|
HC CRYPTOCOCCAL AG CSF
|
Facility
IP
|
$86.19
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.64 |
| Max. Negotiated Rate |
$80.16 |
| Rate for Payer: Aetna Commercial |
$74.47
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Cigna All Commercial |
$74.38
|
| Rate for Payer: CORVEL All Commercial |
$80.16
|
| Rate for Payer: Coventry All Commercial |
$75.85
|
| Rate for Payer: Encore All Commercial |
$79.34
|
| Rate for Payer: Frontpath All Commercial |
$79.29
|
| Rate for Payer: Humana ChoiceCare |
$74.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.57
|
| Rate for Payer: PHCS All Commercial |
$64.64
|
| Rate for Payer: PHP All Commercial |
$65.37
|
| Rate for Payer: Sagamore Health Network All Products |
$66.54
|
| Rate for Payer: Signature Care EPO |
$71.54
|
| Rate for Payer: Signature Care PPO |
$75.85
|
| Rate for Payer: United Healthcare Commercial |
$67.92
|
|
|
HC CRYPTOCOCCAL AG CSF
|
Facility
OP
|
$86.19
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$80.16 |
| Rate for Payer: Aetna Commercial |
$72.74
|
| Rate for Payer: Aetna Medicare |
$28.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.29
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Centivo All Commercial |
$43.96
|
| Rate for Payer: Cigna All Commercial |
$74.38
|
| Rate for Payer: CORVEL All Commercial |
$80.16
|
| Rate for Payer: Coventry All Commercial |
$75.85
|
| Rate for Payer: Encore All Commercial |
$79.34
|
| Rate for Payer: Frontpath All Commercial |
$79.29
|
| Rate for Payer: Humana ChoiceCare |
$74.44
|
| Rate for Payer: Humana Medicare |
$43.96
|
| Rate for Payer: Lucent All Commercial |
$43.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.57
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| Rate for Payer: MDWise Medicaid |
$11.54
|
| Rate for Payer: PHCS All Commercial |
$64.64
|
| Rate for Payer: PHP All Commercial |
$65.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.61
|
| Rate for Payer: Sagamore Health Network All Products |
$66.54
|
| Rate for Payer: Signature Care EPO |
$71.54
|
| Rate for Payer: Signature Care PPO |
$75.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$67.92
|
| Rate for Payer: United Healthcare Medicare |
$28.44
|
|
|
HC CRYPTOCOCCUS AB
|
Facility
OP
|
$110.68
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$93.41
|
| Rate for Payer: Aetna Medicare |
$36.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.18
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Centivo All Commercial |
$56.45
|
| Rate for Payer: Cigna All Commercial |
$95.52
|
| Rate for Payer: CORVEL All Commercial |
$102.93
|
| Rate for Payer: Coventry All Commercial |
$97.40
|
| Rate for Payer: Encore All Commercial |
$101.88
|
| Rate for Payer: Frontpath All Commercial |
$101.83
|
| Rate for Payer: Humana ChoiceCare |
$95.59
|
| Rate for Payer: Humana Medicare |
$56.45
|
| Rate for Payer: Lucent All Commercial |
$56.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.61
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| Rate for Payer: MDWise Medicaid |
$11.54
|
| Rate for Payer: PHCS All Commercial |
$83.01
|
| Rate for Payer: PHP All Commercial |
$83.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.17
|
| Rate for Payer: Sagamore Health Network All Products |
$85.45
|
| Rate for Payer: Signature Care EPO |
$91.86
|
| Rate for Payer: Signature Care PPO |
$97.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.08
|
| Rate for Payer: United Healthcare Commercial |
$87.22
|
| Rate for Payer: United Healthcare Medicare |
$36.52
|
|
|
HC CRYPTOCOCCUS AB
|
Facility
IP
|
$110.68
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.01 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$95.63
|
| Rate for Payer: Cash Price |
$68.62
|
| Rate for Payer: Cigna All Commercial |
$95.52
|
| Rate for Payer: CORVEL All Commercial |
$102.93
|
| Rate for Payer: Coventry All Commercial |
$97.40
|
| Rate for Payer: Encore All Commercial |
$101.88
|
| Rate for Payer: Frontpath All Commercial |
$101.83
|
| Rate for Payer: Humana ChoiceCare |
$95.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.61
|
| Rate for Payer: PHCS All Commercial |
$83.01
|
| Rate for Payer: PHP All Commercial |
$83.94
|
| Rate for Payer: Sagamore Health Network All Products |
$85.45
|
| Rate for Payer: Signature Care EPO |
$91.86
|
| Rate for Payer: Signature Care PPO |
$97.40
|
| Rate for Payer: United Healthcare Commercial |
$87.22
|
|
|
HC CRYPTOCOCCUS ANTIGEN, SERUM
|
Facility
OP
|
$106.86
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$99.38 |
| Rate for Payer: Aetna Commercial |
$90.19
|
| Rate for Payer: Aetna Medicare |
$35.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.79
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Centivo All Commercial |
$54.50
|
| Rate for Payer: Cigna All Commercial |
$92.22
|
| Rate for Payer: CORVEL All Commercial |
$99.38
|
| Rate for Payer: Coventry All Commercial |
$94.03
|
| Rate for Payer: Encore All Commercial |
$98.36
|
| Rate for Payer: Frontpath All Commercial |
