|
HC BONE SCAN - SINGLE AREA
|
Facility
|
OP
|
$1,497.45
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
1638300
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$105.77 |
| Max. Negotiated Rate |
$1,392.63 |
| Rate for Payer: Aetna Commercial |
$1,263.85
|
| Rate for Payer: Aetna Medicare |
$479.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$464.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$859.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$936.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$551.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$527.10
|
| Rate for Payer: Cash Price |
$898.47
|
| Rate for Payer: Cash Price |
$898.47
|
| Rate for Payer: Centivo All Commercial |
$814.61
|
| Rate for Payer: Cigna All Commercial |
$1,292.30
|
| Rate for Payer: CORVEL All Commercial |
$1,392.63
|
| Rate for Payer: Coventry All Commercial |
$1,317.76
|
| Rate for Payer: Encore All Commercial |
$1,378.40
|
| Rate for Payer: Frontpath All Commercial |
$1,377.65
|
| Rate for Payer: Humana ChoiceCare |
$1,293.35
|
| Rate for Payer: Humana Medicare |
$479.18
|
| Rate for Payer: Lucent All Commercial |
$814.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,347.70
|
| Rate for Payer: Managed Health Services Medicaid |
$105.77
|
| Rate for Payer: MDWise Medicaid |
$105.77
|
| Rate for Payer: PHCS All Commercial |
$1,123.09
|
| Rate for Payer: PHP All Commercial |
$1,135.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$584.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.03
|
| Rate for Payer: Signature Care EPO |
$1,242.88
|
| Rate for Payer: Signature Care PPO |
$1,317.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,272.83
|
| Rate for Payer: United Healthcare Commercial |
$1,179.99
|
| Rate for Payer: United Healthcare Medicare |
$479.18
|
|
|
HC BONE SCAN - THREE PHASE
|
Facility
|
IP
|
$2,491.56
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
1638315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,868.67 |
| Max. Negotiated Rate |
$2,317.15 |
| Rate for Payer: Aetna Commercial |
$2,152.71
|
| Rate for Payer: Cash Price |
$1,494.94
|
| Rate for Payer: Cigna All Commercial |
$2,150.22
|
| Rate for Payer: CORVEL All Commercial |
$2,317.15
|
| Rate for Payer: Coventry All Commercial |
$2,192.57
|
| Rate for Payer: Encore All Commercial |
$2,293.48
|
| Rate for Payer: Frontpath All Commercial |
$2,292.24
|
| Rate for Payer: Humana ChoiceCare |
$2,151.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,242.40
|
| Rate for Payer: PHCS All Commercial |
$1,868.67
|
| Rate for Payer: PHP All Commercial |
$1,889.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,923.48
|
| Rate for Payer: Signature Care EPO |
$2,067.99
|
| Rate for Payer: Signature Care PPO |
$2,192.57
|
| Rate for Payer: United Healthcare Commercial |
$1,963.35
|
|
|
HC BONE SCAN - THREE PHASE
|
Facility
|
OP
|
$2,491.56
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
1638315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$2,317.15 |
| Rate for Payer: Aetna Commercial |
$2,102.88
|
| Rate for Payer: Aetna Medicare |
$797.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$210.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$772.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,430.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,557.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$210.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$916.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$877.03
|
| Rate for Payer: Cash Price |
$1,494.94
|
| Rate for Payer: Cash Price |
$1,494.94
|
| Rate for Payer: Centivo All Commercial |
$1,355.41
|
| Rate for Payer: Cigna All Commercial |
$2,150.22
|
| Rate for Payer: CORVEL All Commercial |
$2,317.15
|
| Rate for Payer: Coventry All Commercial |
$2,192.57
|
| Rate for Payer: Encore All Commercial |
$2,293.48
|
| Rate for Payer: Frontpath All Commercial |
$2,292.24
|
| Rate for Payer: Humana ChoiceCare |
$2,151.96
|
| Rate for Payer: Humana Medicare |
$797.30
|
| Rate for Payer: Lucent All Commercial |
$1,355.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,242.40
|
| Rate for Payer: Managed Health Services Medicaid |
$210.56
|
| Rate for Payer: MDWise Medicaid |
$210.56
|
| Rate for Payer: PHCS All Commercial |
$1,868.67
|
