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Service Code CPT 84597
Hospital Charge Code 63001717
Hospital Revenue Code 300
Min. Negotiated Rate $313.04
Max. Negotiated Rate $388.17
Rate for Payer: Aetna Commercial $360.62
Rate for Payer: Cash Price $258.78
Rate for Payer: Cigna All Commercial $360.20
Rate for Payer: CORVEL All Commercial $388.17
Rate for Payer: Coventry All Commercial $367.30
Rate for Payer: Encore All Commercial $384.20
Rate for Payer: Frontpath All Commercial $383.99
Rate for Payer: Humana ChoiceCare $360.49
Rate for Payer: Lutheran Preferred All Commercial $375.65
Rate for Payer: PHCS All Commercial $313.04
Rate for Payer: PHP All Commercial $316.54
Rate for Payer: Sagamore Health Network All Products $322.22
Rate for Payer: Signature Care EPO $346.43
Rate for Payer: Signature Care PPO $367.30
Rate for Payer: United Healthcare Commercial $328.90
Service Code CPT 84597
Hospital Charge Code 63001717
Hospital Revenue Code 300
Min. Negotiated Rate $13.72
Max. Negotiated Rate $388.17
Rate for Payer: Aetna Commercial $352.27
Rate for Payer: Aetna Medicare $137.74
Rate for Payer: Anthem Blue Cross of IN Medicare $137.74
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $239.70
Rate for Payer: Anthem Blue Cross of IN Traditional $260.91
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $13.72
Rate for Payer: CareSource Indiana of IN Just 4 Me $158.40
Rate for Payer: CareSource Indiana of IN Medicare $151.51
Rate for Payer: Cash Price $258.78
Rate for Payer: Cash Price $258.78
Rate for Payer: Centivo All Commercial $212.87
Rate for Payer: Cigna All Commercial $360.20
Rate for Payer: CORVEL All Commercial $388.17
Rate for Payer: Coventry All Commercial $367.30
Rate for Payer: Encore All Commercial $384.20
Rate for Payer: Frontpath All Commercial $383.99
Rate for Payer: Humana ChoiceCare $360.49
Rate for Payer: Humana Medicare $212.87
Rate for Payer: Lucent All Commercial $212.87
Rate for Payer: Lutheran Preferred All Commercial $375.65
Rate for Payer: Managed Health Services Medicaid $13.72
Rate for Payer: MDWise Medicaid $13.72
Rate for Payer: PHCS All Commercial $313.04
Rate for Payer: PHP All Commercial $316.54
Rate for Payer: Plain Church Group Ministry All Commercial $162.78
Rate for Payer: Sagamore Health Network All Products $322.22
Rate for Payer: Signature Care EPO $346.43
Rate for Payer: Signature Care PPO $367.30
Rate for Payer: Three Rivers Preferred All Commercial $354.78
Rate for Payer: United Healthcare Commercial $328.90
Rate for Payer: United Healthcare Medicare $137.74
Service Code CPT 82652
Hospital Charge Code 63001530
Hospital Revenue Code 300
Min. Negotiated Rate $38.50
Max. Negotiated Rate $282.52
Rate for Payer: Aetna Commercial $256.40
Rate for Payer: Aetna Medicare $100.25
Rate for Payer: Anthem Blue Cross of IN Medicare $100.25
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $139.62
Rate for Payer: Anthem Blue Cross of IN Traditional $139.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $38.50
Rate for Payer: CareSource Indiana of IN Just 4 Me $115.29
Rate for Payer: CareSource Indiana of IN Medicare $110.27
Rate for Payer: Cash Price $188.35
Rate for Payer: Cash Price $188.35
Rate for Payer: Centivo All Commercial $154.93
Rate for Payer: Cigna All Commercial $262.17
Rate for Payer: CORVEL All Commercial $282.52
Rate for Payer: Coventry All Commercial $267.33
Rate for Payer: Encore All Commercial $279.64
Rate for Payer: Frontpath All Commercial $279.48
Rate for Payer: Humana ChoiceCare $262.38
Rate for Payer: Humana Medicare $154.93
Rate for Payer: Lucent All Commercial $154.93
Rate for Payer: Lutheran Preferred All Commercial $273.41
Rate for Payer: Managed Health Services Medicaid $38.50
Rate for Payer: MDWise Medicaid $38.50
Rate for Payer: PHCS All Commercial $227.84
Rate for Payer: PHP All Commercial $230.39
