|
HC BRA VELCRO 50-54 SUPER QUEEN
|
Facility
|
IP
|
$476.14
|
|
| Hospital Charge Code |
41601456
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$357.11 |
| Max. Negotiated Rate |
$442.81 |
| Rate for Payer: Aetna Commercial |
$411.38
|
| Rate for Payer: Cash Price |
$285.68
|
| Rate for Payer: Cigna All Commercial |
$410.91
|
| Rate for Payer: CORVEL All Commercial |
$442.81
|
| Rate for Payer: Coventry All Commercial |
$419.00
|
| Rate for Payer: Encore All Commercial |
$438.29
|
| Rate for Payer: Frontpath All Commercial |
$438.05
|
| Rate for Payer: Humana ChoiceCare |
$411.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.53
|
| Rate for Payer: PHCS All Commercial |
$357.11
|
| Rate for Payer: PHP All Commercial |
$361.10
|
| Rate for Payer: Sagamore Health Network All Products |
$367.58
|
| Rate for Payer: Signature Care EPO |
$395.20
|
| Rate for Payer: Signature Care PPO |
$419.00
|
| Rate for Payer: United Healthcare Commercial |
$375.20
|
|
|
HC BRA VELCRO 50-54 SUPER QUEEN
|
Facility
|
OP
|
$476.14
|
|
| Hospital Charge Code |
41601456
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$442.81 |
| Rate for Payer: Aetna Commercial |
$401.86
|
| Rate for Payer: Aetna Medicare |
$152.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$273.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.60
|
| Rate for Payer: Cash Price |
$285.68
|
| Rate for Payer: Cash Price |
$285.68
|
| Rate for Payer: Centivo All Commercial |
$259.02
|
| Rate for Payer: Cigna All Commercial |
$410.91
|
| Rate for Payer: CORVEL All Commercial |
$442.81
|
| Rate for Payer: Coventry All Commercial |
$419.00
|
| Rate for Payer: Encore All Commercial |
$438.29
|
| Rate for Payer: Frontpath All Commercial |
$438.05
|
| Rate for Payer: Humana ChoiceCare |
$411.24
|
| Rate for Payer: Humana Medicare |
$152.36
|
| Rate for Payer: Lucent All Commercial |
$259.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.53
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$357.11
|
| Rate for Payer: PHP All Commercial |
$361.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.69
|
| Rate for Payer: Sagamore Health Network All Products |
$367.58
|
| Rate for Payer: Signature Care EPO |
$395.20
|
| Rate for Payer: Signature Care PPO |
$419.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.72
|
| Rate for Payer: United Healthcare Commercial |
$375.20
|
| Rate for Payer: United Healthcare Medicare |
$152.36
|
|
|
HC BREAST PUMP TUBING KIT DISP
|
Facility
|
OP
|
$215.32
|
|
| Hospital Charge Code |
41601819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Aetna Commercial |
$181.73
|
| Rate for Payer: Aetna Medicare |
$68.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$123.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.79
|
| Rate for Payer: Cash Price |
$129.19
|
| Rate for Payer: Cash Price |
$129.19
|
| Rate for Payer: Centivo All Commercial |
$117.13
|
| Rate for Payer: Cigna All Commercial |
$185.82
|
| Rate for Payer: CORVEL All Commercial |
$200.25
|
| Rate for Payer: Coventry All Commercial |
$189.48
|
| Rate for Payer: Encore All Commercial |
$198.20
|
| Rate for Payer: Frontpath All Commercial |
$198.09
|
| Rate for Payer: Humana ChoiceCare |
$185.97
|
| Rate for Payer: Humana Medicare |
$68.90
|
| Rate for Payer: Lucent All Commercial |
$117.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.79
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$161.49
|
| Rate for Payer: PHP All Commercial |
$163.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.97
|
| Rate for Payer: Sagamore Health Network All Products |
$166.23
|
| Rate for Payer: Signature Care EPO |
$178.72
|
| Rate for Payer: Signature Care PPO |
$189.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.02
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare |
$68.90
|
|
|
HC BREAST PUMP TUBING KIT DISP
|
Facility
|
IP
|
$215.32
|
|
| Hospital Charge Code |
41601819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Aetna Commercial |
