|
HC AR TIGHTROPE SYN IMPLANT
|
Facility
OP
|
$8,971.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,343.22 |
| Rate for Payer: Aetna Commercial |
$7,571.69
|
| Rate for Payer: Aetna Medicare |
$2,960.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,960.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,152.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,607.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,404.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,256.55
|
| Rate for Payer: Cash Price |
$5,562.14
|
| Rate for Payer: Cash Price |
$5,562.14
|
| Rate for Payer: Centivo All Commercial |
$4,575.31
|
| Rate for Payer: Cigna All Commercial |
$7,742.15
|
| Rate for Payer: CORVEL All Commercial |
$8,343.22
|
| Rate for Payer: Coventry All Commercial |
$7,894.66
|
| Rate for Payer: Encore All Commercial |
$8,257.99
|
| Rate for Payer: Frontpath All Commercial |
$8,253.50
|
| Rate for Payer: Humana ChoiceCare |
$7,748.43
|
| Rate for Payer: Humana Medicare |
$4,575.31
|
| Rate for Payer: Lucent All Commercial |
$4,575.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,074.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,728.40
|
| Rate for Payer: PHP All Commercial |
$6,803.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,498.77
|
| Rate for Payer: Sagamore Health Network All Products |
$6,925.77
|
| Rate for Payer: Signature Care EPO |
$7,446.10
|
| Rate for Payer: Signature Care PPO |
$7,894.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,625.52
|
| Rate for Payer: United Healthcare Commercial |
$7,069.31
|
| Rate for Payer: United Healthcare Medicare |
$2,960.50
|
|
|
HC AR TIGHTROPE W FLIP-FIBER
|
Facility
IP
|
$6,091.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,568.40 |
| Max. Negotiated Rate |
$5,664.82 |
| Rate for Payer: Aetna Commercial |
$5,262.80
|
| Rate for Payer: Cash Price |
$3,776.54
|
| Rate for Payer: Cigna All Commercial |
$5,256.71
|
| Rate for Payer: CORVEL All Commercial |
$5,664.82
|
| Rate for Payer: Coventry All Commercial |
$5,360.26
|
| Rate for Payer: Encore All Commercial |
$5,606.95
|
| Rate for Payer: Frontpath All Commercial |
$5,603.90
|
| Rate for Payer: Humana ChoiceCare |
$5,260.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,482.08
|
| Rate for Payer: PHCS All Commercial |
$4,568.40
|
| Rate for Payer: PHP All Commercial |
$4,619.57
|
| Rate for Payer: Sagamore Health Network All Products |
$4,702.41
|
| Rate for Payer: Signature Care EPO |
$5,055.70
|
| Rate for Payer: Signature Care PPO |
$5,360.26
|
| Rate for Payer: United Healthcare Commercial |
$4,799.87
|
|
|
HC AR TIGHTROPE W FLIP-FIBER
|
Facility
OP
|
$6,091.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,664.82 |
| Rate for Payer: Aetna Commercial |
$5,140.97
|
| Rate for Payer: Aetna Medicare |
$2,010.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,010.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,498.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,807.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,311.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,211.11
|
| Rate for Payer: Cash Price |
$3,776.54
|
| Rate for Payer: Cash Price |
$3,776.54
|
| Rate for Payer: Centivo All Commercial |
$3,106.51
|
| Rate for Payer: Cigna All Commercial |
$5,256.71
|
| Rate for Payer: CORVEL All Commercial |
$5,664.82
|
| Rate for Payer: Coventry All Commercial |
$5,360.26
|
| Rate for Payer: Encore All Commercial |
$5,606.95
|
| Rate for Payer: Frontpath All Commercial |
$5,603.90
|
| Rate for Payer: Humana ChoiceCare |
$5,260.97
|
| Rate for Payer: Humana Medicare |
$3,106.51
|
| Rate for Payer: Lucent All Commercial |
$3,106.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,482.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,568.40
|
| Rate for Payer: PHP All Commercial |
$4,619.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,375.57
|
| Rate for Payer: Sagamore Health Network All Products |
$4,702.41
|
| Rate for Payer: Signature Care EPO |
$5,055.70
|
| Rate for Payer: Signature Care PPO |
$5,360.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,177.52
|