| Rate for Payer: PHP All Commercial |
$1,889.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$971.71
|
| Rate for Payer: Sagamore Health Network All Products |
$1,923.48
|
| Rate for Payer: Signature Care EPO |
$2,067.99
|
| Rate for Payer: Signature Care PPO |
$2,192.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,117.83
|
| Rate for Payer: United Healthcare Commercial |
$1,963.35
|
| Rate for Payer: United Healthcare Medicare |
$797.30
|
|
|
HC BONE SCAN - WHOLE BODY
|
Facility
|
OP
|
$2,275.67
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
1638306
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.39 |
| Max. Negotiated Rate |
$2,116.37 |
| Rate for Payer: Aetna Commercial |
$1,920.67
|
| Rate for Payer: Aetna Medicare |
$728.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$147.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$705.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,306.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,422.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$837.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$801.04
|
| Rate for Payer: Cash Price |
$1,365.40
|
| Rate for Payer: Cash Price |
$1,365.40
|
| Rate for Payer: Centivo All Commercial |
$1,237.96
|
| Rate for Payer: Cigna All Commercial |
$1,963.90
|
| Rate for Payer: CORVEL All Commercial |
$2,116.37
|
| Rate for Payer: Coventry All Commercial |
$2,002.59
|
| Rate for Payer: Encore All Commercial |
$2,094.75
|
| Rate for Payer: Frontpath All Commercial |
$2,093.62
|
| Rate for Payer: Humana ChoiceCare |
$1,965.50
|
| Rate for Payer: Humana Medicare |
$728.21
|
| Rate for Payer: Lucent All Commercial |
$1,237.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,048.10
|
| Rate for Payer: Managed Health Services Medicaid |
$147.39
|
| Rate for Payer: MDWise Medicaid |
$147.39
|
| Rate for Payer: PHCS All Commercial |
$1,706.75
|
| Rate for Payer: PHP All Commercial |
$1,725.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$887.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,756.82
|
| Rate for Payer: Signature Care EPO |
$1,888.81
|
| Rate for Payer: Signature Care PPO |
$2,002.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,934.32
|
| Rate for Payer: United Healthcare Commercial |
$1,793.23
|
| Rate for Payer: United Healthcare Medicare |
$728.21
|
|
|
HC BONE SCAN - WHOLE BODY
|
Facility
|
IP
|
$2,275.67
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
1638306
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,706.75 |
| Max. Negotiated Rate |
$2,116.37 |
| Rate for Payer: Aetna Commercial |
$1,966.18
|
| Rate for Payer: Cash Price |
$1,365.40
|
| Rate for Payer: Cigna All Commercial |
$1,963.90
|
| Rate for Payer: CORVEL All Commercial |
$2,116.37
|
| Rate for Payer: Coventry All Commercial |
$2,002.59
|
| Rate for Payer: Encore All Commercial |
$2,094.75
|
| Rate for Payer: Frontpath All Commercial |
$2,093.62
|
| Rate for Payer: Humana ChoiceCare |
$1,965.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,048.10
|
| Rate for Payer: PHCS All Commercial |
$1,706.75
|
| Rate for Payer: PHP All Commercial |
$1,725.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,756.82
|
| Rate for Payer: Signature Care EPO |
$1,888.81
|
| Rate for Payer: Signature Care PPO |
$2,002.59
|
| Rate for Payer: United Healthcare Commercial |
$1,793.23
|
|
|
HC BORDETELLA PERTUS CONFIRM - IMMUNOBLOT
|
Facility
|
IP
|
$96.75
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$89.98 |
| Rate for Payer: Aetna Commercial |
$83.59
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna All Commercial |
$83.50
|
| Rate for Payer: CORVEL All Commercial |
$89.98
|
| Rate for Payer: Coventry All Commercial |
$85.14
|
| Rate for Payer: Encore All Commercial |
$89.06
|
| Rate for Payer: Frontpath All Commercial |
$89.01
|
| Rate for Payer: Humana ChoiceCare |
$83.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.08
|
| Rate for Payer: PHCS All Commercial |
$72.56
|
| Rate for Payer: PHP All Commercial |
$73.38
|
| Rate for Payer: Sagamore Health Network All Products |
$74.69
|
| Rate for Payer: Signature Care EPO |
$80.30
|
| Rate for Payer: Signature Care PPO |
$85.14
|
| Rate for Payer: United Healthcare Commercial |
$76.24
|
|
|
HC BORDETELLA PERTUS CONFIRM - IMMUNOBLOT
|
Facility
|
OP
|
$96.75