$186.04
|
| Rate for Payer: Cash Price |
$129.19
|
| Rate for Payer: Cigna All Commercial |
$185.82
|
| Rate for Payer: CORVEL All Commercial |
$200.25
|
| Rate for Payer: Coventry All Commercial |
$189.48
|
| Rate for Payer: Encore All Commercial |
$198.20
|
| Rate for Payer: Frontpath All Commercial |
$198.09
|
| Rate for Payer: Humana ChoiceCare |
$185.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.79
|
| Rate for Payer: PHCS All Commercial |
$161.49
|
| Rate for Payer: PHP All Commercial |
$163.30
|
| Rate for Payer: Sagamore Health Network All Products |
$166.23
|
| Rate for Payer: Signature Care EPO |
$178.72
|
| Rate for Payer: Signature Care PPO |
$189.48
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
|
|
HC BREAST SPECIMEN RADIOGRAPH
|
Facility
|
IP
|
$675.03
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
1616098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$506.27 |
| Max. Negotiated Rate |
$627.78 |
| Rate for Payer: Aetna Commercial |
$583.23
|
| Rate for Payer: Cash Price |
$405.02
|
| Rate for Payer: Cigna All Commercial |
$582.55
|
| Rate for Payer: CORVEL All Commercial |
$627.78
|
| Rate for Payer: Coventry All Commercial |
$594.03
|
| Rate for Payer: Encore All Commercial |
$621.37
|
| Rate for Payer: Frontpath All Commercial |
$621.03
|
| Rate for Payer: Humana ChoiceCare |
$583.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.53
|
| Rate for Payer: PHCS All Commercial |
$506.27
|
| Rate for Payer: PHP All Commercial |
$511.94
|
| Rate for Payer: Sagamore Health Network All Products |
$521.12
|
| Rate for Payer: Signature Care EPO |
$560.27
|
| Rate for Payer: Signature Care PPO |
$594.03
|
| Rate for Payer: United Healthcare Commercial |
$531.92
|
|
|
HC BREAST SPECIMEN RADIOGRAPH
|
Facility
|
OP
|
$675.03
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
1616098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$627.78 |
| Rate for Payer: Aetna Commercial |
$569.73
|
| Rate for Payer: Aetna Medicare |
$216.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$209.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$387.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$421.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.61
|
| Rate for Payer: Cash Price |
$405.02
|
| Rate for Payer: Cash Price |
$405.02
|
| Rate for Payer: Centivo All Commercial |
$367.22
|
| Rate for Payer: Cigna All Commercial |
$582.55
|
| Rate for Payer: CORVEL All Commercial |
$627.78
|
| Rate for Payer: Coventry All Commercial |
$594.03
|
| Rate for Payer: Encore All Commercial |
$621.37
|
| Rate for Payer: Frontpath All Commercial |
$621.03
|
| Rate for Payer: Humana ChoiceCare |
$583.02
|
| Rate for Payer: Humana Medicare |
$216.01
|
| Rate for Payer: Lucent All Commercial |
$367.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.53
|
| Rate for Payer: Managed Health Services Medicaid |
$7.60
|
| Rate for Payer: MDWise Medicaid |
$7.60
|
| Rate for Payer: PHCS All Commercial |
$506.27
|
| Rate for Payer: PHP All Commercial |
$511.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$263.26
|
| Rate for Payer: Sagamore Health Network All Products |
$521.12
|
| Rate for Payer: Signature Care EPO |
$560.27
|
| Rate for Payer: Signature Care PPO |
$594.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$573.78
|
| Rate for Payer: United Healthcare Commercial |
$531.92
|
| Rate for Payer: United Healthcare Medicare |
$216.01
|
|
|
HC BREATHALYZER COMPANY
|
Facility
|
OP
|
$40.79
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
63001201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$37.93 |
| Rate for Payer: Aetna Commercial |
$34.43
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.36
|
| Rate for Payer: Cash Price |
$24.47
|
| Rate for Payer: Cash Price |
$24.47
|
| Rate for Payer: Centivo All Commercial |
$22.19
|
| Rate for Payer: Cigna All Commercial |
$35.20
|
| Rate for Payer: CORVEL All Commercial |
$37.93