| Rate for Payer: United Healthcare Commercial |
$4,799.87
|
| Rate for Payer: United Healthcare Medicare |
$2,010.10
|
|
|
HC AR TIGHTROPE W INTBRCE
|
Facility
IP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.30 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,760.47
|
| Rate for Payer: Cash Price |
$2,698.49
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
|
|
HC AR TIGHTROPE W INTBRCE
|
Facility
OP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,673.43
|
| Rate for Payer: Aetna Medicare |
$1,436.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,436.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,499.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,720.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,651.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,579.92
|
| Rate for Payer: Cash Price |
$2,698.49
|
| Rate for Payer: Cash Price |
$2,698.49
|
| Rate for Payer: Centivo All Commercial |
$2,219.72
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Humana Medicare |
$2,219.72
|
| Rate for Payer: Lucent All Commercial |
$2,219.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,697.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,699.54
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
| Rate for Payer: United Healthcare Medicare |
$1,436.29
|
|
|
HC AR TRIPLEDAM CANNULA
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR TRIPLEDAM CANNULA
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR TRIPLEDAM CANNULA 7X7
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR TRIPLEDAM CANNULA 7X7
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR WASHER 10MM
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$572.88 |
| Rate for Payer: Aetna Commercial |
$532.22
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna All Commercial |
$531.61
|
| Rate for Payer: CORVEL All Commercial |
$572.88
|
| Rate for Payer: Coventry All Commercial |
$542.08
|
| Rate for Payer: Encore All Commercial |
$567.03
|
| Rate for Payer: Frontpath All Commercial |
$566.72
|
| Rate for Payer: Humana ChoiceCare |
$532.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$554.40
|
| Rate for Payer: PHCS All Commercial |
$462.00
|
| Rate for Payer: PHP All Commercial |
$467.17
|
| Rate for Payer: Sagamore Health Network All Products |
$475.55
|
| Rate for Payer: Signature Care EPO |
$511.28
|
| Rate for Payer: Signature Care PPO |
$542.08
|
| Rate for Payer: United Healthcare Commercial |
$485.41
|
|
|
HC AR WASHER 10MM
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.28 |
| Max. Negotiated Rate |
$572.88 |
| Rate for Payer: Aetna Commercial |
$519.90
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$353.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$233.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.61
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Centivo All Commercial |
$314.16
|
| Rate for Payer: Cigna All Commercial |
$531.61
|
| Rate for Payer: CORVEL All Commercial |
$572.88
|
| Rate for Payer: Coventry All Commercial |
$542.08
|
| Rate for Payer: Encore All Commercial |
$567.03
|
| Rate for Payer: Frontpath All Commercial |
$566.72
|
| Rate for Payer: Humana ChoiceCare |
$532.04
|
| Rate for Payer: Humana Medicare |
$314.16
|
| Rate for Payer: Lucent All Commercial |
$314.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$554.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$462.00
|
| Rate for Payer: PHP All Commercial |
$467.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.24
|
| Rate for Payer: Sagamore Health Network All Products |
$475.55
|
| Rate for Payer: Signature Care EPO |
$511.28
|
| Rate for Payer: Signature Care PPO |
$542.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$523.60
|
| Rate for Payer: United Healthcare Commercial |
$485.41
|
| Rate for Payer: United Healthcare Medicare |
$203.28
|
|
|
HC AR WASHER 7.0
|
Facility
OP
|
$374.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.58 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$316.08
|
| Rate for Payer: Aetna Medicare |
$123.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$215.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$234.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.94