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$89.98 |
| Rate for Payer: Aetna Commercial |
$81.66
|
| Rate for Payer: Aetna Medicare |
$30.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$44.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.06
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Centivo All Commercial |
$52.63
|
| Rate for Payer: Cigna All Commercial |
$83.50
|
| Rate for Payer: CORVEL All Commercial |
$89.98
|
| Rate for Payer: Coventry All Commercial |
$85.14
|
| Rate for Payer: Encore All Commercial |
$89.06
|
| Rate for Payer: Frontpath All Commercial |
$89.01
|
| Rate for Payer: Humana ChoiceCare |
$83.56
|
| Rate for Payer: Humana Medicare |
$30.96
|
| Rate for Payer: Lucent All Commercial |
$52.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.08
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$72.56
|
| Rate for Payer: PHP All Commercial |
$73.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.73
|
| Rate for Payer: Sagamore Health Network All Products |
$74.69
|
| Rate for Payer: Signature Care EPO |
$80.30
|
| Rate for Payer: Signature Care PPO |
$85.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.24
|
| Rate for Payer: United Healthcare Commercial |
$76.24
|
| Rate for Payer: United Healthcare Medicare |
$30.96
|
|
|
HC BORDETELLA PERTUS CONFIRM IMMUNOBLOT IGG
|
Facility
|
IP
|
$174.08
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$161.89 |
| Rate for Payer: Aetna Commercial |
$150.41
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cigna All Commercial |
$150.23
|
| Rate for Payer: CORVEL All Commercial |
$161.89
|
| Rate for Payer: Coventry All Commercial |
$153.19
|
| Rate for Payer: Encore All Commercial |
$160.24
|
| Rate for Payer: Frontpath All Commercial |
$160.15
|
| Rate for Payer: Humana ChoiceCare |
$150.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.67
|
| Rate for Payer: PHCS All Commercial |
$130.56
|
| Rate for Payer: PHP All Commercial |
$132.02
|
| Rate for Payer: Sagamore Health Network All Products |
$134.39
|
| Rate for Payer: Signature Care EPO |
$144.49
|
| Rate for Payer: Signature Care PPO |
$153.19
|
| Rate for Payer: United Healthcare Commercial |
$137.18
|
|
|
HC BORDETELLA PERTUS CONFIRM IMMUNOBLOT IGG
|
Facility
|
OP
|
$174.08
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63001924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$161.89 |
| Rate for Payer: Aetna Commercial |
$146.92
|
| Rate for Payer: Aetna Medicare |
$55.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$80.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.28
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Centivo All Commercial |
$94.70
|
| Rate for Payer: Cigna All Commercial |
$150.23
|
| Rate for Payer: CORVEL All Commercial |
$161.89
|
| Rate for Payer: Coventry All Commercial |
$153.19
|
| Rate for Payer: Encore All Commercial |
$160.24
|
| Rate for Payer: Frontpath All Commercial |
$160.15
|
| Rate for Payer: Humana ChoiceCare |
$150.35
|
| Rate for Payer: Humana Medicare |
$55.71
|
| Rate for Payer: Lucent All Commercial |
$94.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.67
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$130.56
|
| Rate for Payer: PHP All Commercial |
$132.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.89
|
| Rate for Payer: Sagamore Health Network All Products |
$134.39
|
| Rate for Payer: Signature Care EPO |
$144.49
|
| Rate for Payer: Signature Care PPO |
$153.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.97
|
| Rate for Payer: United Healthcare Commercial |
$137.18
|
| Rate for Payer: United Healthcare Medicare |
$55.71
|
|
|
HC BORDETELLA PERTUS IGG, IGA, IGM
|
Facility
|
IP
|
$146.12
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63002199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.59 |
| Max. Negotiated Rate |
$135.89 |
| Rate for Payer: Aetna Commercial |
$126.25
|
| Rate for Payer: Cash Price |
$87.67
|
| Rate for Payer: Cigna All Commercial |
$126.10
|
| Rate for Payer: CORVEL All Commercial |
$135.89
|
| Rate for Payer: Coventry All Commercial |
$128.59
|
| Rate for Payer: Encore All Commercial |
$134.50
|
| Rate for Payer: Frontpath All Commercial |
$134.43
|
| Rate for Payer: Humana ChoiceCare |
$126.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.51