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.55
|
| Rate for Payer: Frontpath All Commercial |
$37.53
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Humana Medicare |
$13.05
|
| Rate for Payer: Lucent All Commercial |
$22.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.71
|
| Rate for Payer: Managed Health Services Medicaid |
$30.00
|
| Rate for Payer: MDWise Medicaid |
$30.00
|
| Rate for Payer: PHCS All Commercial |
$30.59
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.49
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$32.14
|
| Rate for Payer: United Healthcare Medicare |
$13.05
|
|
|
HC BREATHALYZER COMPANY
|
Facility
|
IP
|
$40.79
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
63001201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$37.93 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Cash Price |
$24.47
|
| Rate for Payer: Cigna All Commercial |
$35.20
|
| Rate for Payer: CORVEL All Commercial |
$37.93
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.55
|
| Rate for Payer: Frontpath All Commercial |
$37.53
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.71
|
| Rate for Payer: PHCS All Commercial |
$30.59
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Sagamore Health Network All Products |
$31.49
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.14
|
|
|
HC BRONCH GLIDE BFLEX 3.8
|
Facility
|
IP
|
$1,327.50
|
|
| Hospital Charge Code |
41607854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.62 |
| Max. Negotiated Rate |
$1,234.58 |
| Rate for Payer: Aetna Commercial |
$1,146.96
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna All Commercial |
$1,145.63
|
| Rate for Payer: CORVEL All Commercial |
$1,234.58
|
| Rate for Payer: Coventry All Commercial |
$1,168.20
|
| Rate for Payer: Encore All Commercial |
$1,221.96
|
| Rate for Payer: Frontpath All Commercial |
$1,221.30
|
| Rate for Payer: Humana ChoiceCare |
$1,146.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.75
|
| Rate for Payer: PHCS All Commercial |
$995.62
|
| Rate for Payer: PHP All Commercial |
$1,006.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,024.83
|
| Rate for Payer: Signature Care EPO |
$1,101.83
|
| Rate for Payer: Signature Care PPO |
$1,168.20
|
| Rate for Payer: United Healthcare Commercial |
$1,046.07
|
|
|
HC BRONCH GLIDE BFLEX 3.8
|
Facility
|
OP
|
$1,327.50
|
|
| Hospital Charge Code |
41607854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,234.58 |
| Rate for Payer: Aetna Commercial |
$1,120.41
|
| Rate for Payer: Aetna Medicare |
$424.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$411.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$762.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$829.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$488.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$467.28
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Centivo All Commercial |
$722.16
|
| Rate for Payer: Cigna All Commercial |
$1,145.63
|
| Rate for Payer: CORVEL All Commercial |
$1,234.58
|
| Rate for Payer: Coventry All Commercial |
$1,168.20
|
| Rate for Payer: Encore All Commercial |
$1,221.96
|
| Rate for Payer: Frontpath All Commercial |
$1,221.30
|
| Rate for Payer: Humana ChoiceCare |
$1,146.56
|
| Rate for Payer: Humana Medicare |
$424.80
|
| Rate for Payer: Lucent All Commercial |
$722.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$995.62
|
| Rate for Payer: PHP All Commercial |
$1,006.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$517.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,024.83
|
| Rate for Payer: Signature Care EPO |
$1,101.83
|
| Rate for Payer: Signature Care PPO |
$1,168.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,128.38
|
| Rate for Payer: United Healthcare Commercial |
$1,046.07
|
| Rate for Payer: United Healthcare Medicare |
$424.80
|
|
|
HC BRONCH GLIDE BFLEX 5.8
|
Facility
|
OP
|
$1,615.00
|
|
| Hospital Charge Code |