Rate for Payer: Plain Church Group Ministry All Commercial $118.48
Rate for Payer: Sagamore Health Network All Products $234.52
Rate for Payer: Signature Care EPO $252.14
Rate for Payer: Signature Care PPO $267.33
Rate for Payer: Three Rivers Preferred All Commercial $258.22
Rate for Payer: United Healthcare Commercial $239.38
Rate for Payer: United Healthcare Medicare $100.25
Service Code CPT 82652
Hospital Charge Code 63001530
Hospital Revenue Code 300
Min. Negotiated Rate $227.84
Max. Negotiated Rate $282.52
Rate for Payer: Aetna Commercial $262.47
Rate for Payer: Cash Price $188.35
Rate for Payer: Cigna All Commercial $262.17
Rate for Payer: CORVEL All Commercial $282.52
Rate for Payer: Coventry All Commercial $267.33
Rate for Payer: Encore All Commercial $279.64
Rate for Payer: Frontpath All Commercial $279.48
Rate for Payer: Humana ChoiceCare $262.38
Rate for Payer: Lutheran Preferred All Commercial $273.41
Rate for Payer: PHCS All Commercial $227.84
Rate for Payer: PHP All Commercial $230.39
Rate for Payer: Sagamore Health Network All Products $234.52
Rate for Payer: Signature Care EPO $252.14
Rate for Payer: Signature Care PPO $267.33
Rate for Payer: United Healthcare Commercial $239.38
Service Code CPT 82306
Hospital Charge Code 63001126
Hospital Revenue Code 300
Min. Negotiated Rate $169.20
Max. Negotiated Rate $209.80
Rate for Payer: Aetna Commercial $194.91
Rate for Payer: Cash Price $139.87
Rate for Payer: Cigna All Commercial $194.69
Rate for Payer: CORVEL All Commercial $209.80
Rate for Payer: Coventry All Commercial $198.52
Rate for Payer: Encore All Commercial $207.66
Rate for Payer: Frontpath All Commercial $207.55
Rate for Payer: Humana ChoiceCare $194.85
Rate for Payer: Lutheran Preferred All Commercial $203.03
Rate for Payer: PHCS All Commercial $169.20
Rate for Payer: PHP All Commercial $171.09
Rate for Payer: Sagamore Health Network All Products $174.16
Rate for Payer: Signature Care EPO $187.24
Rate for Payer: Signature Care PPO $198.52
Rate for Payer: United Healthcare Commercial $177.77
Service Code CPT 82306
Hospital Charge Code 63001126
Hospital Revenue Code 300
Min. Negotiated Rate $29.60
Max. Negotiated Rate $209.80
Rate for Payer: Aetna Commercial $190.40
Rate for Payer: Aetna Medicare $74.45
Rate for Payer: Anthem Blue Cross of IN Medicare $74.45
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $103.68
Rate for Payer: Anthem Blue Cross of IN Traditional $103.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $29.60
Rate for Payer: CareSource Indiana of IN Just 4 Me $85.61
Rate for Payer: CareSource Indiana of IN Medicare $81.89
Rate for Payer: Cash Price $139.87
Rate for Payer: Cash Price $139.87
Rate for Payer: Centivo All Commercial $115.05
Rate for Payer: Cigna All Commercial $194.69
Rate for Payer: CORVEL All Commercial $209.80
Rate for Payer: Coventry All Commercial $198.52
Rate for Payer: Encore All Commercial $207.66
Rate for Payer: Frontpath All Commercial $207.55
Rate for Payer: Humana ChoiceCare $194.85
Rate for Payer: Humana Medicare $115.05
Rate for Payer: Lucent All Commercial $115.05
Rate for Payer: Lutheran Preferred All Commercial $203.03
Rate for Payer: Managed Health Services Medicaid $29.60
Rate for Payer: MDWise Medicaid $29.60
Rate for Payer: PHCS All Commercial $169.20
Rate for Payer: PHP All Commercial $171.09
Rate for Payer: Plain Church Group Ministry All Commercial $87.98
Rate for Payer: Sagamore Health Network All Products $174.16
Rate for Payer: Signature Care EPO $187.24
Rate for Payer: Signature Care PPO $198.52
Rate for Payer: Three Rivers Preferred All Commercial $191.75
Rate for Payer: United Healthcare Commercial $177.77
Rate for Payer: United Healthcare Medicare $74.45
Service Code CPT 74455
Hospital Charge Code 01614456
Hospital Revenue Code 320
Min. Negotiated Rate $185.17
Max. Negotiated Rate $1,198.42
