Payer: Signature Care PPO |
$398.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$384.68
|
| Rate for Payer: United Healthcare Commercial |
$356.62
|
| Rate for Payer: United Healthcare Medicare |
$144.82
|
|
|
HC X-RAY-SPINE ENTIRE 1 VIEW
|
Facility
|
IP
|
$452.56
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
1612015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.42 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$391.01
|
| Rate for Payer: Cash Price |
$271.54
|
| Rate for Payer: Cigna All Commercial |
$390.56
|
| Rate for Payer: CORVEL All Commercial |
$420.88
|
| Rate for Payer: Coventry All Commercial |
$398.25
|
| Rate for Payer: Encore All Commercial |
$416.58
|
| Rate for Payer: Frontpath All Commercial |
$416.36
|
| Rate for Payer: Humana ChoiceCare |
$390.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.30
|
| Rate for Payer: PHCS All Commercial |
$339.42
|
| Rate for Payer: PHP All Commercial |
$343.22
|
| Rate for Payer: Sagamore Health Network All Products |
$349.38
|
| Rate for Payer: Signature Care EPO |
$375.62
|
| Rate for Payer: Signature Care PPO |
$398.25
|
| Rate for Payer: United Healthcare Commercial |
$356.62
|
|
|
HC X-RAY-SPINE ENTIRE 2-3 VIEWS
|
Facility
|
OP
|
$452.56
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
1612010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$381.96
|
| Rate for Payer: Aetna Medicare |
$144.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$259.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$282.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.30
|
| Rate for Payer: Cash Price |
$271.54
|
| Rate for Payer: Cash Price |
$271.54
|
| Rate for Payer: Centivo All Commercial |
$246.19
|
| Rate for Payer: Cigna All Commercial |
$390.56
|
| Rate for Payer: CORVEL All Commercial |
$420.88
|
| Rate for Payer: Coventry All Commercial |
$398.25
|
| Rate for Payer: Encore All Commercial |
$416.58
|
| Rate for Payer: Frontpath All Commercial |
$416.36
|
| Rate for Payer: Humana ChoiceCare |
$390.88
|
| Rate for Payer: Humana Medicare |
$144.82
|
| Rate for Payer: Lucent All Commercial |
$246.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.30
|
| Rate for Payer: Managed Health Services Medicaid |
$31.87
|
| Rate for Payer: MDWise Medicaid |
$31.87
|
| Rate for Payer: PHCS All Commercial |
$339.42
|
| Rate for Payer: PHP All Commercial |
$343.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$176.50
|
| Rate for Payer: Sagamore Health Network All Products |
$349.38
|
| Rate for Payer: Signature Care EPO |
$375.62
|
| Rate for Payer: Signature Care PPO |
$398.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$384.68
|
| Rate for Payer: United Healthcare Commercial |
$356.62
|
| Rate for Payer: United Healthcare Medicare |
$144.82
|
|
|
HC X-RAY-SPINE ENTIRE 2-3 VIEWS
|
Facility
|
IP
|
$452.56
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
1612010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.42 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$391.01
|
| Rate for Payer: Cash Price |
$271.54
|
| Rate for Payer: Cigna All Commercial |
$390.56
|
| Rate for Payer: CORVEL All Commercial |
$420.88
|
| Rate for Payer: Coventry All Commercial |
$398.25
|
| Rate for Payer: Encore All Commercial |
$416.58
|
| Rate for Payer: Frontpath All Commercial |
$416.36
|
| Rate for Payer: Humana ChoiceCare |
$390.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.30
|
| Rate for Payer: PHCS All Commercial |
$339.42
|
| Rate for Payer: PHP All Commercial |
$343.22
|
| Rate for Payer: Sagamore Health Network All Products |
$349.38
|
| Rate for Payer: Signature Care EPO |
$375.62
|
| Rate for Payer: Signature Care PPO |
$398.25
|
| Rate for Payer: United Healthcare Commercial |
$356.62
|
|
|
HC X-RAY-SPINE SINGLE VIEW
|
Facility
|
IP
|
$361.68
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
1618606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.26 |
| Max. Negotiated Rate |
$336.36 |
| Rate for Payer: Aetna Commercial |
$312.49
|
| Rate for Payer: Cash Price |
$217.01
|
| Rate for Payer: Cigna All Commercial |
$312.13
|
| Rate for Payer: CORVEL All Commercial |
$336.36
|
| Rate for Payer: Coventry All Commercial |