$98.31
|
| Rate for Payer: Humana ChoiceCare |
$92.29
|
| Rate for Payer: Humana Medicare |
$54.50
|
| Rate for Payer: Lucent All Commercial |
$54.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.17
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| Rate for Payer: MDWise Medicaid |
$11.54
|
| Rate for Payer: PHCS All Commercial |
$80.14
|
| Rate for Payer: PHP All Commercial |
$81.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.67
|
| Rate for Payer: Sagamore Health Network All Products |
$82.49
|
| Rate for Payer: Signature Care EPO |
$88.69
|
| Rate for Payer: Signature Care PPO |
$94.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.83
|
| Rate for Payer: United Healthcare Commercial |
$84.20
|
| Rate for Payer: United Healthcare Medicare |
$35.26
|
|
|
HC CRYPTOCOCCUS ANTIGEN, SERUM
|
Facility
IP
|
$106.86
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
63001913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$99.38 |
| Rate for Payer: Aetna Commercial |
$92.32
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Cigna All Commercial |
$92.22
|
| Rate for Payer: CORVEL All Commercial |
$99.38
|
| Rate for Payer: Coventry All Commercial |
$94.03
|
| Rate for Payer: Encore All Commercial |
$98.36
|
| Rate for Payer: Frontpath All Commercial |
$98.31
|
| Rate for Payer: Humana ChoiceCare |
$92.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.17
|
| Rate for Payer: PHCS All Commercial |
$80.14
|
| Rate for Payer: PHP All Commercial |
$81.04
|
| Rate for Payer: Sagamore Health Network All Products |
$82.49
|
| Rate for Payer: Signature Care EPO |
$88.69
|
| Rate for Payer: Signature Care PPO |
$94.03
|
| Rate for Payer: United Healthcare Commercial |
$84.20
|
|
|
HC CRYPTOSPORIDIUM AG, BY EIA, FECES
|
Facility
OP
|
$118.15
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
63002025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Aetna Commercial |
$99.72
|
| Rate for Payer: Aetna Medicare |
$38.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.89
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Centivo All Commercial |
$60.25
|
| Rate for Payer: Cigna All Commercial |
$101.96
|
| Rate for Payer: CORVEL All Commercial |
$109.88
|
| Rate for Payer: Coventry All Commercial |
$103.97
|
| Rate for Payer: Encore All Commercial |
$108.75
|
| Rate for Payer: Frontpath All Commercial |
$108.69
|
| Rate for Payer: Humana ChoiceCare |
$102.04
|
| Rate for Payer: Humana Medicare |
$60.25
|
| Rate for Payer: Lucent All Commercial |
$60.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.33
|
| Rate for Payer: Managed Health Services Medicaid |
$13.82
|
| Rate for Payer: MDWise Medicaid |
$13.82
|
| Rate for Payer: PHCS All Commercial |
$88.61
|
| Rate for Payer: PHP All Commercial |
$89.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.08
|
| Rate for Payer: Sagamore Health Network All Products |
$91.21
|
| Rate for Payer: Signature Care EPO |
$98.06
|
| Rate for Payer: Signature Care PPO |
$103.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.42
|
| Rate for Payer: United Healthcare Commercial |
$93.10
|
| Rate for Payer: United Healthcare Medicare |
$38.99
|
|
|
HC CRYPTOSPORIDIUM AG, BY EIA, FECES
|
Facility
IP
|
$118.15
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
63002025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Aetna Commercial |
$102.08
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cigna All Commercial |
$101.96
|
| Rate for Payer: CORVEL All Commercial |
$109.88
|
| Rate for Payer: Coventry All Commercial |
$103.97
|
| Rate for Payer: Encore All Commercial |
$108.75
|
| Rate for Payer: Frontpath All Commercial |
$108.69
|
| Rate for Payer: Humana ChoiceCare |
$102.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.33
|
| Rate for Payer: PHCS All Commercial |
$88.61
|
| Rate for Payer: PHP All Commercial |
$89.60
|
| Rate for Payer: Sagamore Health Network All Products |
$91.21
|
| Rate for Payer: Signature Care EPO |
$98.06
|
| Rate for Payer: Signature Care PPO |
$103.97
|
| Rate for Payer: United Healthcare Commercial |
$93.10
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
OP
|
$107.59
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
63001296
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$90.81
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$66.71
|
| Rate for Payer: Cash Price |
$66.71
|
| Rate for Payer: Centivo All Commercial |
$54.87
|
| Rate for Payer: Cigna All Commercial |
$92.85
|
| Rate for Payer: CORVEL All Commercial |
$100.06
|
| Rate for Payer: Coventry All Commercial |
$94.68
|
| Rate for Payer: Encore All Commercial |
$99.04
|
| Rate for Payer: Frontpath All Commercial |
$98.98
|
| Rate for Payer: Humana ChoiceCare |
$92.93
|
| Rate for Payer: Humana Medicare |
$54.87
|
| Rate for Payer: Lucent All Commercial |
$54.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.83
|
| Rate for Payer: Managed Health Services Medicaid |
$7.33
|
| Rate for Payer: MDWise Medicaid |
$7.33
|
| Rate for Payer: PHCS All Commercial |