|
| Rate for Payer: PHCS All Commercial |
$109.59
|
| Rate for Payer: PHP All Commercial |
$110.82
|
| Rate for Payer: Sagamore Health Network All Products |
$112.80
|
| Rate for Payer: Signature Care EPO |
$121.28
|
| Rate for Payer: Signature Care PPO |
$128.59
|
| Rate for Payer: United Healthcare Commercial |
$115.14
|
|
|
HC BORDETELLA PERTUS IGG, IGA, IGM
|
Facility
|
OP
|
$146.12
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
63002199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$135.89 |
| Rate for Payer: Aetna Commercial |
$123.33
|
| Rate for Payer: Aetna Medicare |
$46.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.43
|
| Rate for Payer: Cash Price |
$87.67
|
| Rate for Payer: Cash Price |
$87.67
|
| Rate for Payer: Centivo All Commercial |
$79.49
|
| Rate for Payer: Cigna All Commercial |
$126.10
|
| Rate for Payer: CORVEL All Commercial |
$135.89
|
| Rate for Payer: Coventry All Commercial |
$128.59
|
| Rate for Payer: Encore All Commercial |
$134.50
|
| Rate for Payer: Frontpath All Commercial |
$134.43
|
| Rate for Payer: Humana ChoiceCare |
$126.20
|
| Rate for Payer: Humana Medicare |
$46.76
|
| Rate for Payer: Lucent All Commercial |
$79.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.51
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: MDWise Medicaid |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$109.59
|
| Rate for Payer: PHP All Commercial |
$110.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.99
|
| Rate for Payer: Sagamore Health Network All Products |
$112.80
|
| Rate for Payer: Signature Care EPO |
$121.28
|
| Rate for Payer: Signature Care PPO |
$128.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.20
|
| Rate for Payer: United Healthcare Commercial |
$115.14
|
| Rate for Payer: United Healthcare Medicare |
$46.76
|
|
|
HC BORDETELLA PERTUSSIS-PCR
|
Facility
|
OP
|
$304.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63001029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$97.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.03
|
| Rate for Payer: Cash Price |
$182.44
|
| Rate for Payer: Cash Price |
$182.44
|
| Rate for Payer: Centivo All Commercial |
$165.41
|
| Rate for Payer: Cigna All Commercial |
$262.40
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Humana Medicare |
$97.30
|
| Rate for Payer: Lucent All Commercial |
$165.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.65
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$228.04
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.58
|
| Rate for Payer: Sagamore Health Network All Products |
$234.73
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.45
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
| Rate for Payer: United Healthcare Medicare |
$97.30
|
|
|
HC BORDETELLA PERTUSSIS-PCR
|
Facility
|
IP
|
$304.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63001029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.04 |
| Max. Negotiated Rate |
$282.78 |
| Rate for Payer: Aetna Commercial |
$262.71
|
| Rate for Payer: Cash Price |
$182.44
|
| Rate for Payer: Cigna All Commercial |
$262.40
|
| Rate for Payer: CORVEL All Commercial |
$282.78
|
| Rate for Payer: Coventry All Commercial |
$267.57
|
| Rate for Payer: Encore All Commercial |
$279.89
|
| Rate for Payer: Frontpath All Commercial |
$279.74
|
| Rate for Payer: Humana ChoiceCare |
$262.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.65
|
| Rate for Payer: PHCS All Commercial |
$228.04
|
| Rate for Payer: PHP All Commercial |
$230.60
|
| Rate for Payer: Sagamore Health Network All Products |
$234.73
|
| Rate for Payer: Signature Care EPO |
$252.37
|
| Rate for Payer: Signature Care PPO |
$267.57
|
| Rate for Payer: United Healthcare Commercial |
$239.60
|
|
|
HC BRAIN SCAN SPECT
|
Facility
|
IP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
1638607
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,559.69 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,948.76
|
| Rate for Payer: Cash Price |
$2,047.75
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
|
|
HC BRAIN SCAN SPECT
|
Facility
|
OP
|
$3,412.92
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
1638607
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.13 |
| Max. Negotiated Rate |
$3,174.02 |