$318.28
|
| Rate for Payer: Encore All Commercial |
$332.93
|
| Rate for Payer: Frontpath All Commercial |
$332.75
|
| Rate for Payer: Humana ChoiceCare |
$312.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.51
|
| Rate for Payer: PHCS All Commercial |
$271.26
|
| Rate for Payer: PHP All Commercial |
$274.30
|
| Rate for Payer: Sagamore Health Network All Products |
$279.22
|
| Rate for Payer: Signature Care EPO |
$300.19
|
| Rate for Payer: Signature Care PPO |
$318.28
|
| Rate for Payer: United Healthcare Commercial |
$285.00
|
|
|
HC X-RAY-SPINE SINGLE VIEW
|
Facility
|
OP
|
$361.68
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
1618606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$336.36 |
| Rate for Payer: Aetna Commercial |
$305.26
|
| Rate for Payer: Aetna Medicare |
$115.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$207.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.31
|
| Rate for Payer: Cash Price |
$217.01
|
| Rate for Payer: Cash Price |
$217.01
|
| Rate for Payer: Centivo All Commercial |
$196.75
|
| Rate for Payer: Cigna All Commercial |
$312.13
|
| Rate for Payer: CORVEL All Commercial |
$336.36
|
| Rate for Payer: Coventry All Commercial |
$318.28
|
| Rate for Payer: Encore All Commercial |
$332.93
|
| Rate for Payer: Frontpath All Commercial |
$332.75
|
| Rate for Payer: Humana ChoiceCare |
$312.38
|
| Rate for Payer: Humana Medicare |
$115.74
|
| Rate for Payer: Lucent All Commercial |
$196.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.51
|
| Rate for Payer: Managed Health Services Medicaid |
$10.82
|
| Rate for Payer: MDWise Medicaid |
$10.82
|
| Rate for Payer: PHCS All Commercial |
$271.26
|
| Rate for Payer: PHP All Commercial |
$274.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.06
|
| Rate for Payer: Sagamore Health Network All Products |
$279.22
|
| Rate for Payer: Signature Care EPO |
$300.19
|
| Rate for Payer: Signature Care PPO |
$318.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.43
|
| Rate for Payer: United Healthcare Commercial |
$285.00
|
| Rate for Payer: United Healthcare Medicare |
$115.74
|
|
|
HC X-RAY-STERNO CLAVICULAR JOINTS 3+ VIEWS
|
Facility
|
IP
|
$95.15
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
1611130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$88.49 |
| Rate for Payer: Aetna Commercial |
$82.21
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Cigna All Commercial |
$82.11
|
| Rate for Payer: CORVEL All Commercial |
$88.49
|
| Rate for Payer: Coventry All Commercial |
$83.73
|
| Rate for Payer: Encore All Commercial |
$87.59
|
| Rate for Payer: Frontpath All Commercial |
$87.54
|
| Rate for Payer: Humana ChoiceCare |
$82.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.64
|
| Rate for Payer: PHCS All Commercial |
$71.36
|
| Rate for Payer: PHP All Commercial |
$72.16
|
| Rate for Payer: Sagamore Health Network All Products |
$73.46
|
| Rate for Payer: Signature Care EPO |
$78.97
|
| Rate for Payer: Signature Care PPO |
$83.73
|
| Rate for Payer: United Healthcare Commercial |
$74.98
|
|
|
HC X-RAY-STERNO CLAVICULAR JOINTS 3+ VIEWS
|
Facility
|
OP
|
$95.15
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
1611130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$88.49 |
| Rate for Payer: Aetna Commercial |
$80.31
|
| Rate for Payer: Aetna Medicare |
$30.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Cash Price |
$57.09
|
| Rate for Payer: Centivo All Commercial |
$51.76
|
| Rate for Payer: Cigna All Commercial |
$82.11
|
| Rate for Payer: CORVEL All Commercial |
$88.49
|
| Rate for Payer: Coventry All Commercial |
$83.73
|
| Rate for Payer: Encore All Commercial |
$87.59
|
| Rate for Payer: Frontpath All Commercial |
$87.54
|
| Rate for Payer: Humana ChoiceCare |
$82.18
|
| Rate for Payer: Humana Medicare |
$30.45
|
| Rate for Payer: Lucent All Commercial |
$51.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.64
|
| Rate for Payer: Managed Health Services Medicaid |
$18.50
|
| Rate for Payer: MDWise Medicaid |
$18.50
|
| Rate for Payer: PHCS All Commercial |
$71.36
|
| Rate for Payer: PHP All Commercial |
$72.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.11