41607853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Aetna Commercial |
$1,363.06
|
| Rate for Payer: Aetna Medicare |
$516.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$500.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$927.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,009.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$594.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$568.48
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Centivo All Commercial |
$878.56
|
| Rate for Payer: Cigna All Commercial |
$1,393.74
|
| Rate for Payer: CORVEL All Commercial |
$1,501.95
|
| Rate for Payer: Coventry All Commercial |
$1,421.20
|
| Rate for Payer: Encore All Commercial |
$1,486.61
|
| Rate for Payer: Frontpath All Commercial |
$1,485.80
|
| Rate for Payer: Humana ChoiceCare |
$1,394.88
|
| Rate for Payer: Humana Medicare |
$516.80
|
| Rate for Payer: Lucent All Commercial |
$878.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,453.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,211.25
|
| Rate for Payer: PHP All Commercial |
$1,224.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$629.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,246.78
|
| Rate for Payer: Signature Care EPO |
$1,340.45
|
| Rate for Payer: Signature Care PPO |
$1,421.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,372.75
|
| Rate for Payer: United Healthcare Commercial |
$1,272.62
|
| Rate for Payer: United Healthcare Medicare |
$516.80
|
|
|
HC BRONCH GLIDE BFLEX 5.8
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
41607853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,211.25 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Aetna Commercial |
$1,395.36
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna All Commercial |
$1,393.74
|
| Rate for Payer: CORVEL All Commercial |
$1,501.95
|
| Rate for Payer: Coventry All Commercial |
$1,421.20
|
| Rate for Payer: Encore All Commercial |
$1,486.61
|
| Rate for Payer: Frontpath All Commercial |
$1,485.80
|
| Rate for Payer: Humana ChoiceCare |
$1,394.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,453.50
|
| Rate for Payer: PHCS All Commercial |
$1,211.25
|
| Rate for Payer: PHP All Commercial |
$1,224.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,246.78
|
| Rate for Payer: Signature Care EPO |
$1,340.45
|
| Rate for Payer: Signature Care PPO |
$1,421.20
|
| Rate for Payer: United Healthcare Commercial |
$1,272.62
|
|
|
HC BRONCHIAL PROVOCATION
|
Facility
|
IP
|
$1,354.73
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
1706680
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$1,016.05 |
| Max. Negotiated Rate |
$1,259.90 |
| Rate for Payer: Aetna Commercial |
$1,170.49
|
| Rate for Payer: Cash Price |
$812.84
|
| Rate for Payer: Cigna All Commercial |
$1,169.13
|
| Rate for Payer: CORVEL All Commercial |
$1,259.90
|
| Rate for Payer: Coventry All Commercial |
$1,192.16
|
| Rate for Payer: Encore All Commercial |
$1,247.03
|
| Rate for Payer: Frontpath All Commercial |
$1,246.35
|
| Rate for Payer: Humana ChoiceCare |
$1,170.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.26
|
| Rate for Payer: PHCS All Commercial |
$1,016.05
|
| Rate for Payer: PHP All Commercial |
$1,027.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,045.85
|
| Rate for Payer: Signature Care EPO |
$1,124.43
|
| Rate for Payer: Signature Care PPO |
$1,192.16
|
| Rate for Payer: United Healthcare Commercial |
$1,067.53
|
|
|
HC BRONCHIAL PROVOCATION
|
Facility
|
OP
|
$1,354.73
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
1706680
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$1,259.90 |
| Rate for Payer: Aetna Commercial |
$1,143.39
|
| Rate for Payer: Aetna Medicare |
$433.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$778.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$846.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$498.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$476.86
|