|
| Rate for Payer: Cash Price |
$232.19
|
| Rate for Payer: Cash Price |
$232.19
|
| Rate for Payer: Centivo All Commercial |
$191.00
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.28
|
| Rate for Payer: Coventry All Commercial |
$329.56
|
| Rate for Payer: Encore All Commercial |
$344.73
|
| Rate for Payer: Frontpath All Commercial |
$344.54
|
| Rate for Payer: Humana ChoiceCare |
$323.46
|
| Rate for Payer: Humana Medicare |
$191.00
|
| Rate for Payer: Lucent All Commercial |
$191.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$280.88
|
| Rate for Payer: PHP All Commercial |
$284.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$146.06
|
| Rate for Payer: Sagamore Health Network All Products |
$289.11
|
| Rate for Payer: Signature Care EPO |
$310.84
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$318.32
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
|
|
HC AR WASHER 7.0
|
Facility
IP
|
$374.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.88 |
| Max. Negotiated Rate |
$348.28 |
| Rate for Payer: Aetna Commercial |
$323.57
|
| Rate for Payer: Cash Price |
$232.19
|
| Rate for Payer: Cigna All Commercial |
$323.19
|
| Rate for Payer: CORVEL All Commercial |
$348.28
|
| Rate for Payer: Coventry All Commercial |
$329.56
|
| Rate for Payer: Encore All Commercial |
$344.73
|
| Rate for Payer: Frontpath All Commercial |
$344.54
|
| Rate for Payer: Humana ChoiceCare |
$323.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.05
|
| Rate for Payer: PHCS All Commercial |
$280.88
|
| Rate for Payer: PHP All Commercial |
$284.02
|
| Rate for Payer: Sagamore Health Network All Products |
$289.11
|
| Rate for Payer: Signature Care EPO |
$310.84
|
| Rate for Payer: Signature Care PPO |
$329.56
|
| Rate for Payer: United Healthcare Commercial |
$295.11
|
|
|
HC AR WASHER 7.0 TI
|
Facility
OP
|
$409.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.14 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$345.62
|
| Rate for Payer: Aetna Medicare |
$135.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$235.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.65
|
| Rate for Payer: Cash Price |
$253.89
|
| Rate for Payer: Cash Price |
$253.89
|
| Rate for Payer: Centivo All Commercial |
$208.84
|
| Rate for Payer: Cigna All Commercial |
$353.40
|
| Rate for Payer: CORVEL All Commercial |
$380.84
|
| Rate for Payer: Coventry All Commercial |
$360.36
|
| Rate for Payer: Encore All Commercial |
$376.94
|
| Rate for Payer: Frontpath All Commercial |
$376.74
|
| Rate for Payer: Humana ChoiceCare |
$353.69
|
| Rate for Payer: Humana Medicare |
$208.84
|
| Rate for Payer: Lucent All Commercial |
$208.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.55
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$307.12
|
| Rate for Payer: PHP All Commercial |
$310.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.70
|
| Rate for Payer: Sagamore Health Network All Products |
$316.13
|
| Rate for Payer: Signature Care EPO |
$339.88
|
| Rate for Payer: Signature Care PPO |
$360.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$348.08
|
| Rate for Payer: United Healthcare Commercial |
$322.69
|
| Rate for Payer: United Healthcare Medicare |
$135.14
|
|
|
HC AR WASHER 7.0 TI
|
Facility
IP
|
$409.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$380.84 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Cash Price |
$253.89
|
| Rate for Payer: Cigna All Commercial |
$353.40
|
| Rate for Payer: CORVEL All Commercial |
$380.84
|
| Rate for Payer: Coventry All Commercial |
$360.36
|
| Rate for Payer: Encore All Commercial |
$376.94
|
| Rate for Payer: Frontpath All Commercial |
$376.74
|
| Rate for Payer: Humana ChoiceCare |
$353.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.55
|
| Rate for Payer: PHCS All Commercial |
$307.12
|
| Rate for Payer: PHP All Commercial |
$310.56
|
| Rate for Payer: Sagamore Health Network All Products |
$316.13
|
| Rate for Payer: Signature Care EPO |
$339.88
|
| Rate for Payer: Signature Care PPO |
$360.36
|
| Rate for Payer: United Healthcare Commercial |