|
| Rate for Payer: Sagamore Health Network All Products |
$73.46
|
| Rate for Payer: Signature Care EPO |
$78.97
|
| Rate for Payer: Signature Care PPO |
$83.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.88
|
| Rate for Payer: United Healthcare Commercial |
$74.98
|
| Rate for Payer: United Healthcare Medicare |
$30.45
|
|
|
HC X-RAY-STERNUM 2+ VIEWS
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
1611120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.87 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$419.18
|
| Rate for Payer: Cash Price |
$291.10
|
| Rate for Payer: Cigna All Commercial |
$418.69
|
| Rate for Payer: CORVEL All Commercial |
$451.20
|
| Rate for Payer: Coventry All Commercial |
$426.94
|
| Rate for Payer: Encore All Commercial |
$446.59
|
| Rate for Payer: Frontpath All Commercial |
$446.35
|
| Rate for Payer: Humana ChoiceCare |
$419.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$436.64
|
| Rate for Payer: PHCS All Commercial |
$363.87
|
| Rate for Payer: PHP All Commercial |
$367.95
|
| Rate for Payer: Sagamore Health Network All Products |
$374.54
|
| Rate for Payer: Signature Care EPO |
$402.68
|
| Rate for Payer: Signature Care PPO |
$426.94
|
| Rate for Payer: United Healthcare Commercial |
$382.31
|
|
|
HC X-RAY-STERNUM 2+ VIEWS
|
Facility
|
OP
|
$485.16
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
1611120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Medicare |
$155.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$278.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$303.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$178.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.78
|
| Rate for Payer: Cash Price |
$291.10
|
| Rate for Payer: Cash Price |
$291.10
|
| Rate for Payer: Centivo All Commercial |
$263.93
|
| Rate for Payer: Cigna All Commercial |
$418.69
|
| Rate for Payer: CORVEL All Commercial |
$451.20
|
| Rate for Payer: Coventry All Commercial |
$426.94
|
| Rate for Payer: Encore All Commercial |
$446.59
|
| Rate for Payer: Frontpath All Commercial |
$446.35
|
| Rate for Payer: Humana ChoiceCare |
$419.03
|
| Rate for Payer: Humana Medicare |
$155.25
|
| Rate for Payer: Lucent All Commercial |
$263.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$436.64
|
| Rate for Payer: Managed Health Services Medicaid |
$15.28
|
| Rate for Payer: MDWise Medicaid |
$15.28
|
| Rate for Payer: PHCS All Commercial |
$363.87
|
| Rate for Payer: PHP All Commercial |
$367.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.21
|
| Rate for Payer: Sagamore Health Network All Products |
$374.54
|
| Rate for Payer: Signature Care EPO |
$402.68
|
| Rate for Payer: Signature Care PPO |
$426.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$412.39
|
| Rate for Payer: United Healthcare Commercial |
$382.31
|
| Rate for Payer: United Healthcare Medicare |
$155.25
|
|
|
HC X-RAY-SURGICAL CHOLANGIOGRAM
|
Facility
|
OP
|
$1,090.32
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1614300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.57 |
| Max. Negotiated Rate |
$1,014.00 |
| Rate for Payer: Aetna Commercial |
$920.23
|
| Rate for Payer: Aetna Medicare |
$348.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$50.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$626.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$681.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$50.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.79
|
| Rate for Payer: Cash Price |
$654.19
|
| Rate for Payer: Cash Price |
$654.19
|
| Rate for Payer: Centivo All Commercial |
$593.13
|
| Rate for Payer: Cigna All Commercial |
$940.95
|
| Rate for Payer: CORVEL All Commercial |
$1,014.00
|
| Rate for Payer: Coventry All Commercial |
$959.48
|
| Rate for Payer: Encore All Commercial |
$1,003.64
|
| Rate for Payer: Frontpath All Commercial |
$1,003.09
|
| Rate for Payer: Humana ChoiceCare |
$941.71
|
| Rate for Payer: Humana Medicare |
$348.90
|
| Rate for Payer: Lucent All Commercial |
$593.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.29
|
| Rate for Payer: Managed Health Services Medicaid |
$50.57
|
| Rate for Payer: MDWise Medicaid |
