|
HC ALLERGEN HICKORY
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN IGE BARLEY
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN IGE BARLEY
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN (IGE), EGG COMPONENTS
|
Facility
|
OP
|
$33.97
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
63003005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$31.59 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.96
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Centivo All Commercial |
$18.48
|
| Rate for Payer: Cigna All Commercial |
$29.32
|
| Rate for Payer: CORVEL All Commercial |
$31.59
|
| Rate for Payer: Coventry All Commercial |
$29.89
|
| Rate for Payer: Encore All Commercial |
$31.27
|
| Rate for Payer: Frontpath All Commercial |
$31.25
|
| Rate for Payer: Humana ChoiceCare |
$29.34
|
| Rate for Payer: Humana Medicare |
$10.87
|
| Rate for Payer: Lucent All Commercial |
$18.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.57
|
| Rate for Payer: PHCS All Commercial |
$25.48
|
| Rate for Payer: PHP All Commercial |
$25.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.25
|
| Rate for Payer: Sagamore Health Network All Products |
$26.22
|
| Rate for Payer: Signature Care EPO |
$28.20
|
| Rate for Payer: Signature Care PPO |
$29.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.87
|
| Rate for Payer: United Healthcare Commercial |
$26.77
|
| Rate for Payer: United Healthcare Medicare |
$10.87
|
|
|
HC ALLERGEN (IGE), EGG COMPONENTS
|
Facility
|
IP
|
$33.97
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
63003005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$31.59 |
| Rate for Payer: Aetna Commercial |
$29.35
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cigna All Commercial |
$29.32
|
| Rate for Payer: CORVEL All Commercial |
$31.59
|
| Rate for Payer: Coventry All Commercial |
$29.89
|
| Rate for Payer: Encore All Commercial |
$31.27
|
| Rate for Payer: Frontpath All Commercial |
$31.25
|
| Rate for Payer: Humana ChoiceCare |
$29.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.57
|
| Rate for Payer: PHCS All Commercial |
$25.48
|
| Rate for Payer: PHP All Commercial |
$25.76
|
| Rate for Payer: Sagamore Health Network All Products |
$26.22
|
| Rate for Payer: Signature Care EPO |
$28.20
|
| Rate for Payer: Signature Care PPO |
$29.89
|
| Rate for Payer: United Healthcare Commercial |
$26.77
|
|
|
HC ALLERGEN (IGE), GLUTEN,FOOD OF PLANT ORIGIN
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63003006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN (IGE), GLUTEN,FOOD OF PLANT ORIGIN
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63003006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN (IGE), MILK COMPONENTS CRUDE
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63003004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN (IGE), MILK COMPONENTS CRUDE
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63003004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN (IGE), MILK COMPONENTSÂ Â RECOMBINANT
|
Facility
|
IP
|
$76.30
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
63003003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cigna All Commercial |
$65.85
|
| Rate for Payer: CORVEL All Commercial |
$70.96
|
| Rate for Payer: Coventry All Commercial |
$67.14
|
| Rate for Payer: Encore All Commercial |
$70.23
|
| Rate for Payer: Frontpath All Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$65.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.67
|
| Rate for Payer: PHCS All Commercial |
$57.23
|
| Rate for Payer: PHP All Commercial |
$57.87
|
| Rate for Payer: Sagamore Health Network All Products |
$58.90
|
| Rate for Payer: Signature Care EPO |
$63.33
|
| Rate for Payer: Signature Care PPO |
$67.14
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
|
|
HC ALLERGEN (IGE), MILK COMPONENTSÂ Â RECOMBINANT
|
Facility
|
OP
|
$76.30
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
63003003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Centivo All Commercial |
$41.51
|
| Rate for Payer: Cigna All Commercial |
$65.85
|
| Rate for Payer: CORVEL All Commercial |
$70.96
|
| Rate for Payer: Coventry All Commercial |
$67.14
|
| Rate for Payer: Encore All Commercial |
$70.23
|
| Rate for Payer: Frontpath All Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$65.90
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Lucent All Commercial |
$41.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.67
|
| Rate for Payer: PHCS All Commercial |
$57.23
|
| Rate for Payer: PHP All Commercial |
$57.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.76
|
| Rate for Payer: Sagamore Health Network All Products |
$58.90
|
| Rate for Payer: Signature Care EPO |
$63.33
|
| Rate for Payer: Signature Care PPO |
$67.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.86
|
| Rate for Payer: United Healthcare Commercial |
$60.12
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
|
|
HC ALLERGEN (IGE), PEANUT COMPONENTS CRUDE
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63003001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN (IGE), PEANUT COMPONENTS CRUDE
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63003001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN(IGE) RED DYE#4(CARMINE)
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN(IGE) RED DYE#4(CARMINE)
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN IGE RYE
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN IGE RYE
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN INHALANT - EA
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN INHALANT - EA
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN INHALANT PROFILE- EA
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN INHALANT PROFILE- EA
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN JOHNSON GRASS
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
|
HC ALLERGEN JOHNSON GRASS
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN K BLUE GRAS
|
Facility
|
IP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
|
|
HC ALLERGEN K BLUE GRAS
|
Facility
|
OP
|
$102.46
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
63001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Aetna Medicare |
$32.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Cash Price |
$61.48
|
| Rate for Payer: Centivo All Commercial |
$55.74
|
| Rate for Payer: Cigna All Commercial |
$88.42
|
| Rate for Payer: CORVEL All Commercial |
$95.29
|
| Rate for Payer: Coventry All Commercial |
$90.16
|
| Rate for Payer: Encore All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$94.26
|
| Rate for Payer: Humana ChoiceCare |
$88.49
|
| Rate for Payer: Humana Medicare |
$32.79
|
| Rate for Payer: Lucent All Commercial |
$55.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.21
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: MDWise Medicaid |
$5.22
|
| Rate for Payer: PHCS All Commercial |
$76.84
|
| Rate for Payer: PHP All Commercial |
$77.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.96
|
| Rate for Payer: Sagamore Health Network All Products |
$79.10
|
| Rate for Payer: Signature Care EPO |
$85.04
|
| Rate for Payer: Signature Care PPO |
$90.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.09
|
| Rate for Payer: United Healthcare Commercial |
$80.74
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
|