| Rate for Payer: Aetna Commercial |
$2,880.50
|
| Rate for Payer: Aetna Medicare |
$1,092.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$203.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,058.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,960.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,133.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$203.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,255.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,201.35
|
| Rate for Payer: Cash Price |
$2,047.75
|
| Rate for Payer: Cash Price |
$2,047.75
|
| Rate for Payer: Centivo All Commercial |
$1,856.63
|
| Rate for Payer: Cigna All Commercial |
$2,945.35
|
| Rate for Payer: CORVEL All Commercial |
$3,174.02
|
| Rate for Payer: Coventry All Commercial |
$3,003.37
|
| Rate for Payer: Encore All Commercial |
$3,141.59
|
| Rate for Payer: Frontpath All Commercial |
$3,139.89
|
| Rate for Payer: Humana ChoiceCare |
$2,947.74
|
| Rate for Payer: Humana Medicare |
$1,092.13
|
| Rate for Payer: Lucent All Commercial |
$1,856.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,071.63
|
| Rate for Payer: Managed Health Services Medicaid |
$203.13
|
| Rate for Payer: MDWise Medicaid |
$203.13
|
| Rate for Payer: PHCS All Commercial |
$2,559.69
|
| Rate for Payer: PHP All Commercial |
$2,588.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,331.04
|
| Rate for Payer: Sagamore Health Network All Products |
$2,634.77
|
| Rate for Payer: Signature Care EPO |
$2,832.72
|
| Rate for Payer: Signature Care PPO |
$3,003.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,900.98
|
| Rate for Payer: United Healthcare Commercial |
$2,689.38
|
| Rate for Payer: United Healthcare Medicare |
$1,092.13
|
|
|
HC BRA VELCRO 30-32 SMALL
|
Facility
|
IP
|
$263.48
|
|
| Hospital Charge Code |
41601395
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$227.65
|
| Rate for Payer: Cash Price |
$158.09
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
|
|
HC BRA VELCRO 30-32 SMALL
|
Facility
|
OP
|
$263.48
|
|
| Hospital Charge Code |
41601395
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$245.04 |
| Rate for Payer: Aetna Commercial |
$222.38
|
| Rate for Payer: Aetna Medicare |
$84.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$151.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.74
|
| Rate for Payer: Cash Price |
$158.09
|
| Rate for Payer: Cash Price |
$158.09
|
| Rate for Payer: Centivo All Commercial |
$143.33
|
| Rate for Payer: Cigna All Commercial |
$227.38
|
| Rate for Payer: CORVEL All Commercial |
$245.04
|
| Rate for Payer: Coventry All Commercial |
$231.86
|
| Rate for Payer: Encore All Commercial |
$242.53
|
| Rate for Payer: Frontpath All Commercial |
$242.40
|
| Rate for Payer: Humana ChoiceCare |
$227.57
|
| Rate for Payer: Humana Medicare |
$84.31
|
| Rate for Payer: Lucent All Commercial |
$143.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$237.13
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$197.61
|
| Rate for Payer: PHP All Commercial |
$199.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.76
|
| Rate for Payer: Sagamore Health Network All Products |
$203.41
|
| Rate for Payer: Signature Care EPO |
$218.69
|
| Rate for Payer: Signature Care PPO |
$231.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$223.96
|
| Rate for Payer: United Healthcare Commercial |
$207.62
|
| Rate for Payer: United Healthcare Medicare |
$84.31
|
|
|
HC BRA VELCRO 34-36 MED
|
Facility
|
IP
|
$268.73
|
|
| Hospital Charge Code |
41601396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$249.92 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Cash Price |
$161.24
|
| Rate for Payer: Cigna All Commercial |
$231.91
|
| Rate for Payer: CORVEL All Commercial |
$249.92
|
| Rate for Payer: Coventry All Commercial |
$236.48
|
| Rate for Payer: Encore All Commercial |
$247.37
|
| Rate for Payer: Frontpath All Commercial |
$247.23
|
| Rate for Payer: Humana ChoiceCare |
$232.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.86
|
| Rate for Payer: PHCS All Commercial |
$201.55
|
| Rate for Payer: PHP All Commercial |
$203.80
|
| Rate for Payer: Sagamore Health Network All Products |
$207.46
|
| Rate for Payer: Signature Care EPO |
$223.05
|
| Rate for Payer: Signature Care PPO |
$236.48