$322.69
|
|
|
HC ASO TITER
|
Facility
IP
|
$122.67
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
63001027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$105.98
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna All Commercial |
$105.86
|
| Rate for Payer: CORVEL All Commercial |
$114.08
|
| Rate for Payer: Coventry All Commercial |
$107.95
|
| Rate for Payer: Encore All Commercial |
$112.91
|
| Rate for Payer: Frontpath All Commercial |
$112.85
|
| Rate for Payer: Humana ChoiceCare |
$105.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.40
|
| Rate for Payer: PHCS All Commercial |
$92.00
|
| Rate for Payer: PHP All Commercial |
$93.03
|
| Rate for Payer: Sagamore Health Network All Products |
$94.70
|
| Rate for Payer: Signature Care EPO |
$101.81
|
| Rate for Payer: Signature Care PPO |
$107.95
|
| Rate for Payer: United Healthcare Commercial |
$96.66
|
|
|
HC ASO TITER
|
Facility
OP
|
$122.67
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
63001027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$103.53
|
| Rate for Payer: Aetna Medicare |
$40.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.53
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Centivo All Commercial |
$62.56
|
| Rate for Payer: Cigna All Commercial |
$105.86
|
| Rate for Payer: CORVEL All Commercial |
$114.08
|
| Rate for Payer: Coventry All Commercial |
$107.95
|
| Rate for Payer: Encore All Commercial |
$112.91
|
| Rate for Payer: Frontpath All Commercial |
$112.85
|
| Rate for Payer: Humana ChoiceCare |
$105.95
|
| Rate for Payer: Humana Medicare |
$62.56
|
| Rate for Payer: Lucent All Commercial |
$62.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.40
|
| Rate for Payer: Managed Health Services Medicaid |
$7.30
|
| Rate for Payer: MDWise Medicaid |
$7.30
|
| Rate for Payer: PHCS All Commercial |
$92.00
|
| Rate for Payer: PHP All Commercial |
$93.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.84
|
| Rate for Payer: Sagamore Health Network All Products |
$94.70
|
| Rate for Payer: Signature Care EPO |
$101.81
|
| Rate for Payer: Signature Care PPO |
$107.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.27
|
| Rate for Payer: United Healthcare Commercial |
$96.66
|
| Rate for Payer: United Healthcare Medicare |
$40.48
|
|
|
HC ASPERGILLUS AB - CF
|
Facility
IP
|
$103.02
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$95.81 |
| Rate for Payer: Aetna Commercial |
$89.01
|
| Rate for Payer: Cash Price |
$63.87
|
| Rate for Payer: Cigna All Commercial |
$88.91
|
| Rate for Payer: CORVEL All Commercial |
$95.81
|
| Rate for Payer: Coventry All Commercial |
$90.66
|
| Rate for Payer: Encore All Commercial |
$94.83
|
| Rate for Payer: Frontpath All Commercial |
$94.78
|
| Rate for Payer: Humana ChoiceCare |
$88.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.72
|
| Rate for Payer: PHCS All Commercial |
$77.26
|
| Rate for Payer: PHP All Commercial |
$78.13
|
| Rate for Payer: Sagamore Health Network All Products |
$79.53
|
| Rate for Payer: Signature Care EPO |
$85.51
|
| Rate for Payer: Signature Care PPO |
$90.66
|
| Rate for Payer: United Healthcare Commercial |
$81.18
|
|
|
HC ASPERGILLUS AB - CF
|
Facility
OP
|
$103.02
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
63001918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$95.81 |
| Rate for Payer: Aetna Commercial |
$86.95
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.40
|
| Rate for Payer: Cash Price |
$63.87
|
| Rate for Payer: Cash Price |
$63.87
|
| Rate for Payer: Centivo All Commercial |
$52.54
|
| Rate for Payer: Cigna All Commercial |
$88.91
|
| Rate for Payer: CORVEL All Commercial |
$95.81
|
| Rate for Payer: Coventry All Commercial |
$90.66
|
| Rate for Payer: Encore All Commercial |
$94.83
|
| Rate for Payer: Frontpath All Commercial |
$94.78
|
| Rate for Payer: Humana ChoiceCare |
$88.98
|
| Rate for Payer: Humana Medicare |
$52.54
|
| Rate for Payer: Lucent All Commercial |
$52.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.72
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$77.26
|
| Rate for Payer: PHP All Commercial |