Rate for Payer: Aetna Commercial $1,087.60
Rate for Payer: Aetna Medicare $425.25
Rate for Payer: Anthem Blue Cross of IN Medicare $425.25
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $740.06
Rate for Payer: Anthem Blue Cross of IN Traditional $805.52
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $185.17
Rate for Payer: CareSource Indiana of IN Just 4 Me $489.03
Rate for Payer: CareSource Indiana of IN Medicare $467.77
Rate for Payer: Cash Price $798.95
Rate for Payer: Cash Price $798.95
Rate for Payer: Centivo All Commercial $657.20
Rate for Payer: Cigna All Commercial $1,112.09
Rate for Payer: CORVEL All Commercial $1,198.42
Rate for Payer: Coventry All Commercial $1,133.99
Rate for Payer: Encore All Commercial $1,186.18
Rate for Payer: Frontpath All Commercial $1,185.54
Rate for Payer: Humana ChoiceCare $1,112.99
Rate for Payer: Humana Medicare $657.20
Rate for Payer: Lucent All Commercial $657.20
Rate for Payer: Lutheran Preferred All Commercial $1,159.76
Rate for Payer: Managed Health Services Medicaid $185.17
Rate for Payer: MDWise Medicaid $185.17
Rate for Payer: PHCS All Commercial $966.47
Rate for Payer: PHP All Commercial $977.29
Rate for Payer: Plain Church Group Ministry All Commercial $502.56
Rate for Payer: Sagamore Health Network All Products $994.82
Rate for Payer: Signature Care EPO $1,069.56
Rate for Payer: Signature Care PPO $1,133.99
Rate for Payer: Three Rivers Preferred All Commercial $1,095.33
Rate for Payer: United Healthcare Commercial $1,015.44
Rate for Payer: United Healthcare Medicare $425.25
Service Code CPT 74455
Hospital Charge Code 01614456
Hospital Revenue Code 320
Min. Negotiated Rate $966.47
Max. Negotiated Rate $1,198.42
Rate for Payer: Aetna Commercial $1,113.37
Rate for Payer: Cash Price $798.95
Rate for Payer: Cigna All Commercial $1,112.09
Rate for Payer: CORVEL All Commercial $1,198.42
Rate for Payer: Coventry All Commercial $1,133.99
Rate for Payer: Encore All Commercial $1,186.18
Rate for Payer: Frontpath All Commercial $1,185.54
Rate for Payer: Humana ChoiceCare $1,112.99
Rate for Payer: Lutheran Preferred All Commercial $1,159.76
Rate for Payer: PHCS All Commercial $966.47
Rate for Payer: PHP All Commercial $977.29
Rate for Payer: Sagamore Health Network All Products $994.82
Rate for Payer: Signature Care EPO $1,069.56
Rate for Payer: Signature Care PPO $1,133.99
Rate for Payer: United Healthcare Commercial $1,015.44
Service Code CPT 85246
Hospital Charge Code 63001737
Hospital Revenue Code 300
Min. Negotiated Rate $211.22
Max. Negotiated Rate $261.91
Rate for Payer: Aetna Commercial $243.32
Rate for Payer: Cash Price $174.61
Rate for Payer: Cigna All Commercial $243.04
Rate for Payer: CORVEL All Commercial $261.91
Rate for Payer: Coventry All Commercial $247.83
Rate for Payer: Encore All Commercial $259.23
Rate for Payer: Frontpath All Commercial $259.09
Rate for Payer: Humana ChoiceCare $243.24
Rate for Payer: Lutheran Preferred All Commercial $253.46
Rate for Payer: PHCS All Commercial $211.22
Rate for Payer: PHP All Commercial $213.58
Rate for Payer: Sagamore Health Network All Products $217.41
Rate for Payer: Signature Care EPO $233.75
Rate for Payer: Signature Care PPO $247.83
Rate for Payer: United Healthcare Commercial $221.92
Service Code CPT 85246
Hospital Charge Code 63001737
Hospital Revenue Code 300
Min. Negotiated Rate $22.94
Max. Negotiated Rate $261.91
Rate for Payer: Aetna Commercial $237.69
Rate for Payer: Aetna Medicare $92.94
Rate for Payer: Anthem Blue Cross of IN Medicare $92.94
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $161.74
Rate for Payer: Anthem Blue Cross of IN Traditional $176.04
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $22.94
Rate for Payer: CareSource Indiana of IN Just 4 Me $106.88
Rate for Payer: CareSource Indiana of IN Medicare $102.23