| Rate for Payer: Cash Price |
$812.84
|
| Rate for Payer: Cash Price |
$812.84
|
| Rate for Payer: Centivo All Commercial |
$736.97
|
| Rate for Payer: Cigna All Commercial |
$1,169.13
|
| Rate for Payer: CORVEL All Commercial |
$1,259.90
|
| Rate for Payer: Coventry All Commercial |
$1,192.16
|
| Rate for Payer: Encore All Commercial |
$1,247.03
|
| Rate for Payer: Frontpath All Commercial |
$1,246.35
|
| Rate for Payer: Humana ChoiceCare |
$1,170.08
|
| Rate for Payer: Humana Medicare |
$433.51
|
| Rate for Payer: Lucent All Commercial |
$736.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,219.26
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$1,016.05
|
| Rate for Payer: PHP All Commercial |
$1,027.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,045.85
|
| Rate for Payer: Signature Care EPO |
$1,124.43
|
| Rate for Payer: Signature Care PPO |
$1,192.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,151.52
|
| Rate for Payer: United Healthcare Commercial |
$1,067.53
|
| Rate for Payer: United Healthcare Medicare |
$433.51
|
|
|
HC BRONCHOSPASM EVAL; SPIROMETRY
|
Facility
|
IP
|
$761.58
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
1704060
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$571.18 |
| Max. Negotiated Rate |
$708.27 |
| Rate for Payer: Aetna Commercial |
$658.01
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Cigna All Commercial |
$657.24
|
| Rate for Payer: CORVEL All Commercial |
$708.27
|
| Rate for Payer: Coventry All Commercial |
$670.19
|
| Rate for Payer: Encore All Commercial |
$701.03
|
| Rate for Payer: Frontpath All Commercial |
$700.65
|
| Rate for Payer: Humana ChoiceCare |
$657.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.42
|
| Rate for Payer: PHCS All Commercial |
$571.18
|
| Rate for Payer: PHP All Commercial |
$577.58
|
| Rate for Payer: Sagamore Health Network All Products |
$587.94
|
| Rate for Payer: Signature Care EPO |
$632.11
|
| Rate for Payer: Signature Care PPO |
$670.19
|
| Rate for Payer: United Healthcare Commercial |
$600.13
|
|
|
HC BRONCHOSPASM EVAL; SPIROMETRY
|
Facility
|
OP
|
$761.58
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
1704060
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$708.27 |
| Rate for Payer: Aetna Commercial |
$642.77
|
| Rate for Payer: Aetna Medicare |
$243.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$236.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$437.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$476.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$280.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$268.08
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Centivo All Commercial |
$414.30
|
| Rate for Payer: Cigna All Commercial |
$657.24
|
| Rate for Payer: CORVEL All Commercial |
$708.27
|
| Rate for Payer: Coventry All Commercial |
$670.19
|
| Rate for Payer: Encore All Commercial |
$701.03
|
| Rate for Payer: Frontpath All Commercial |
$700.65
|
| Rate for Payer: Humana ChoiceCare |
$657.78
|
| Rate for Payer: Humana Medicare |
$243.71
|
| Rate for Payer: Lucent All Commercial |
$414.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.42
|
| Rate for Payer: Managed Health Services Medicaid |
$36.37
|
| Rate for Payer: MDWise Medicaid |
$36.37
|
| Rate for Payer: PHCS All Commercial |
$571.18
|
| Rate for Payer: PHP All Commercial |
$577.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$297.02
|
| Rate for Payer: Sagamore Health Network All Products |
$587.94
|
| Rate for Payer: Signature Care EPO |
$632.11
|
| Rate for Payer: Signature Care PPO |
$670.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$647.34
|
| Rate for Payer: United Healthcare Commercial |
$600.13
|
| Rate for Payer: United Healthcare Medicare |
$243.71
|
|
|
HC BRUSH CYTOLOGY
|
Facility
|
OP
|
$111.35
|
|
| Hospital Charge Code |
41602262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$103.56 |
| Rate for Payer: Aetna Commercial |
$93.98
|
