|
HC BB TAKS NON THREADED ACFS
|
Facility
|
OP
|
$584.50
|
|
| Hospital Charge Code |
41601268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$543.59 |
| Rate for Payer: Aetna Commercial |
$493.32
|
| Rate for Payer: Aetna Medicare |
$187.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$335.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.74
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Centivo All Commercial |
$317.97
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.59
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Humana Medicare |
$187.04
|
| Rate for Payer: Lucent All Commercial |
$317.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.96
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.13
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$496.82
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
| Rate for Payer: United Healthcare Medicare |
$187.04
|
|
|
HC BCR/ABL FISH 100-300 CELL
|
Facility
|
OP
|
$626.45
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$528.72
|
| Rate for Payer: Aetna Medicare |
$200.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$287.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$287.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.51
|
| Rate for Payer: Cash Price |
$375.87
|
| Rate for Payer: Cash Price |
$375.87
|
| Rate for Payer: Centivo All Commercial |
$340.79
|
| Rate for Payer: Cigna All Commercial |
$540.63
|
| Rate for Payer: CORVEL All Commercial |
$582.60
|
| Rate for Payer: Coventry All Commercial |
$551.28
|
| Rate for Payer: Encore All Commercial |
$576.65
|
| Rate for Payer: Frontpath All Commercial |
$576.33
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Humana Medicare |
$200.46
|
| Rate for Payer: Lucent All Commercial |
$340.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.80
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: MDWise Medicaid |
$51.19
|
| Rate for Payer: PHCS All Commercial |
$469.84
|
| Rate for Payer: PHP All Commercial |
$475.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.32
|
| Rate for Payer: Sagamore Health Network All Products |
$483.62
|
| Rate for Payer: Signature Care EPO |
$519.95
|
| Rate for Payer: Signature Care PPO |
$551.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$532.48
|
| Rate for Payer: United Healthcare Commercial |
$493.64
|
| Rate for Payer: United Healthcare Medicare |
$200.46
|
|
|
HC BCR/ABL FISH 100-300 CELL
|
Facility
|
IP
|
$626.45
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
63002088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$541.25
|
| Rate for Payer: Cash Price |
$375.87
|
| Rate for Payer: Cigna All Commercial |
$540.63
|
| Rate for Payer: CORVEL All Commercial |
$582.60
|
| Rate for Payer: Coventry All Commercial |
$551.28
|
| Rate for Payer: Encore All Commercial |
$576.65
|
| Rate for Payer: Frontpath All Commercial |
$576.33
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.80
|
| Rate for Payer: PHCS All Commercial |
$469.84
|
| Rate for Payer: PHP All Commercial |
$475.10
|
| Rate for Payer: Sagamore Health Network All Products |
$483.62
|
| Rate for Payer: Signature Care EPO |
$519.95
|
| Rate for Payer: Signature Care PPO |
$551.28
|
| Rate for Payer: United Healthcare Commercial |
$493.64
|
|
|
HC BCR/ABL FISH-DNA PROBE EA
|
Facility
|
IP
|
$76.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna Commercial |
$65.96
|
| Rate for Payer: Cash Price |
$45.80
|
| Rate for Payer: Cigna All Commercial |
$65.88
|
| Rate for Payer: CORVEL All Commercial |
$71.00
|
| Rate for Payer: Coventry All Commercial |
$67.18
|
| Rate for Payer: Encore All Commercial |
$70.27
|
| Rate for Payer: Frontpath All Commercial |
$70.23
|
| Rate for Payer: Humana ChoiceCare |
$65.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.71
|
| Rate for Payer: PHCS All Commercial |
$57.26
|
| Rate for Payer: PHP All Commercial |
$57.90
|
| Rate for Payer: Sagamore Health Network All Products |
$58.93
|
| Rate for Payer: Signature Care EPO |
$63.36
|
| Rate for Payer: Signature Care PPO |
$67.18
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
|
|
HC BCR/ABL FISH-DNA PROBE EA
|
Facility
|
OP
|
$76.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
63002080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna Commercial |
$64.43
|
| Rate for Payer: Aetna Medicare |
$24.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.87
|
| Rate for Payer: Cash Price |
$45.80
|
| Rate for Payer: Cash Price |
$45.80
|
| Rate for Payer: Centivo All Commercial |
$41.53
|
| Rate for Payer: Cigna All Commercial |
$65.88
|
| Rate for Payer: CORVEL All Commercial |
$71.00
|
| Rate for Payer: Coventry All Commercial |
$67.18
|
| Rate for Payer: Encore All Commercial |
$70.27