$50.57
|
| Rate for Payer: PHCS All Commercial |
$817.74
|
| Rate for Payer: PHP All Commercial |
$826.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.22
|
| Rate for Payer: Sagamore Health Network All Products |
$841.73
|
| Rate for Payer: Signature Care EPO |
$904.97
|
| Rate for Payer: Signature Care PPO |
$959.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$926.77
|
| Rate for Payer: United Healthcare Commercial |
$859.17
|
| Rate for Payer: United Healthcare Medicare |
$348.90
|
|
|
HC X-RAY-SURGICAL CHOLANGIOGRAM
|
Facility
|
IP
|
$1,090.32
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1614300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$817.74 |
| Max. Negotiated Rate |
$1,014.00 |
| Rate for Payer: Aetna Commercial |
$942.04
|
| Rate for Payer: Cash Price |
$654.19
|
| Rate for Payer: Cigna All Commercial |
$940.95
|
| Rate for Payer: CORVEL All Commercial |
$1,014.00
|
| Rate for Payer: Coventry All Commercial |
$959.48
|
| Rate for Payer: Encore All Commercial |
$1,003.64
|
| Rate for Payer: Frontpath All Commercial |
$1,003.09
|
| Rate for Payer: Humana ChoiceCare |
$941.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$981.29
|
| Rate for Payer: PHCS All Commercial |
$817.74
|
| Rate for Payer: PHP All Commercial |
$826.90
|
| Rate for Payer: Sagamore Health Network All Products |
$841.73
|
| Rate for Payer: Signature Care EPO |
$904.97
|
| Rate for Payer: Signature Care PPO |
$959.48
|
| Rate for Payer: United Healthcare Commercial |
$859.17
|
|
|
HC X-RAY-THORACIC SPINE 2 VIEWS
|
Facility
|
OP
|
$631.22
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
11612070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$587.03 |
| Rate for Payer: Aetna Commercial |
$532.75
|
| Rate for Payer: Aetna Medicare |
$201.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$362.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$394.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.19
|
| Rate for Payer: Cash Price |
$378.73
|
| Rate for Payer: Cash Price |
$378.73
|
| Rate for Payer: Centivo All Commercial |
$343.38
|
| Rate for Payer: Cigna All Commercial |
$544.74
|
| Rate for Payer: CORVEL All Commercial |
$587.03
|
| Rate for Payer: Coventry All Commercial |
$555.47
|
| Rate for Payer: Encore All Commercial |
$581.04
|
| Rate for Payer: Frontpath All Commercial |
$580.72
|
| Rate for Payer: Humana ChoiceCare |
$545.18
|
| Rate for Payer: Humana Medicare |
$201.99
|
| Rate for Payer: Lucent All Commercial |
$343.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$568.10
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$473.42
|
| Rate for Payer: PHP All Commercial |
$478.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$246.18
|
| Rate for Payer: Sagamore Health Network All Products |
$487.30
|
| Rate for Payer: Signature Care EPO |
$523.91
|
| Rate for Payer: Signature Care PPO |
$555.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$536.54
|
| Rate for Payer: United Healthcare Commercial |
$497.40
|
| Rate for Payer: United Healthcare Medicare |
$201.99
|
|
|
HC X-RAY-THORACIC SPINE 2 VIEWS
|
Facility
|
IP
|
$631.22
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
11612070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$473.42 |
| Max. Negotiated Rate |
$587.03 |
| Rate for Payer: Aetna Commercial |
$545.37
|
| Rate for Payer: Cash Price |
$378.73
|
| Rate for Payer: Cigna All Commercial |
$544.74
|
| Rate for Payer: CORVEL All Commercial |
$587.03
|
| Rate for Payer: Coventry All Commercial |
$555.47
|
| Rate for Payer: Encore All Commercial |
$581.04
|
| Rate for Payer: Frontpath All Commercial |
$580.72
|
| Rate for Payer: Humana ChoiceCare |
$545.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$568.10
|
| Rate for Payer: PHCS All Commercial |
$473.42
|
| Rate for Payer: PHP All Commercial |
$478.72
|
| Rate for Payer: Sagamore Health Network All Products |
$487.30
|
| Rate for Payer: Signature Care EPO |
$523.91
|
| Rate for Payer: Signature Care PPO |
$555.47
|
| Rate for Payer: United Healthcare Commercial |
$497.40
|
|
|
HC X-RAY-THORACIC SPINE 3 VIEWS
|
Facility
|
IP
|
$550.70
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