| Rate for Payer: Aetna Medicare |
$35.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.20
|
| Rate for Payer: Cash Price |
$66.81
|
| Rate for Payer: Cash Price |
$66.81
|
| Rate for Payer: Centivo All Commercial |
$60.57
|
| Rate for Payer: Cigna All Commercial |
$96.10
|
| Rate for Payer: CORVEL All Commercial |
$103.56
|
| Rate for Payer: Coventry All Commercial |
$97.99
|
| Rate for Payer: Encore All Commercial |
$102.50
|
| Rate for Payer: Frontpath All Commercial |
$102.44
|
| Rate for Payer: Humana ChoiceCare |
$96.17
|
| Rate for Payer: Humana Medicare |
$35.63
|
| Rate for Payer: Lucent All Commercial |
$60.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.22
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$83.51
|
| Rate for Payer: PHP All Commercial |
$84.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.43
|
| Rate for Payer: Sagamore Health Network All Products |
$85.96
|
| Rate for Payer: Signature Care EPO |
$92.42
|
| Rate for Payer: Signature Care PPO |
$97.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.65
|
| Rate for Payer: United Healthcare Commercial |
$87.74
|
| Rate for Payer: United Healthcare Medicare |
$35.63
|
|
|
HC BRUSH CYTOLOGY
|
Facility
|
IP
|
$111.35
|
|
| Hospital Charge Code |
41602262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.51 |
| Max. Negotiated Rate |
$103.56 |
| Rate for Payer: Aetna Commercial |
$96.21
|
| Rate for Payer: Cash Price |
$66.81
|
| Rate for Payer: Cigna All Commercial |
$96.10
|
| Rate for Payer: CORVEL All Commercial |
$103.56
|
| Rate for Payer: Coventry All Commercial |
$97.99
|
| Rate for Payer: Encore All Commercial |
$102.50
|
| Rate for Payer: Frontpath All Commercial |
$102.44
|
| Rate for Payer: Humana ChoiceCare |
$96.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.22
|
| Rate for Payer: PHCS All Commercial |
$83.51
|
| Rate for Payer: PHP All Commercial |
$84.45
|
| Rate for Payer: Sagamore Health Network All Products |
$85.96
|
| Rate for Payer: Signature Care EPO |
$92.42
|
| Rate for Payer: Signature Care PPO |
$97.99
|
| Rate for Payer: United Healthcare Commercial |
$87.74
|
|
|
HC BUN
|
Facility
|
OP
|
$40.39
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
63001103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.22
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Centivo All Commercial |
$21.97
|
| Rate for Payer: Cigna All Commercial |
$34.86
|
| Rate for Payer: CORVEL All Commercial |
$37.56
|
| Rate for Payer: Coventry All Commercial |
$35.54
|
| Rate for Payer: Encore All Commercial |
$37.18
|
| Rate for Payer: Frontpath All Commercial |
$37.16
|
| Rate for Payer: Humana ChoiceCare |
$34.88
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: Lucent All Commercial |
$21.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.35
|
| Rate for Payer: Managed Health Services Medicaid |
$3.95
|
| Rate for Payer: MDWise Medicaid |
$3.95
|
| Rate for Payer: PHCS All Commercial |
$30.29
|
| Rate for Payer: PHP All Commercial |
$30.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.75
|
| Rate for Payer: Sagamore Health Network All Products |
$31.18
|
| Rate for Payer: Signature Care EPO |
$33.52
|
| Rate for Payer: Signature Care PPO |
$35.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.33
|
| Rate for Payer: United Healthcare Commercial |
$31.83
|
| Rate for Payer: United Healthcare Medicare |
$12.92
|
|
|
HC BUN
|
Facility
|
IP
|
$40.39
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
63001103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cigna All Commercial |
$34.86
|
| Rate for Payer: CORVEL All Commercial |
$37.56
|
| Rate for Payer: Coventry All Commercial |
$35.54
|
| Rate for Payer: Encore All Commercial |
$37.18
|
| Rate for Payer: Frontpath All Commercial |
$37.16
|
| Rate for Payer: Humana ChoiceCare |
$34.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.35
|
| Rate for Payer: PHCS All Commercial |
$30.29
|
| Rate for Payer: PHP All Commercial |