|
| Rate for Payer: Frontpath All Commercial |
$70.23
|
| Rate for Payer: Humana ChoiceCare |
$65.93
|
| Rate for Payer: Humana Medicare |
$24.43
|
| Rate for Payer: Lucent All Commercial |
$41.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.71
|
| Rate for Payer: Managed Health Services Medicaid |
$21.42
|
| Rate for Payer: MDWise Medicaid |
$21.42
|
| Rate for Payer: PHCS All Commercial |
$57.26
|
| Rate for Payer: PHP All Commercial |
$57.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.77
|
| Rate for Payer: Sagamore Health Network All Products |
$58.93
|
| Rate for Payer: Signature Care EPO |
$63.36
|
| Rate for Payer: Signature Care PPO |
$67.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.89
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
| Rate for Payer: United Healthcare Medicare |
$24.43
|
|
|
HC BCR/ABL MAJOR BREAKPOINT, QUANT PCR
|
Facility
|
OP
|
$465.63
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
63001433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.35 |
| Max. Negotiated Rate |
$433.04 |
| Rate for Payer: Aetna Commercial |
$392.99
|
| Rate for Payer: Aetna Medicare |
$149.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$163.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$163.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.90
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Centivo All Commercial |
$253.30
|
| Rate for Payer: Cigna All Commercial |
$401.84
|
| Rate for Payer: CORVEL All Commercial |
$433.04
|
| Rate for Payer: Coventry All Commercial |
$409.75
|
| Rate for Payer: Encore All Commercial |
$428.61
|
| Rate for Payer: Frontpath All Commercial |
$428.38
|
| Rate for Payer: Humana ChoiceCare |
$402.16
|
| Rate for Payer: Humana Medicare |
$149.00
|
| Rate for Payer: Lucent All Commercial |
$253.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.07
|
| Rate for Payer: Managed Health Services Medicaid |
$163.96
|
| Rate for Payer: MDWise Medicaid |
$163.96
|
| Rate for Payer: PHCS All Commercial |
$349.22
|
| Rate for Payer: PHP All Commercial |
$353.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.60
|
| Rate for Payer: Sagamore Health Network All Products |
$359.47
|
| Rate for Payer: Signature Care EPO |
$386.47
|
| Rate for Payer: Signature Care PPO |
$409.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$395.79
|
| Rate for Payer: United Healthcare Commercial |
$366.92
|
| Rate for Payer: United Healthcare Medicare |
$149.00
|
|
|
HC BCR/ABL MAJOR BREAKPOINT, QUANT PCR
|
Facility
|
IP
|
$465.63
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
63001433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$349.22 |
| Max. Negotiated Rate |
$433.04 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Cigna All Commercial |
$401.84
|
| Rate for Payer: CORVEL All Commercial |
$433.04
|
| Rate for Payer: Coventry All Commercial |
$409.75
|
| Rate for Payer: Encore All Commercial |
$428.61
|
| Rate for Payer: Frontpath All Commercial |
$428.38
|
| Rate for Payer: Humana ChoiceCare |
$402.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$419.07
|
| Rate for Payer: PHCS All Commercial |
$349.22
|
| Rate for Payer: PHP All Commercial |
$353.13
|
| Rate for Payer: Sagamore Health Network All Products |
$359.47
|
| Rate for Payer: Signature Care EPO |
$386.47
|
| Rate for Payer: Signature Care PPO |
$409.75
|
| Rate for Payer: United Healthcare Commercial |
$366.92
|
|
|
HC BEDDED OUTPATIENT EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$19.27
|
|
| Hospital Charge Code |
1681007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$194.29 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
HC BEDDED OUTPATIENT EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$19.27
|
|
| Hospital Charge Code |
1681007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC BEDDED OUTPATIENT INITIAL HOUR
|
Facility
|
IP
|
$1,201.14
|
|
| Hospital Charge Code |
1681006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$900.86 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$1,037.78
|
| Rate for Payer: Cash Price |
$720.68
|
| Rate for Payer: Cigna All Commercial |
$1,036.58
|
| Rate for Payer: CORVEL All Commercial |
$1,117.06
|
| Rate for Payer: Coventry All Commercial |
$1,057.00
|
| Rate for Payer: Encore All Commercial |
$1,105.65
|
| Rate for Payer: Frontpath All Commercial |
$1,105.05
|
| Rate for Payer: Humana ChoiceCare |
$1,037.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.03
|
| Rate for Payer: PHCS All Commercial |
$900.86
|
| Rate for Payer: PHP All Commercial |
$910.94
|
| Rate for Payer: Sagamore Health Network All Products |
$927.28
|
| Rate for Payer: Signature Care EPO |
$996.95
|
| Rate for Payer: Signature Care PPO |
$1,057.00
|
