|
HC SIG 3PX SILK CIC HA MON
|
Facility
OP
|
$2,145.00
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603631
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,810.38
|
| Rate for Payer: Aetna Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,231.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,340.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$814.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$778.64
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Centivo All Commercial |
$1,093.95
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Humana Medicare |
$1,093.95
|
| Rate for Payer: Lucent All Commercial |
$1,093.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$836.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
| Rate for Payer: United Healthcare Medicare |
$707.85
|
|
|
HC SIG 3PX SILK CIC HA MON
|
Facility
IP
|
$2,145.00
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603631
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,608.75 |
| Max. Negotiated Rate |
$1,994.85 |
| Rate for Payer: Aetna Commercial |
$1,853.28
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna All Commercial |
$1,851.14
|
| Rate for Payer: CORVEL All Commercial |
$1,994.85
|
| Rate for Payer: Coventry All Commercial |
$1,887.60
|
| Rate for Payer: Encore All Commercial |
$1,974.47
|
| Rate for Payer: Frontpath All Commercial |
$1,973.40
|
| Rate for Payer: Humana ChoiceCare |
$1,852.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,930.50
|
| Rate for Payer: PHCS All Commercial |
$1,608.75
|
| Rate for Payer: PHP All Commercial |
$1,626.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,655.94
|
| Rate for Payer: Signature Care EPO |
$1,780.35
|
| Rate for Payer: Signature Care PPO |
$1,887.60
|
| Rate for Payer: United Healthcare Commercial |
$1,690.26
|
|
|
HC SIG 5PX ACE BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603621
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX ACE BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603621
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX CARAT BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603623
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX CARAT BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603623
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX CELLION BTE HA MON
|
Facility
IP
|
$2,768.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603628
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,076.30 |
| Max. Negotiated Rate |
$2,574.61 |
| Rate for Payer: Aetna Commercial |
$2,391.90
|
| Rate for Payer: Cash Price |
$1,716.41
|
| Rate for Payer: Cigna All Commercial |
$2,389.13
|
| Rate for Payer: CORVEL All Commercial |
$2,574.61
|
| Rate for Payer: Coventry All Commercial |
$2,436.19
|
| Rate for Payer: Encore All Commercial |
$2,548.31
|
| Rate for Payer: Frontpath All Commercial |
$2,546.93
|
| Rate for Payer: Humana ChoiceCare |
$2,391.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,491.56
|
| Rate for Payer: PHCS All Commercial |
$2,076.30
|
| Rate for Payer: PHP All Commercial |
$2,099.55
|
| Rate for Payer: Sagamore Health Network All Products |
$2,137.20
|
| Rate for Payer: Signature Care EPO |
$2,297.77
|
| Rate for Payer: Signature Care PPO |
$2,436.19
|
| Rate for Payer: United Healthcare Commercial |
$2,181.50
|
|
|
HC SIG 5PX CELLION BTE HA MON
|
Facility
OP
|
$2,768.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603628
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,574.61 |
| Rate for Payer: Aetna Commercial |
$2,336.53
|
| Rate for Payer: Aetna Medicare |
$913.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$913.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,589.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,730.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,050.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,004.93
|
| Rate for Payer: Cash Price |
$1,716.41
|
| Rate for Payer: Cash Price |
$1,716.41
|
| Rate for Payer: Centivo All Commercial |
$1,411.88
|
| Rate for Payer: Cigna All Commercial |
$2,389.13
|
| Rate for Payer: CORVEL All Commercial |
$2,574.61
|
| Rate for Payer: Coventry All Commercial |
$2,436.19
|
| Rate for Payer: Encore All Commercial |
$2,548.31
|
| Rate for Payer: Frontpath All Commercial |
$2,546.93
|
| Rate for Payer: Humana ChoiceCare |
$2,391.07
|
| Rate for Payer: Humana Medicare |
$1,411.88
|
| Rate for Payer: Lucent All Commercial |
$1,411.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,491.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,076.30
|
| Rate for Payer: PHP All Commercial |
$2,099.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,079.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,137.20
|
| Rate for Payer: Signature Care EPO |
$2,297.77
|
| Rate for Payer: Signature Care PPO |
$2,436.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,353.14
|
| Rate for Payer: United Healthcare Commercial |
$2,181.50
|
| Rate for Payer: United Healthcare Medicare |
$913.57
|
|
|
HC SIG 5PX INSIO CUST CIC HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603630
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX INSIO CUST CIC HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603630