$80.69
|
| Rate for Payer: PHP All Commercial |
$81.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.96
|
| Rate for Payer: Sagamore Health Network All Products |
$83.06
|
| Rate for Payer: Signature Care EPO |
$89.30
|
| Rate for Payer: Signature Care PPO |
$94.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.45
|
| Rate for Payer: United Healthcare Commercial |
$84.78
|
| Rate for Payer: United Healthcare Medicare |
$35.50
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
IP
|
$107.59
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
63001296
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.69 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$92.96
|
| Rate for Payer: Cash Price |
$66.71
|
| Rate for Payer: Cigna All Commercial |
$92.85
|
| Rate for Payer: CORVEL All Commercial |
$100.06
|
| Rate for Payer: Coventry All Commercial |
$94.68
|
| Rate for Payer: Encore All Commercial |
$99.04
|
| Rate for Payer: Frontpath All Commercial |
$98.98
|
| Rate for Payer: Humana ChoiceCare |
$92.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.83
|
| Rate for Payer: PHCS All Commercial |
$80.69
|
| Rate for Payer: PHP All Commercial |
$81.60
|
| Rate for Payer: Sagamore Health Network All Products |
$83.06
|
| Rate for Payer: Signature Care EPO |
$89.30
|
| Rate for Payer: Signature Care PPO |
$94.68
|
| Rate for Payer: United Healthcare Commercial |
$84.78
|
|
|
HC CRYTOSPORIDIUM AG
|
Facility
OP
|
$142.33
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
63002026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$132.37 |
| Rate for Payer: Aetna Commercial |
$120.13
|
| Rate for Payer: Aetna Medicare |
$46.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.67
|
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Centivo All Commercial |
$72.59
|
| Rate for Payer: Cigna All Commercial |
$122.83
|
| Rate for Payer: CORVEL All Commercial |
$132.37
|
| Rate for Payer: Coventry All Commercial |
$125.25
|
| Rate for Payer: Encore All Commercial |
$131.02
|
| Rate for Payer: Frontpath All Commercial |
$130.94
|
| Rate for Payer: Humana ChoiceCare |
$122.93
|
| Rate for Payer: Humana Medicare |
$72.59
|
| Rate for Payer: Lucent All Commercial |
$72.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.10
|
| Rate for Payer: Managed Health Services Medicaid |
$13.82
|
| Rate for Payer: MDWise Medicaid |
$13.82
|
| Rate for Payer: PHCS All Commercial |
$106.75
|
| Rate for Payer: PHP All Commercial |
$107.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.51
|
| Rate for Payer: Sagamore Health Network All Products |
$109.88
|
| Rate for Payer: Signature Care EPO |
$118.13
|
| Rate for Payer: Signature Care PPO |
$125.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.98
|
| Rate for Payer: United Healthcare Commercial |
$112.16
|
| Rate for Payer: United Healthcare Medicare |
$46.97
|
|
|
HC CRYTOSPORIDIUM AG
|
Facility
IP
|
$142.33
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
63002026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$132.37 |
| Rate for Payer: Aetna Commercial |
$122.97
|
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Cigna All Commercial |
$122.83
|
| Rate for Payer: CORVEL All Commercial |
$132.37
|
| Rate for Payer: Coventry All Commercial |
$125.25
|
| Rate for Payer: Encore All Commercial |
$131.02
|
| Rate for Payer: Frontpath All Commercial |
$130.94
|
| Rate for Payer: Humana ChoiceCare |
$122.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.10
|
| Rate for Payer: PHCS All Commercial |
$106.75
|
| Rate for Payer: PHP All Commercial |
$107.94
|
| Rate for Payer: Sagamore Health Network All Products |
$109.88
|
| Rate for Payer: Signature Care EPO |
$118.13
|
| Rate for Payer: Signature Care PPO |
$125.25
|
| Rate for Payer: United Healthcare Commercial |
$112.16
|
|
|
HC CSF CULTURE
|
Facility
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.22
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Centivo All Commercial |
$111.30
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$111.30
|
| Rate for Payer: Lucent All Commercial |
$111.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$72.02
|
|
|
HC CSF CULTURE
|
Facility
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$135.31
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC CTA-ABDOMEN
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
01665175
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$791.86 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$791.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$791.86
|
| Rate for Payer: MDWise Medicaid |
$791.86
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-ABDOMEN
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
01665175
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA ABDOMEN & PELVIS
|
Facility
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
01669174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,830.50 |
| Max. Negotiated Rate |
$3,509.82 |
| Rate for Payer: Aetna Commercial |