| Rate for Payer: United Healthcare Commercial |
$946.50
|
|
|
HC BEDDED OUTPATIENT INITIAL HOUR
|
Facility
|
OP
|
$1,201.14
|
|
| Hospital Charge Code |
1681006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$194.29 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$1,013.76
|
| Rate for Payer: Aetna Medicare |
$384.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$372.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$689.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.80
|
| Rate for Payer: Cash Price |
$720.68
|
| Rate for Payer: Cash Price |
$720.68
|
| Rate for Payer: Centivo All Commercial |
$653.42
|
| Rate for Payer: Cigna All Commercial |
$1,036.58
|
| Rate for Payer: CORVEL All Commercial |
$1,117.06
|
| Rate for Payer: Coventry All Commercial |
$1,057.00
|
| Rate for Payer: Encore All Commercial |
$1,105.65
|
| Rate for Payer: Frontpath All Commercial |
$1,105.05
|
| Rate for Payer: Humana ChoiceCare |
$1,037.42
|
| Rate for Payer: Humana Medicare |
$384.36
|
| Rate for Payer: Lucent All Commercial |
$653.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,081.03
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$900.86
|
| Rate for Payer: PHP All Commercial |
$910.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.44
|
| Rate for Payer: Sagamore Health Network All Products |
$927.28
|
| Rate for Payer: Signature Care EPO |
$996.95
|
| Rate for Payer: Signature Care PPO |
$1,057.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.97
|
| Rate for Payer: United Healthcare Commercial |
$946.50
|
| Rate for Payer: United Healthcare Medicare |
$384.36
|
|
|
HC BENZODIAZEPINE QTMS
|
Facility
|
IP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
|
HC BENZODIAZEPINE QTMS
|
Facility
|
OP
|
$127.31
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$40.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.81
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Centivo All Commercial |
$69.26
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Humana Medicare |
$40.74
|
| Rate for Payer: Lucent All Commercial |
$69.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$40.74
|
|
|
HC BENZODIAZEPINE QTMS
|
Facility
|
OP
|
$127.31
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
63001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$107.45
|
| Rate for Payer: Aetna Medicare |
$40.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.81
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Centivo All Commercial |
$69.26
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Humana Medicare |
$40.74
|
| Rate for Payer: Lucent All Commercial |
$69.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.21
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$40.74
|
|
|
HC BENZODIAZEPINE QTMS
|
Facility
|
IP
|
$127.31
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
63001414
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna All Commercial |
$109.87
|
| Rate for Payer: CORVEL All Commercial |
$118.40
|
| Rate for Payer: Coventry All Commercial |
$112.03
|
| Rate for Payer: Encore All Commercial |
$117.19
|
| Rate for Payer: Frontpath All Commercial |
$117.13
|
| Rate for Payer: Humana ChoiceCare |
$109.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$95.48
|
| Rate for Payer: PHP All Commercial |
$96.55
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.67
|
| Rate for Payer: Signature Care PPO |
$112.03
|
| Rate for Payer: United Healthcare Commercial |
$100.32
|
|
|
HC BETA-2 GLYCOPROTEIN 1 ANTIBODY CHARGE
|
Facility
|
OP
|
$69.46
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.53 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna Commercial |
$58.62
|
| Rate for Payer: Aetna Medicare |
$22.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.45
|
| Rate for Payer: Cash Price |
$41.68
|
| Rate for Payer: Cash Price |
$41.68
|
| Rate for Payer: Centivo All Commercial |
$37.79
|
| Rate for Payer: Cigna All Commercial |
$59.94
|
| Rate for Payer: CORVEL All Commercial |
$64.60
|
| Rate for Payer: Coventry All Commercial |
$61.12
|
| Rate for Payer: Encore All Commercial |
$63.94
|
| Rate for Payer: Frontpath All Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$59.99
|
| Rate for Payer: Humana Medicare |
$22.23
|
| Rate for Payer: Lucent All Commercial |
$37.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.51
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$52.09
|
| Rate for Payer: PHP All Commercial |
$52.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.09
|
| Rate for Payer: Sagamore Health Network All Products |
$53.62
|
| Rate for Payer: Signature Care EPO |
$57.65
|
| Rate for Payer: Signature Care PPO |
$61.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.04
|