1612070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.02 |
| Max. Negotiated Rate |
$512.15 |
| Rate for Payer: Aetna Commercial |
$475.80
|
| Rate for Payer: Cash Price |
$330.42
|
| Rate for Payer: Cigna All Commercial |
$475.25
|
| Rate for Payer: CORVEL All Commercial |
$512.15
|
| Rate for Payer: Coventry All Commercial |
$484.62
|
| Rate for Payer: Encore All Commercial |
$506.92
|
| Rate for Payer: Frontpath All Commercial |
$506.64
|
| Rate for Payer: Humana ChoiceCare |
$475.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$495.63
|
| Rate for Payer: PHCS All Commercial |
$413.02
|
| Rate for Payer: PHP All Commercial |
$417.65
|
| Rate for Payer: Sagamore Health Network All Products |
$425.14
|
| Rate for Payer: Signature Care EPO |
$457.08
|
| Rate for Payer: Signature Care PPO |
$484.62
|
| Rate for Payer: United Healthcare Commercial |
$433.95
|
|
|
HC X-RAY-THORACIC SPINE 3 VIEWS
|
Facility
|
OP
|
$550.70
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
1612070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$512.15 |
| Rate for Payer: Aetna Commercial |
$464.79
|
| Rate for Payer: Aetna Medicare |
$176.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$316.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$202.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$193.85
|
| Rate for Payer: Cash Price |
$330.42
|
| Rate for Payer: Cash Price |
$330.42
|
| Rate for Payer: Centivo All Commercial |
$299.58
|
| Rate for Payer: Cigna All Commercial |
$475.25
|
| Rate for Payer: CORVEL All Commercial |
$512.15
|
| Rate for Payer: Coventry All Commercial |
$484.62
|
| Rate for Payer: Encore All Commercial |
$506.92
|
| Rate for Payer: Frontpath All Commercial |
$506.64
|
| Rate for Payer: Humana ChoiceCare |
$475.64
|
| Rate for Payer: Humana Medicare |
$176.22
|
| Rate for Payer: Lucent All Commercial |
$299.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$495.63
|
| Rate for Payer: Managed Health Services Medicaid |
$18.74
|
| Rate for Payer: MDWise Medicaid |
$18.74
|
| Rate for Payer: PHCS All Commercial |
$413.02
|
| Rate for Payer: PHP All Commercial |
$417.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$214.77
|
| Rate for Payer: Sagamore Health Network All Products |
$425.14
|
| Rate for Payer: Signature Care EPO |
$457.08
|
| Rate for Payer: Signature Care PPO |
$484.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$468.10
|
| Rate for Payer: United Healthcare Commercial |
$433.95
|
| Rate for Payer: United Healthcare Medicare |
$176.22
|
|
|
HC X-RAY-TIBIA-FIBULA 2 VIEWS BI
|
Facility
|
OP
|
$623.13
|
|
|
Service Code
|
CPT 73590 50
|
| Hospital Charge Code |
21613590
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$579.51 |
| Rate for Payer: Aetna Commercial |
$525.92
|
| Rate for Payer: Aetna Medicare |
$199.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$357.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$389.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.34
|
| Rate for Payer: Cash Price |
$373.88
|
| Rate for Payer: Cash Price |
$373.88
|
| Rate for Payer: Centivo All Commercial |
$338.98
|
| Rate for Payer: Cigna All Commercial |
$537.76
|
| Rate for Payer: CORVEL All Commercial |
$579.51
|
| Rate for Payer: Coventry All Commercial |
$548.35
|
| Rate for Payer: Encore All Commercial |
$573.59
|
| Rate for Payer: Frontpath All Commercial |
$573.28
|
| Rate for Payer: Humana ChoiceCare |
$538.20
|
| Rate for Payer: Humana Medicare |
$199.40
|
| Rate for Payer: Lucent All Commercial |
$338.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.82
|
| Rate for Payer: Managed Health Services Medicaid |
$13.29
|
| Rate for Payer: MDWise Medicaid |
$13.29
|
| Rate for Payer: PHCS All Commercial |
$467.35
|
| Rate for Payer: PHP All Commercial |
$472.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$243.02
|
| Rate for Payer: Sagamore Health Network All Products |
$481.06
|
| Rate for Payer: Signature Care EPO |
$517.20
|
| Rate for Payer: Signature Care PPO |
$548.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$529.66
|
| Rate for Payer: United Healthcare Commercial |
$491.03
|
| Rate for Payer: United Healthcare Medicare |
$199.40
|
|