Rate for Payer: Cash Price $174.61
Rate for Payer: Cash Price $174.61
Rate for Payer: Centivo All Commercial $143.63
Rate for Payer: Cigna All Commercial $243.04
Rate for Payer: CORVEL All Commercial $261.91
Rate for Payer: Coventry All Commercial $247.83
Rate for Payer: Encore All Commercial $259.23
Rate for Payer: Frontpath All Commercial $259.09
Rate for Payer: Humana ChoiceCare $243.24
Rate for Payer: Humana Medicare $143.63
Rate for Payer: Lucent All Commercial $143.63
Rate for Payer: Lutheran Preferred All Commercial $253.46
Rate for Payer: Managed Health Services Medicaid $22.94
Rate for Payer: MDWise Medicaid $22.94
Rate for Payer: PHCS All Commercial $211.22
Rate for Payer: PHP All Commercial $213.58
Rate for Payer: Plain Church Group Ministry All Commercial $109.83
Rate for Payer: Sagamore Health Network All Products $217.41
Rate for Payer: Signature Care EPO $233.75
Rate for Payer: Signature Care PPO $247.83
Rate for Payer: Three Rivers Preferred All Commercial $239.38
Rate for Payer: United Healthcare Commercial $221.92
Rate for Payer: United Healthcare Medicare $92.94
Service Code CPT 87480
Hospital Charge Code 63087804
Hospital Revenue Code 306
Min. Negotiated Rate $35.04
Max. Negotiated Rate $43.45
Rate for Payer: Aetna Commercial $40.36
Rate for Payer: Cash Price $28.96
Rate for Payer: Cigna All Commercial $40.32
Rate for Payer: CORVEL All Commercial $43.45
Rate for Payer: Coventry All Commercial $41.11
Rate for Payer: Encore All Commercial $43.00
Rate for Payer: Frontpath All Commercial $42.98
Rate for Payer: Humana ChoiceCare $40.35
Rate for Payer: Lutheran Preferred All Commercial $42.04
Rate for Payer: PHCS All Commercial $35.04
Rate for Payer: PHP All Commercial $35.43
Rate for Payer: Sagamore Health Network All Products $36.06
Rate for Payer: Signature Care EPO $38.77
Rate for Payer: Signature Care PPO $41.11
Rate for Payer: United Healthcare Commercial $36.81
Service Code CPT 87480
Hospital Charge Code 63087804
Hospital Revenue Code 306
Min. Negotiated Rate $15.42
Max. Negotiated Rate $43.45
Rate for Payer: Aetna Commercial $39.43
Rate for Payer: Aetna Medicare $15.42
Rate for Payer: Anthem Blue Cross of IN Medicare $15.42
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $26.83
Rate for Payer: Anthem Blue Cross of IN Traditional $29.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $20.05
Rate for Payer: CareSource Indiana of IN Just 4 Me $17.73
Rate for Payer: CareSource Indiana of IN Medicare $16.96
Rate for Payer: Cash Price $28.96
Rate for Payer: Cash Price $28.96
Rate for Payer: Centivo All Commercial $23.83
Rate for Payer: Cigna All Commercial $40.32
Rate for Payer: CORVEL All Commercial $43.45
Rate for Payer: Coventry All Commercial $41.11
Rate for Payer: Encore All Commercial $43.00
Rate for Payer: Frontpath All Commercial $42.98
Rate for Payer: Humana ChoiceCare $40.35
Rate for Payer: Humana Medicare $23.83
Rate for Payer: Lucent All Commercial $23.83
Rate for Payer: Lutheran Preferred All Commercial $42.04
Rate for Payer: Managed Health Services Medicaid $20.05
Rate for Payer: MDWise Medicaid $20.05
Rate for Payer: PHCS All Commercial $35.04
Rate for Payer: PHP All Commercial $35.43
Rate for Payer: Plain Church Group Ministry All Commercial $18.22
Rate for Payer: Sagamore Health Network All Products $36.06
Rate for Payer: Signature Care EPO $38.77
Rate for Payer: Signature Care PPO $41.11
Rate for Payer: Three Rivers Preferred All Commercial $39.71
Rate for Payer: United Healthcare Commercial $36.81
Rate for Payer: United Healthcare Medicare $15.42
Service Code CPT 87510
Hospital Charge Code 63087805
Hospital Revenue Code 306
Min. Negotiated Rate $15.42
Max. Negotiated Rate $43.45
Rate for Payer: Aetna Commercial $39.43
Rate for Payer: Aetna Medicare $15.42
Rate for Payer: Anthem Blue Cross of IN Medicare $15.42