| Rate for Payer: United Healthcare Commercial |
$54.73
|
| Rate for Payer: United Healthcare Medicare |
$22.23
|
|
|
HC BETA-2 GLYCOPROTEIN 1 ANTIBODY CHARGE
|
Facility
|
IP
|
$69.46
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.09 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna Commercial |
$60.01
|
| Rate for Payer: Cash Price |
$41.68
|
| Rate for Payer: Cigna All Commercial |
$59.94
|
| Rate for Payer: CORVEL All Commercial |
$64.60
|
| Rate for Payer: Coventry All Commercial |
$61.12
|
| Rate for Payer: Encore All Commercial |
$63.94
|
| Rate for Payer: Frontpath All Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$59.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.51
|
| Rate for Payer: PHCS All Commercial |
$52.09
|
| Rate for Payer: PHP All Commercial |
$52.68
|
| Rate for Payer: Sagamore Health Network All Products |
$53.62
|
| Rate for Payer: Signature Care EPO |
$57.65
|
| Rate for Payer: Signature Care PPO |
$61.12
|
| Rate for Payer: United Healthcare Commercial |
$54.73
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGA ANTIBODY
|
Facility
|
OP
|
$130.64
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna Commercial |
$110.26
|
| Rate for Payer: Aetna Medicare |
$41.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.99
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Centivo All Commercial |
$71.07
|
| Rate for Payer: Cigna All Commercial |
$112.74
|
| Rate for Payer: CORVEL All Commercial |
$121.50
|
| Rate for Payer: Coventry All Commercial |
$114.96
|
| Rate for Payer: Encore All Commercial |
$120.25
|
| Rate for Payer: Frontpath All Commercial |
$120.19
|
| Rate for Payer: Humana ChoiceCare |
$112.83
|
| Rate for Payer: Humana Medicare |
$41.80
|
| Rate for Payer: Lucent All Commercial |
$71.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.58
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$97.98
|
| Rate for Payer: PHP All Commercial |
$99.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.95
|
| Rate for Payer: Sagamore Health Network All Products |
$100.85
|
| Rate for Payer: Signature Care EPO |
$108.43
|
| Rate for Payer: Signature Care PPO |
$114.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.04
|
| Rate for Payer: United Healthcare Commercial |
$102.94
|
| Rate for Payer: United Healthcare Medicare |
$41.80
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGA ANTIBODY
|
Facility
|
IP
|
$130.64
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63001861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna Commercial |
$112.87
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cigna All Commercial |
$112.74
|
| Rate for Payer: CORVEL All Commercial |
$121.50
|
| Rate for Payer: Coventry All Commercial |
$114.96
|
| Rate for Payer: Encore All Commercial |
$120.25
|
| Rate for Payer: Frontpath All Commercial |
$120.19
|
| Rate for Payer: Humana ChoiceCare |
$112.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.58
|
| Rate for Payer: PHCS All Commercial |
$97.98
|
| Rate for Payer: PHP All Commercial |
$99.08
|
| Rate for Payer: Sagamore Health Network All Products |
$100.85
|
| Rate for Payer: Signature Care EPO |
$108.43
|
| Rate for Payer: Signature Care PPO |
$114.96
|
| Rate for Payer: United Healthcare Commercial |
$102.94
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGG AND IGM ATBY
|
Facility
|
IP
|
$80.78
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63002194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$69.79
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Cigna All Commercial |
$69.71
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.70
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.26
|
| Rate for Payer: Sagamore Health Network All Products |
$62.36
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
|
|
HC BETA-2 GLYCOPROTEIN 1 IGG AND IGM ATBY
|
Facility
|
OP
|
$80.78
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
63002194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$68.18
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.43
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Centivo All Commercial |
$43.94
|
| Rate for Payer: Cigna All Commercial |
$69.71
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana Medicare |
$25.85
|
| Rate for Payer: Lucent All Commercial |
$43.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.70
|
| Rate for Payer: Managed Health Services Medicaid |
$25.45
|
| Rate for Payer: MDWise Medicaid |
$25.45
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.50
|
| Rate for Payer: Sagamore Health Network All Products |
$62.36
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.66
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare |
$25.85
|
|
|
HC BETA-2MICROGLOB
|