$3,260.74
|
| Rate for Payer: Cash Price |
$2,339.88
|
| Rate for Payer: Cigna All Commercial |
$3,256.96
|
| Rate for Payer: CORVEL All Commercial |
$3,509.82
|
| Rate for Payer: Coventry All Commercial |
$3,321.12
|
| Rate for Payer: Encore All Commercial |
$3,473.97
|
| Rate for Payer: Frontpath All Commercial |
$3,472.08
|
| Rate for Payer: Humana ChoiceCare |
$3,259.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,396.60
|
| Rate for Payer: PHCS All Commercial |
$2,830.50
|
| Rate for Payer: PHP All Commercial |
$2,862.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,913.53
|
| Rate for Payer: Signature Care EPO |
$3,132.42
|
| Rate for Payer: Signature Care PPO |
$3,321.12
|
| Rate for Payer: United Healthcare Commercial |
$2,973.91
|
|
|
HC CTA ABDOMEN & PELVIS
|
Facility
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
01669174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,177.00 |
| Max. Negotiated Rate |
$3,509.82 |
| Rate for Payer: Aetna Commercial |
$3,185.26
|
| Rate for Payer: Aetna Medicare |
$1,245.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,245.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,177.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,432.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,369.96
|
| Rate for Payer: Cash Price |
$2,339.88
|
| Rate for Payer: Cash Price |
$2,339.88
|
| Rate for Payer: Centivo All Commercial |
$1,924.74
|
| Rate for Payer: Cigna All Commercial |
$3,256.96
|
| Rate for Payer: CORVEL All Commercial |
$3,509.82
|
| Rate for Payer: Coventry All Commercial |
$3,321.12
|
| Rate for Payer: Encore All Commercial |
$3,473.97
|
| Rate for Payer: Frontpath All Commercial |
$3,472.08
|
| Rate for Payer: Humana ChoiceCare |
$3,259.60
|
| Rate for Payer: Humana Medicare |
$1,924.74
|
| Rate for Payer: Lucent All Commercial |
$1,924.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,396.60
|
| Rate for Payer: Managed Health Services Medicaid |
$1,177.33
|
| Rate for Payer: MDWise Medicaid |
$1,177.33
|
| Rate for Payer: PHCS All Commercial |
$2,830.50
|
| Rate for Payer: PHP All Commercial |
$2,862.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,471.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2,913.53
|
| Rate for Payer: Signature Care EPO |
$3,132.42
|
| Rate for Payer: Signature Care PPO |
$3,321.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare Commercial |
$2,973.91
|
| Rate for Payer: United Healthcare Medicare |
$1,245.42
|
|
|
HC CTA-AORTA/BILATERAL LEGS
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
01665635
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$812.49 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$812.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$812.49
|
| Rate for Payer: MDWise Medicaid |
$812.49
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-AORTA/BILATERAL LEGS
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
01665635
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CT ABDOMEN W CONTRAST
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
01664160
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$478.84 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$478.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.15
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Centivo All Commercial |
$1,039.88
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$1,039.88
|
| Rate for Payer: Lucent All Commercial |
$1,039.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$478.84
|
| Rate for Payer: MDWise Medicaid |
$478.84
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$672.86
|
|
|
HC CT ABDOMEN W CONTRAST
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
01664160
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT ABDOMEN W/O CONTRAST
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
01664150
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT ABDOMEN W/O CONTRAST
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
01664150
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$256.66 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$256.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$256.66
|
| Rate for Payer: MDWise Medicaid |
$256.66
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$572.22
|
|
|
HC CT ABDOMEN W/WO CONTRAST
|
Facility
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
01664170
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$562.93 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$562.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,141.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,092.27
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Centivo All Commercial |
$1,534.59
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Humana Medicare |
$1,534.59
|
| Rate for Payer: Lucent All Commercial |
$1,534.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$562.93
|
| Rate for Payer: MDWise Medicaid |
$562.93
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$992.97
|
|