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $26.83
Rate for Payer: Anthem Blue Cross of IN Traditional $29.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $20.05
Rate for Payer: CareSource Indiana of IN Just 4 Me $17.73
Rate for Payer: CareSource Indiana of IN Medicare $16.96
Rate for Payer: Cash Price $28.96
Rate for Payer: Cash Price $28.96
Rate for Payer: Centivo All Commercial $23.83
Rate for Payer: Cigna All Commercial $40.32
Rate for Payer: CORVEL All Commercial $43.45
Rate for Payer: Coventry All Commercial $41.11
Rate for Payer: Encore All Commercial $43.00
Rate for Payer: Frontpath All Commercial $42.98
Rate for Payer: Humana ChoiceCare $40.35
Rate for Payer: Humana Medicare $23.83
Rate for Payer: Lucent All Commercial $23.83
Rate for Payer: Lutheran Preferred All Commercial $42.04
Rate for Payer: Managed Health Services Medicaid $20.05
Rate for Payer: MDWise Medicaid $20.05
Rate for Payer: PHCS All Commercial $35.04
Rate for Payer: PHP All Commercial $35.43
Rate for Payer: Plain Church Group Ministry All Commercial $18.22
Rate for Payer: Sagamore Health Network All Products $36.06
Rate for Payer: Signature Care EPO $38.77
Rate for Payer: Signature Care PPO $41.11
Rate for Payer: Three Rivers Preferred All Commercial $39.71
Rate for Payer: United Healthcare Commercial $36.81
Rate for Payer: United Healthcare Medicare $15.42
Service Code CPT 87510
Hospital Charge Code 63087805
Hospital Revenue Code 306
Min. Negotiated Rate $35.04
Max. Negotiated Rate $43.45
Rate for Payer: Aetna Commercial $40.36
Rate for Payer: Cash Price $28.96
Rate for Payer: Cigna All Commercial $40.32
Rate for Payer: CORVEL All Commercial $43.45
Rate for Payer: Coventry All Commercial $41.11
Rate for Payer: Encore All Commercial $43.00
Rate for Payer: Frontpath All Commercial $42.98
Rate for Payer: Humana ChoiceCare $40.35
Rate for Payer: Lutheran Preferred All Commercial $42.04
Rate for Payer: PHCS All Commercial $35.04
Rate for Payer: PHP All Commercial $35.43
Rate for Payer: Sagamore Health Network All Products $36.06
Rate for Payer: Signature Care EPO $38.77
Rate for Payer: Signature Care PPO $41.11
Rate for Payer: United Healthcare Commercial $36.81
Service Code CPT 87660
Hospital Charge Code 63087806
Hospital Revenue Code 306
Min. Negotiated Rate $15.42
Max. Negotiated Rate $43.45
Rate for Payer: Aetna Commercial $39.43
Rate for Payer: Aetna Medicare $15.42
Rate for Payer: Anthem Blue Cross of IN Medicare $15.42
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $26.83
Rate for Payer: Anthem Blue Cross of IN Traditional $29.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $20.05
Rate for Payer: CareSource Indiana of IN Just 4 Me $17.73
Rate for Payer: CareSource Indiana of IN Medicare $16.96
Rate for Payer: Cash Price $28.96
Rate for Payer: Cash Price $28.96
Rate for Payer: Centivo All Commercial $23.83
Rate for Payer: Cigna All Commercial $40.32
Rate for Payer: CORVEL All Commercial $43.45
Rate for Payer: Coventry All Commercial $41.11
Rate for Payer: Encore All Commercial $43.00
Rate for Payer: Frontpath All Commercial $42.98
Rate for Payer: Humana ChoiceCare $40.35
Rate for Payer: Humana Medicare $23.83
Rate for Payer: Lucent All Commercial $23.83
Rate for Payer: Lutheran Preferred All Commercial $42.04
Rate for Payer: Managed Health Services Medicaid $20.05
Rate for Payer: MDWise Medicaid $20.05
Rate for Payer: PHCS All Commercial $35.04
Rate for Payer: PHP All Commercial $35.43
Rate for Payer: Plain Church Group Ministry All Commercial $18.22
Rate for Payer: Sagamore Health Network All Products $36.06
Rate for Payer: Signature Care EPO $38.77
Rate for Payer: Signature Care PPO $41.11
Rate for Payer: Three Rivers Preferred All Commercial $39.71
Rate for Payer: United Healthcare Commercial $36.81
Rate for Payer: United Healthcare Medicare $15.42
Service Code CPT 87660
Hospital Charge Code 63087806