Facility
|
OP
|
$187.94
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
63001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$174.78 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Aetna Medicare |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.15
|
| Rate for Payer: Cash Price |
$112.76
|
| Rate for Payer: Cash Price |
$112.76
|
| Rate for Payer: Centivo All Commercial |
$102.24
|
| Rate for Payer: Cigna All Commercial |
$162.19
|
| Rate for Payer: CORVEL All Commercial |
$174.78
|
| Rate for Payer: Coventry All Commercial |
$165.39
|
| Rate for Payer: Encore All Commercial |
$173.00
|
| Rate for Payer: Frontpath All Commercial |
$172.90
|
| Rate for Payer: Humana ChoiceCare |
$162.32
|
| Rate for Payer: Humana Medicare |
$60.14
|
| Rate for Payer: Lucent All Commercial |
$102.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16.18
|
| Rate for Payer: MDWise Medicaid |
$16.18
|
| Rate for Payer: PHCS All Commercial |
$140.96
|
| Rate for Payer: PHP All Commercial |
$142.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.30
|
| Rate for Payer: Sagamore Health Network All Products |
$145.09
|
| Rate for Payer: Signature Care EPO |
$155.99
|
| Rate for Payer: Signature Care PPO |
$165.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$148.10
|
| Rate for Payer: United Healthcare Medicare |
$60.14
|
|
|
HC BETA-2MICROGLOB
|
Facility
|
IP
|
$187.94
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
63001470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.96 |
| Max. Negotiated Rate |
$174.78 |
| Rate for Payer: Aetna Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$112.76
|
| Rate for Payer: Cigna All Commercial |
$162.19
|
| Rate for Payer: CORVEL All Commercial |
$174.78
|
| Rate for Payer: Coventry All Commercial |
$165.39
|
| Rate for Payer: Encore All Commercial |
$173.00
|
| Rate for Payer: Frontpath All Commercial |
$172.90
|
| Rate for Payer: Humana ChoiceCare |
$162.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.15
|
| Rate for Payer: PHCS All Commercial |
$140.96
|
| Rate for Payer: PHP All Commercial |
$142.53
|
| Rate for Payer: Sagamore Health Network All Products |
$145.09
|
| Rate for Payer: Signature Care EPO |
$155.99
|
| Rate for Payer: Signature Care PPO |
$165.39
|
| Rate for Payer: United Healthcare Commercial |
$148.10
|
|
|
HC BETA-C TELOPEPTIDE
|
Facility
|
OP
|
$198.11
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$184.24 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna Medicare |
$63.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$91.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.73
|
| Rate for Payer: Cash Price |
$118.87
|
| Rate for Payer: Cash Price |
$118.87
|
| Rate for Payer: Centivo All Commercial |
$107.77
|
| Rate for Payer: Cigna All Commercial |
$170.97
|
| Rate for Payer: CORVEL All Commercial |
$184.24
|
| Rate for Payer: Coventry All Commercial |
$174.34
|
| Rate for Payer: Encore All Commercial |
$182.36
|
| Rate for Payer: Frontpath All Commercial |
$182.26
|
| Rate for Payer: Humana ChoiceCare |
$171.11
|
| Rate for Payer: Humana Medicare |
$63.40
|
| Rate for Payer: Lucent All Commercial |
$107.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.30
|
| Rate for Payer: Managed Health Services Medicaid |
$18.68
|
| Rate for Payer: MDWise Medicaid |
$18.68
|
| Rate for Payer: PHCS All Commercial |
$148.58
|
| Rate for Payer: PHP All Commercial |
$150.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.26
|
| Rate for Payer: Sagamore Health Network All Products |
$152.94
|
| Rate for Payer: Signature Care EPO |
$164.43
|
| Rate for Payer: Signature Care PPO |
$174.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$168.39
|
| Rate for Payer: United Healthcare Commercial |
$156.11
|
| Rate for Payer: United Healthcare Medicare |
$63.40
|
|
|
HC BETA-C TELOPEPTIDE
|
Facility
|
IP
|
$198.11
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.58 |
| Max. Negotiated Rate |
$184.24 |
| Rate for Payer: Aetna Commercial |
$171.17
|
| Rate for Payer: Cash Price |
$118.87
|
| Rate for Payer: Cigna All Commercial |
$170.97
|
| Rate for Payer: CORVEL All Commercial |
$184.24
|
| Rate for Payer: Coventry All Commercial |
$174.34
|
| Rate for Payer: Encore All Commercial |
$182.36
|
| Rate for Payer: Frontpath All Commercial |
$182.26
|
| Rate for Payer: Humana ChoiceCare |
$171.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.30
|
| Rate for Payer: PHCS All Commercial |
$148.58
|
| Rate for Payer: PHP All Commercial |
$150.25
|
| Rate for Payer: Sagamore Health Network All Products |
$152.94
|
| Rate for Payer: Signature Care EPO |
$164.43
|
| Rate for Payer: Signature Care PPO |
$174.34
|
| Rate for Payer: United Healthcare Commercial |
$156.11
|
|