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX INSIO CUST ITE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603629
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX INSIO CUST ITE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5256
|
| Hospital Charge Code |
41603629
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX MOTION P BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603626
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX MOTION P BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603626
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX MOTION SA BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603625
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX MOTION SA BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603625
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX MOTION SP BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603627
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX MOTION SP BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603627
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX MOTION SX BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603624
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX MOTION SX BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603624
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX PURE BTE HA MON
|
Facility
OP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603622
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,002.31
|
| Rate for Payer: Aetna Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$782.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,362.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,482.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.18
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Centivo All Commercial |
$1,209.92
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Lucent All Commercial |
$1,209.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$925.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,016.54
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
| Rate for Payer: United Healthcare Medicare |
$782.89
|
|
|
HC SIG 5PX PURE BTE HA MON
|
Facility
IP
|
$2,372.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603622
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$2,206.33 |
| Rate for Payer: Aetna Commercial |
$2,049.75
|
| Rate for Payer: Cash Price |
$1,470.89
|
| Rate for Payer: Cigna All Commercial |
$2,047.38
|
| Rate for Payer: CORVEL All Commercial |
$2,206.33
|
| Rate for Payer: Coventry All Commercial |
$2,087.71
|
| Rate for Payer: Encore All Commercial |
$2,183.79
|
| Rate for Payer: Frontpath All Commercial |
$2,182.61
|
| Rate for Payer: Humana ChoiceCare |
$2,049.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,135.16
|
| Rate for Payer: PHCS All Commercial |
$1,779.30
|
| Rate for Payer: PHP All Commercial |
$1,799.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,831.49
|
| Rate for Payer: Signature Care EPO |
$1,969.09
|
| Rate for Payer: Signature Care PPO |
$2,087.71
|
| Rate for Payer: United Healthcare Commercial |
$1,869.45
|
|
|
HC SIG 5PX SILK CIC HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603620
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
|
HC SIG 5PX SILK CIC HA MON
|
Facility
IP
|
$3,488.40
|
|
|
Service Code
|
CPT V5254
|
| Hospital Charge Code |
41603620
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,616.30 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$3,013.98
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
|
|
HC SIG 7PX ACE BTE HA MON
|
Facility
OP
|
$3,488.40
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
41603610
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$3,244.21 |
| Rate for Payer: Aetna Commercial |
$2,944.21
|
| Rate for Payer: Aetna Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,151.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,003.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,180.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,323.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,266.29
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Cash Price |
$2,162.81
|
| Rate for Payer: Centivo All Commercial |
$1,779.08
|
| Rate for Payer: Cigna All Commercial |
$3,010.49
|
| Rate for Payer: CORVEL All Commercial |
$3,244.21
|
| Rate for Payer: Coventry All Commercial |
$3,069.79
|
| Rate for Payer: Encore All Commercial |
$3,211.07
|
| Rate for Payer: Frontpath All Commercial |
$3,209.33
|
| Rate for Payer: Humana ChoiceCare |
$3,012.93
|
| Rate for Payer: Humana Medicare |
$1,779.08
|
| Rate for Payer: Lucent All Commercial |
$1,779.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,139.56
|
| Rate for Payer: Managed Health Services Medicaid |
$22.11
|
| Rate for Payer: MDWise Medicaid |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$2,616.30
|
| Rate for Payer: PHP All Commercial |
$2,645.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,360.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,693.04
|
| Rate for Payer: Signature Care EPO |
$2,895.37
|
| Rate for Payer: Signature Care PPO |
$3,069.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,965.14
|
| Rate for Payer: United Healthcare Commercial |
$2,748.86
|
| Rate for Payer: United Healthcare Medicare |
$1,151.17
|
|