Hospital Revenue Code 306
Min. Negotiated Rate $35.04
Max. Negotiated Rate $43.45
Rate for Payer: Aetna Commercial $40.36
Rate for Payer: Cash Price $28.96
Rate for Payer: Cigna All Commercial $40.32
Rate for Payer: CORVEL All Commercial $43.45
Rate for Payer: Coventry All Commercial $41.11
Rate for Payer: Encore All Commercial $43.00
Rate for Payer: Frontpath All Commercial $42.98
Rate for Payer: Humana ChoiceCare $40.35
Rate for Payer: Lutheran Preferred All Commercial $42.04
Rate for Payer: PHCS All Commercial $35.04
Rate for Payer: PHP All Commercial $35.43
Rate for Payer: Sagamore Health Network All Products $36.06
Rate for Payer: Signature Care EPO $38.77
Rate for Payer: Signature Care PPO $41.11
Rate for Payer: United Healthcare Commercial $36.81
Hospital Charge Code 41606543
Hospital Revenue Code 272
Min. Negotiated Rate $1,031.25
Max. Negotiated Rate $1,278.75
Rate for Payer: Aetna Commercial $1,188.00
Rate for Payer: Cash Price $852.50
Rate for Payer: Cigna All Commercial $1,186.62
Rate for Payer: CORVEL All Commercial $1,278.75
Rate for Payer: Coventry All Commercial $1,210.00
Rate for Payer: Encore All Commercial $1,265.69
Rate for Payer: Frontpath All Commercial $1,265.00
Rate for Payer: Humana ChoiceCare $1,187.59
Rate for Payer: Lutheran Preferred All Commercial $1,237.50
Rate for Payer: PHCS All Commercial $1,031.25
Rate for Payer: PHP All Commercial $1,042.80
Rate for Payer: Sagamore Health Network All Products $1,061.50
Rate for Payer: Signature Care EPO $1,141.25
Rate for Payer: Signature Care PPO $1,210.00
Rate for Payer: United Healthcare Commercial $1,083.50
Hospital Charge Code 41606543
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $1,278.75
Rate for Payer: Aetna Commercial $1,160.50
Rate for Payer: Aetna Medicare $453.75
Rate for Payer: Anthem Blue Cross of IN Medicare $453.75
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $789.66
Rate for Payer: Anthem Blue Cross of IN Traditional $859.51
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $521.81
Rate for Payer: CareSource Indiana of IN Medicare $499.12
Rate for Payer: Cash Price $852.50
Rate for Payer: Cash Price $852.50
Rate for Payer: Centivo All Commercial $701.25
Rate for Payer: Cigna All Commercial $1,186.62
Rate for Payer: CORVEL All Commercial $1,278.75
Rate for Payer: Coventry All Commercial $1,210.00
Rate for Payer: Encore All Commercial $1,265.69
Rate for Payer: Frontpath All Commercial $1,265.00
Rate for Payer: Humana ChoiceCare $1,187.59
Rate for Payer: Humana Medicare $701.25
Rate for Payer: Lucent All Commercial $701.25
Rate for Payer: Lutheran Preferred All Commercial $1,237.50
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $1,031.25
Rate for Payer: PHP All Commercial $1,042.80
Rate for Payer: Plain Church Group Ministry All Commercial $536.25
Rate for Payer: Sagamore Health Network All Products $1,061.50
Rate for Payer: Signature Care EPO $1,141.25
Rate for Payer: Signature Care PPO $1,210.00
Rate for Payer: Three Rivers Preferred All Commercial $1,168.75
Rate for Payer: United Healthcare Commercial $1,083.50
Rate for Payer: United Healthcare Medicare $453.75
Service Code CPT C1713
Hospital Charge Code 41604413
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $7,432.56
Rate for Payer: Aetna Commercial $6,745.25
Rate for Payer: Aetna Medicare $2,637.36
Rate for Payer: Anthem Blue Cross of IN Medicare $2,637.36
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $4,589.81
Rate for Payer: Anthem Blue Cross of IN Traditional $4,995.80
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $3,032.96
Rate for Payer: CareSource Indiana of IN Medicare $2,901.10
Rate for Payer: Cash Price $4,955.04
Rate for Payer: Cash Price $4,955.04
Rate for Payer: Centivo All Commercial $4,075.92
Rate for Payer: Cigna All Commercial $6,897.10