$78.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.18
|
| Rate for Payer: Sagamore Health Network All Products |
$79.53
|
| Rate for Payer: Signature Care EPO |
$85.51
|
| Rate for Payer: Signature Care PPO |
$90.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.57
|
| Rate for Payer: United Healthcare Commercial |
$81.18
|
| Rate for Payer: United Healthcare Medicare |
$34.00
|
|
|
HC ASPERGILLUS GALACTOMANNAN ANTIGEN DETECTION, BRONCHOALVEOLAR LAVAGE OR SERUM
|
Facility
IP
|
$145.35
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
63044020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$135.18 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cigna All Commercial |
$125.44
|
| Rate for Payer: CORVEL All Commercial |
$135.18
|
| Rate for Payer: Coventry All Commercial |
$127.91
|
| Rate for Payer: Encore All Commercial |
$133.79
|
| Rate for Payer: Frontpath All Commercial |
$133.72
|
| Rate for Payer: Humana ChoiceCare |
$125.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.82
|
| Rate for Payer: PHCS All Commercial |
$109.01
|
| Rate for Payer: PHP All Commercial |
$110.23
|
| Rate for Payer: Sagamore Health Network All Products |
$112.21
|
| Rate for Payer: Signature Care EPO |
$120.64
|
| Rate for Payer: Signature Care PPO |
$127.91
|
| Rate for Payer: United Healthcare Commercial |
$114.54
|
|
|
HC ASPERGILLUS GALACTOMANNAN ANTIGEN DETECTION, BRONCHOALVEOLAR LAVAGE OR SERUM
|
Facility
OP
|
$145.35
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
63044020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$135.18 |
| Rate for Payer: Aetna Commercial |
$122.68
|
| Rate for Payer: Aetna Medicare |
$47.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.76
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Cash Price |
$90.12
|
| Rate for Payer: Centivo All Commercial |
$74.13
|
| Rate for Payer: Cigna All Commercial |
$125.44
|
| Rate for Payer: CORVEL All Commercial |
$135.18
|
| Rate for Payer: Coventry All Commercial |
$127.91
|
| Rate for Payer: Encore All Commercial |
$133.79
|
| Rate for Payer: Frontpath All Commercial |
$133.72
|
| Rate for Payer: Humana ChoiceCare |
$125.54
|
| Rate for Payer: Humana Medicare |
$74.13
|
| Rate for Payer: Lucent All Commercial |
$74.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.82
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$109.01
|
| Rate for Payer: PHP All Commercial |
$110.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.69
|
| Rate for Payer: Sagamore Health Network All Products |
$112.21
|
| Rate for Payer: Signature Care EPO |
$120.64
|
| Rate for Payer: Signature Care PPO |
$127.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.55
|
| Rate for Payer: United Healthcare Commercial |
$114.54
|
| Rate for Payer: United Healthcare Medicare |
$47.97
|
|
|
HC ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Facility
OP
|
$221.34
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
01620612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$285.87 |
| Rate for Payer: Aetna Commercial |
$186.81
|
| Rate for Payer: Aetna Medicare |
$73.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$127.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$138.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.35
|
| Rate for Payer: Cash Price |
$137.23
|
| Rate for Payer: Cash Price |
$137.23
|
| Rate for Payer: Centivo All Commercial |
$112.88
|
| Rate for Payer: Cigna All Commercial |
$191.02
|
| Rate for Payer: CORVEL All Commercial |
$205.85
|
| Rate for Payer: Coventry All Commercial |
$194.78
|
| Rate for Payer: Encore All Commercial |
$203.74
|
| Rate for Payer: Frontpath All Commercial |
$203.63
|
| Rate for Payer: Humana ChoiceCare |
$191.17
|
| Rate for Payer: Humana Medicare |
$112.88
|
| Rate for Payer: Lucent All Commercial |
$112.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.21
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$166.00
|
| Rate for Payer: PHP All Commercial |
$167.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.32
|
| Rate for Payer: Sagamore Health Network All Products |
$170.87
|
| Rate for Payer: Signature Care EPO |
$183.71
|
| Rate for Payer: Signature Care PPO |