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
|
|
HC BRA VELCRO 34-36 MED
|
Facility
|
OP
|
$268.73
|
|
| Hospital Charge Code |
41601396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$249.92 |
| Rate for Payer: Aetna Commercial |
$226.81
|
| Rate for Payer: Aetna Medicare |
$85.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$154.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$167.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.59
|
| Rate for Payer: Cash Price |
$161.24
|
| Rate for Payer: Cash Price |
$161.24
|
| Rate for Payer: Centivo All Commercial |
$146.19
|
| Rate for Payer: Cigna All Commercial |
$231.91
|
| Rate for Payer: CORVEL All Commercial |
$249.92
|
| Rate for Payer: Coventry All Commercial |
$236.48
|
| Rate for Payer: Encore All Commercial |
$247.37
|
| Rate for Payer: Frontpath All Commercial |
$247.23
|
| Rate for Payer: Humana ChoiceCare |
$232.10
|
| Rate for Payer: Humana Medicare |
$85.99
|
| Rate for Payer: Lucent All Commercial |
$146.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.86
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$201.55
|
| Rate for Payer: PHP All Commercial |
$203.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.80
|
| Rate for Payer: Sagamore Health Network All Products |
$207.46
|
| Rate for Payer: Signature Care EPO |
$223.05
|
| Rate for Payer: Signature Care PPO |
$236.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$228.42
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
| Rate for Payer: United Healthcare Medicare |
$85.99
|
|
|
HC BRA VELCRO 38-40 LRG
|
Facility
|
OP
|
$274.33
|
|
| Hospital Charge Code |
41601397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$255.13 |
| Rate for Payer: Aetna Commercial |
$231.53
|
| Rate for Payer: Aetna Medicare |
$87.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$157.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.56
|
| Rate for Payer: Cash Price |
$164.60
|
| Rate for Payer: Cash Price |
$164.60
|
| Rate for Payer: Centivo All Commercial |
$149.24
|
| Rate for Payer: Cigna All Commercial |
$236.75
|
| Rate for Payer: CORVEL All Commercial |
$255.13
|
| Rate for Payer: Coventry All Commercial |
$241.41
|
| Rate for Payer: Encore All Commercial |
$252.52
|
| Rate for Payer: Frontpath All Commercial |
$252.38
|
| Rate for Payer: Humana ChoiceCare |
$236.94
|
| Rate for Payer: Humana Medicare |
$87.79
|
| Rate for Payer: Lucent All Commercial |
$149.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.90
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$205.75
|
| Rate for Payer: PHP All Commercial |
$208.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.99
|
| Rate for Payer: Sagamore Health Network All Products |
$211.78
|
| Rate for Payer: Signature Care EPO |
$227.69
|
| Rate for Payer: Signature Care PPO |
$241.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$233.18
|
| Rate for Payer: United Healthcare Commercial |
$216.17
|
| Rate for Payer: United Healthcare Medicare |
$87.79
|
|
|
HC BRA VELCRO 38-40 LRG
|
Facility
|
IP
|
$274.33
|
|
| Hospital Charge Code |
41601397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$205.75 |
| Max. Negotiated Rate |
$255.13 |
| Rate for Payer: Aetna Commercial |
$237.02
|
| Rate for Payer: Cash Price |
$164.60
|
| Rate for Payer: Cigna All Commercial |
$236.75
|
| Rate for Payer: CORVEL All Commercial |
$255.13
|
| Rate for Payer: Coventry All Commercial |
$241.41
|
| Rate for Payer: Encore All Commercial |
$252.52
|
| Rate for Payer: Frontpath All Commercial |
$252.38
|
| Rate for Payer: Humana ChoiceCare |
$236.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.90
|
| Rate for Payer: PHCS All Commercial |
$205.75
|
| Rate for Payer: PHP All Commercial |
$208.05
|
| Rate for Payer: Sagamore Health Network All Products |
$211.78
|
| Rate for Payer: Signature Care EPO |
$227.69
|
| Rate for Payer: Signature Care PPO |
$241.41
|
| Rate for Payer: United Healthcare Commercial |
$216.17
|
|
|
HC BRA VELCRO 42-44 XLRG
|
Facility
|
OP
|
$312.62
|
|
| Hospital Charge Code |
41601398
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$263.85
|
| Rate for Payer: Aetna Medicare |
$100.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$179.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.04