Rate for Payer: CORVEL All Commercial $7,432.56
Rate for Payer: Coventry All Commercial $7,032.96
Rate for Payer: Encore All Commercial $7,356.64
Rate for Payer: Frontpath All Commercial $7,352.64
Rate for Payer: Humana ChoiceCare $6,902.69
Rate for Payer: Humana Medicare $4,075.92
Rate for Payer: Lucent All Commercial $4,075.92
Rate for Payer: Lutheran Preferred All Commercial $7,192.80
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $5,994.00
Rate for Payer: PHP All Commercial $6,061.13
Rate for Payer: Plain Church Group Ministry All Commercial $3,116.88
Rate for Payer: Sagamore Health Network All Products $6,169.82
Rate for Payer: Signature Care EPO $6,633.36
Rate for Payer: Signature Care PPO $7,032.96
Rate for Payer: Three Rivers Preferred All Commercial $6,793.20
Rate for Payer: United Healthcare Commercial $6,297.70
Rate for Payer: United Healthcare Medicare $2,637.36
Service Code CPT C1713
Hospital Charge Code 41604413
Hospital Revenue Code 278
Min. Negotiated Rate $5,994.00
Max. Negotiated Rate $7,432.56
Rate for Payer: Aetna Commercial $6,905.09
Rate for Payer: Cash Price $4,955.04
Rate for Payer: Cigna All Commercial $6,897.10
Rate for Payer: CORVEL All Commercial $7,432.56
Rate for Payer: Coventry All Commercial $7,032.96
Rate for Payer: Encore All Commercial $7,356.64
Rate for Payer: Frontpath All Commercial $7,352.64
Rate for Payer: Humana ChoiceCare $6,902.69
Rate for Payer: Lutheran Preferred All Commercial $7,192.80
Rate for Payer: PHCS All Commercial $5,994.00
Rate for Payer: PHP All Commercial $6,061.13
Rate for Payer: Sagamore Health Network All Products $6,169.82
Rate for Payer: Signature Care EPO $6,633.36
Rate for Payer: Signature Care PPO $7,032.96
Rate for Payer: United Healthcare Commercial $6,297.70
Service Code CPT C1713
Hospital Charge Code 41604414
Hospital Revenue Code 278
Min. Negotiated Rate $7,333.20
Max. Negotiated Rate $9,093.17
Rate for Payer: Aetna Commercial $8,447.85
Rate for Payer: Cash Price $6,062.11
Rate for Payer: Cigna All Commercial $8,438.07
Rate for Payer: CORVEL All Commercial $9,093.17
Rate for Payer: Coventry All Commercial $8,604.29
Rate for Payer: Encore All Commercial $9,000.28
Rate for Payer: Frontpath All Commercial $8,995.39
Rate for Payer: Humana ChoiceCare $8,444.91
Rate for Payer: Lutheran Preferred All Commercial $8,799.84
Rate for Payer: PHCS All Commercial $7,333.20
Rate for Payer: PHP All Commercial $7,415.33
Rate for Payer: Sagamore Health Network All Products $7,548.31
Rate for Payer: Signature Care EPO $8,115.41
Rate for Payer: Signature Care PPO $8,604.29
Rate for Payer: United Healthcare Commercial $7,704.75
Service Code CPT C1713
Hospital Charge Code 41604414
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $9,093.17
Rate for Payer: Aetna Commercial $8,252.29
Rate for Payer: Aetna Medicare $3,226.61
Rate for Payer: Anthem Blue Cross of IN Medicare $3,226.61
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $5,615.28
Rate for Payer: Anthem Blue Cross of IN Traditional $6,111.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $3,710.60
Rate for Payer: CareSource Indiana of IN Medicare $3,549.27
Rate for Payer: Cash Price $6,062.11
Rate for Payer: Cash Price $6,062.11
Rate for Payer: Centivo All Commercial $4,986.58
Rate for Payer: Cigna All Commercial $8,438.07
Rate for Payer: CORVEL All Commercial $9,093.17
Rate for Payer: Coventry All Commercial $8,604.29
Rate for Payer: Encore All Commercial $9,000.28
Rate for Payer: Frontpath All Commercial $8,995.39
Rate for Payer: Humana ChoiceCare $8,444.91
Rate for Payer: Humana Medicare $4,986.58
Rate for Payer: Lucent All Commercial $4,986.58
Rate for Payer: Lutheran Preferred All Commercial $8,799.84
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $7,333.20
Rate for Payer: PHP All Commercial $7,415.33
Rate for Payer: Plain Church Group Ministry All Commercial $3,813.26