$194.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$188.14
|
| Rate for Payer: United Healthcare Commercial |
$174.42
|
| Rate for Payer: United Healthcare Medicare |
$73.04
|
|
|
HC ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Facility
IP
|
$221.34
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
01620612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$205.85 |
| Rate for Payer: Aetna Commercial |
$191.24
|
| Rate for Payer: Cash Price |
$137.23
|
| Rate for Payer: Cigna All Commercial |
$191.02
|
| Rate for Payer: CORVEL All Commercial |
$205.85
|
| Rate for Payer: Coventry All Commercial |
$194.78
|
| Rate for Payer: Encore All Commercial |
$203.74
|
| Rate for Payer: Frontpath All Commercial |
$203.63
|
| Rate for Payer: Humana ChoiceCare |
$191.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.21
|
| Rate for Payer: PHCS All Commercial |
$166.00
|
| Rate for Payer: PHP All Commercial |
$167.86
|
| Rate for Payer: Sagamore Health Network All Products |
$170.87
|
| Rate for Payer: Signature Care EPO |
$183.71
|
| Rate for Payer: Signature Care PPO |
$194.78
|
| Rate for Payer: United Healthcare Commercial |
$174.42
|
|
|
HC ASPIRATION & INJECTION TREATMENT BONE CYST
|
Facility
OP
|
$5,124.48
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
01620615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.87 |
| Max. Negotiated Rate |
$4,765.77 |
| Rate for Payer: Aetna Commercial |
$4,325.06
|
| Rate for Payer: Aetna Medicare |
$1,691.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,691.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,942.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,203.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$285.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,944.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,860.19
|
| Rate for Payer: Cash Price |
$3,177.18
|
| Rate for Payer: Cash Price |
$3,177.18
|
| Rate for Payer: Centivo All Commercial |
$2,613.48
|
| Rate for Payer: Cigna All Commercial |
$4,422.43
|
| Rate for Payer: CORVEL All Commercial |
$4,765.77
|
| Rate for Payer: Coventry All Commercial |
$4,509.54
|
| Rate for Payer: Encore All Commercial |
$4,717.08
|
| Rate for Payer: Frontpath All Commercial |
$4,714.52
|
| Rate for Payer: Humana ChoiceCare |
$4,426.01
|
| Rate for Payer: Humana Medicare |
$2,613.48
|
| Rate for Payer: Lucent All Commercial |
$2,613.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,612.03
|
| Rate for Payer: Managed Health Services Medicaid |
$285.87
|
| Rate for Payer: MDWise Medicaid |
$285.87
|
| Rate for Payer: PHCS All Commercial |
$3,843.36
|
| Rate for Payer: PHP All Commercial |
$3,886.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,998.55
|
| Rate for Payer: Sagamore Health Network All Products |
$3,956.10
|
| Rate for Payer: Signature Care EPO |
$4,253.32
|
| Rate for Payer: Signature Care PPO |
$4,509.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,355.81
|
| Rate for Payer: United Healthcare Commercial |
$4,038.09
|
| Rate for Payer: United Healthcare Medicare |
$1,691.08
|
|
|
HC ASPIRATION & INJECTION TREATMENT BONE CYST
|
Facility
IP
|
$5,124.48
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
01620615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,843.36 |
| Max. Negotiated Rate |
$4,765.77 |
| Rate for Payer: Aetna Commercial |
$4,427.55
|
| Rate for Payer: Cash Price |
$3,177.18
|
| Rate for Payer: Cigna All Commercial |
$4,422.43
|
| Rate for Payer: CORVEL All Commercial |
$4,765.77
|
| Rate for Payer: Coventry All Commercial |
$4,509.54
|
| Rate for Payer: Encore All Commercial |
$4,717.08
|
| Rate for Payer: Frontpath All Commercial |
$4,714.52
|
| Rate for Payer: Humana ChoiceCare |
$4,426.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,612.03
|
| Rate for Payer: PHCS All Commercial |
$3,843.36
|
| Rate for Payer: PHP All Commercial |
$3,886.41
|
| Rate for Payer: Sagamore Health Network All Products |
$3,956.10
|
| Rate for Payer: Signature Care EPO |
$4,253.32
|
| Rate for Payer: Signature Care PPO |
$4,509.54
|
| Rate for Payer: United Healthcare Commercial |
$4,038.09
|
|