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Centivo All Commercial |
$170.07
|
| Rate for Payer: Cigna All Commercial |
$269.79
|
| Rate for Payer: CORVEL All Commercial |
$290.74
|
| Rate for Payer: Coventry All Commercial |
$275.11
|
| Rate for Payer: Encore All Commercial |
$287.77
|
| Rate for Payer: Frontpath All Commercial |
$287.61
|
| Rate for Payer: Humana ChoiceCare |
$270.01
|
| Rate for Payer: Humana Medicare |
$100.04
|
| Rate for Payer: Lucent All Commercial |
$170.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.36
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$234.47
|
| Rate for Payer: PHP All Commercial |
$237.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.92
|
| Rate for Payer: Sagamore Health Network All Products |
$241.34
|
| Rate for Payer: Signature Care EPO |
$259.47
|
| Rate for Payer: Signature Care PPO |
$275.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.73
|
| Rate for Payer: United Healthcare Commercial |
$246.34
|
| Rate for Payer: United Healthcare Medicare |
$100.04
|
|
|
HC BRA VELCRO 42-44 XLRG
|
Facility
|
IP
|
$312.62
|
|
| Hospital Charge Code |
41601398
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$234.47 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Cigna All Commercial |
$269.79
|
| Rate for Payer: CORVEL All Commercial |
$290.74
|
| Rate for Payer: Coventry All Commercial |
$275.11
|
| Rate for Payer: Encore All Commercial |
$287.77
|
| Rate for Payer: Frontpath All Commercial |
$287.61
|
| Rate for Payer: Humana ChoiceCare |
$270.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.36
|
| Rate for Payer: PHCS All Commercial |
$234.47
|
| Rate for Payer: PHP All Commercial |
$237.09
|
| Rate for Payer: Sagamore Health Network All Products |
$241.34
|
| Rate for Payer: Signature Care EPO |
$259.47
|
| Rate for Payer: Signature Care PPO |
$275.11
|
| Rate for Payer: United Healthcare Commercial |
$246.34
|
|
|
HC BRA VELCRO 44-46 XX LARGE
|
Facility
|
IP
|
$323.47
|
|
| Hospital Charge Code |
41601399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$300.83 |
| Rate for Payer: Aetna Commercial |
$279.48
|
| Rate for Payer: Cash Price |
$194.08
|
| Rate for Payer: Cigna All Commercial |
$279.15
|
| Rate for Payer: CORVEL All Commercial |
$300.83
|
| Rate for Payer: Coventry All Commercial |
$284.65
|
| Rate for Payer: Encore All Commercial |
$297.75
|
| Rate for Payer: Frontpath All Commercial |
$297.59
|
| Rate for Payer: Humana ChoiceCare |
$279.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.12
|
| Rate for Payer: PHCS All Commercial |
$242.60
|
| Rate for Payer: PHP All Commercial |
$245.32
|
| Rate for Payer: Sagamore Health Network All Products |
$249.72
|
| Rate for Payer: Signature Care EPO |
$268.48
|
| Rate for Payer: Signature Care PPO |
$284.65
|
| Rate for Payer: United Healthcare Commercial |
$254.89
|
|
|
HC BRA VELCRO 44-46 XX LARGE
|
Facility
|
OP
|
$323.47
|
|
| Hospital Charge Code |
41601399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$300.83 |
| Rate for Payer: Aetna Commercial |
$273.01
|
| Rate for Payer: Aetna Medicare |
$103.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$185.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$202.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.86
|
| Rate for Payer: Cash Price |
$194.08
|
| Rate for Payer: Cash Price |
$194.08
|
| Rate for Payer: Centivo All Commercial |
$175.97
|
| Rate for Payer: Cigna All Commercial |
$279.15
|
| Rate for Payer: CORVEL All Commercial |
$300.83
|
| Rate for Payer: Coventry All Commercial |
$284.65
|
| Rate for Payer: Encore All Commercial |
$297.75
|
| Rate for Payer: Frontpath All Commercial |
$297.59
|
| Rate for Payer: Humana ChoiceCare |
$279.38
|
| Rate for Payer: Humana Medicare |
$103.51
|
| Rate for Payer: Lucent All Commercial |
$175.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.12
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$242.60
|
| Rate for Payer: PHP All Commercial |
$245.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.15
|
| Rate for Payer: Sagamore Health Network All Products |
$249.72
|
| Rate for Payer: Signature Care EPO |
$268.48
|
| Rate for Payer: Signature Care PPO |
$284.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$254.89
|
| Rate for Payer: United Healthcare Medicare |
$103.51
|
|