Rate for Payer: Sagamore Health Network All Products $7,548.31
Rate for Payer: Signature Care EPO $8,115.41
Rate for Payer: Signature Care PPO $8,604.29
Rate for Payer: Three Rivers Preferred All Commercial $8,310.96
Rate for Payer: United Healthcare Commercial $7,704.75
Rate for Payer: United Healthcare Medicare $3,226.61
Service Code CPT C1713
Hospital Charge Code 41604415
Hospital Revenue Code 278
Min. Negotiated Rate $524.16
Max. Negotiated Rate $15,923.09
Rate for Payer: Aetna Commercial $14,450.63
Rate for Payer: Aetna Medicare $5,650.13
Rate for Payer: Anthem Blue Cross of IN Medicare $5,650.13
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $9,832.93
Rate for Payer: Anthem Blue Cross of IN Traditional $10,702.71
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $524.16
Rate for Payer: CareSource Indiana of IN Just 4 Me $6,497.65
Rate for Payer: CareSource Indiana of IN Medicare $6,215.14
Rate for Payer: Cash Price $10,615.39
Rate for Payer: Cash Price $10,615.39
Rate for Payer: Centivo All Commercial $8,732.02
Rate for Payer: Cigna All Commercial $14,775.94
Rate for Payer: CORVEL All Commercial $15,923.09
Rate for Payer: Coventry All Commercial $15,067.01
Rate for Payer: Encore All Commercial $15,760.43
Rate for Payer: Frontpath All Commercial $15,751.87
Rate for Payer: Humana ChoiceCare $14,787.93
Rate for Payer: Humana Medicare $8,732.02
Rate for Payer: Lucent All Commercial $8,732.02
Rate for Payer: Lutheran Preferred All Commercial $15,409.44
Rate for Payer: Managed Health Services Medicaid $524.16
Rate for Payer: MDWise Medicaid $524.16
Rate for Payer: PHCS All Commercial $12,841.20
Rate for Payer: PHP All Commercial $12,985.02
Rate for Payer: Plain Church Group Ministry All Commercial $6,677.42
Rate for Payer: Sagamore Health Network All Products $13,217.88
Rate for Payer: Signature Care EPO $14,210.93
Rate for Payer: Signature Care PPO $15,067.01
Rate for Payer: Three Rivers Preferred All Commercial $14,553.36
Rate for Payer: United Healthcare Commercial $13,491.82
Rate for Payer: United Healthcare Medicare $5,650.13
Service Code CPT C1713
Hospital Charge Code 41604415
Hospital Revenue Code 278
Min. Negotiated Rate $12,841.20
Max. Negotiated Rate $15,923.09
Rate for Payer: Aetna Commercial $14,793.06
Rate for Payer: Cash Price $10,615.39
Rate for Payer: Cigna All Commercial $14,775.94
Rate for Payer: CORVEL All Commercial $15,923.09
Rate for Payer: Coventry All Commercial $15,067.01
Rate for Payer: Encore All Commercial $15,760.43
Rate for Payer: Frontpath All Commercial $15,751.87
Rate for Payer: Humana ChoiceCare $14,787.93
Rate for Payer: Lutheran Preferred All Commercial $15,409.44
Rate for Payer: PHCS All Commercial $12,841.20
Rate for Payer: PHP All Commercial $12,985.02
Rate for Payer: Sagamore Health Network All Products $13,217.88
Rate for Payer: Signature Care EPO $14,210.93
Rate for Payer: Signature Care PPO $15,067.01
Rate for Payer: United Healthcare Commercial $13,491.82
Service Code CPT C1713
Hospital Charge Code 41604416
Hospital Revenue Code 278
Min. Negotiated Rate $4,644.00
Max. Negotiated Rate $5,758.56
Rate for Payer: Aetna Commercial $5,349.89
Rate for Payer: Cash Price $3,839.04
Rate for Payer: Cigna All Commercial $5,343.70
Rate for Payer: CORVEL All Commercial $5,758.56
Rate for Payer: Coventry All Commercial $5,448.96
Rate for Payer: Encore All Commercial $5,699.74
Rate for Payer: Frontpath All Commercial $5,696.64
Rate for Payer: Humana ChoiceCare $5,348.03
Rate for Payer: Lutheran Preferred All Commercial $5,572.80
Rate for Payer: PHCS All Commercial $4,644.00
Rate for Payer: PHP All Commercial $4,696.01
Rate for Payer: Sagamore Health Network All Products $4,780.22
Rate for Payer: Signature Care EPO $5,139.36
Rate for Payer: Signature Care PPO $5,448.96
Rate for Payer: United Healthcare Commercial $4,879.30