$30.63
|
| Rate for Payer: Sagamore Health Network All Products |
$31.18
|
| Rate for Payer: Signature Care EPO |
$33.52
|
| Rate for Payer: Signature Care PPO |
$35.54
|
| Rate for Payer: United Healthcare Commercial |
$31.83
|
|
|
HC BUPRENORPHINE CONFIRMATION, URINE
|
Facility
|
IP
|
$93.33
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$80.64
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
|
|
HC BUPRENORPHINE CONFIRMATION, URINE
|
Facility
|
OP
|
$93.33
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
63044023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$78.77
|
| Rate for Payer: Aetna Medicare |
$29.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.85
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Centivo All Commercial |
$50.77
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Humana Medicare |
$29.87
|
| Rate for Payer: Lucent All Commercial |
$50.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.40
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.33
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$29.87
|
|
|
HC BUPRENORPHINE CONFIRMATION, URINE
|
Facility
|
OP
|
$93.33
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63044023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$114.43 |
| Rate for Payer: Aetna Commercial |
$78.77
|
| Rate for Payer: Aetna Medicare |
$29.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.85
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Centivo All Commercial |
$50.77
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Humana Medicare |
$29.87
|
| Rate for Payer: Lucent All Commercial |
$50.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.40
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.33
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$29.87
|
|
|
HC BUPRENORPHINE CONFIRMATION, URINE
|
Facility
|
IP
|
$93.33
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
63044023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$86.80 |
| Rate for Payer: Aetna Commercial |
$80.64
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna All Commercial |
$80.54
|
| Rate for Payer: CORVEL All Commercial |
$86.80
|
| Rate for Payer: Coventry All Commercial |
$82.13
|
| Rate for Payer: Encore All Commercial |
$85.91
|
| Rate for Payer: Frontpath All Commercial |
$85.86
|
| Rate for Payer: Humana ChoiceCare |
$80.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$70.00
|
| Rate for Payer: PHP All Commercial |
$70.78
|
| Rate for Payer: Sagamore Health Network All Products |
$72.05
|
| Rate for Payer: Signature Care EPO |
$77.46
|
| Rate for Payer: Signature Care PPO |
$82.13
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
|
|
HC BUR BARREL 6 FLUTE 5.5
|
Facility
|
OP
|
$426.37
|
|
| Hospital Charge Code |
41602504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$359.86
|
| Rate for Payer: Aetna Medicare |
$136.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$244.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$266.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.08
|
| Rate for Payer: Cash Price |
$255.82
|
| Rate for Payer: Cash Price |
$255.82
|
| Rate for Payer: Centivo All Commercial |
$231.95
|
| Rate for Payer: Cigna All Commercial |
$367.96
|
| Rate for Payer: CORVEL All Commercial |
$396.52
|
| Rate for Payer: Coventry All Commercial |
$375.21
|
| Rate for Payer: Encore All Commercial |
$392.47
|
| Rate for Payer: Frontpath All Commercial |
$392.26
|
| Rate for Payer: Humana ChoiceCare |
$368.26
|
| Rate for Payer: Humana Medicare |
$136.44
|
| Rate for Payer: Lucent All Commercial |
$231.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$383.73
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$319.78
|
| Rate for Payer: PHP All Commercial |
$323.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.28
|
| Rate for Payer: Sagamore Health Network All Products |
$329.16
|
| Rate for Payer: Signature Care EPO |
$353.89
|
| Rate for Payer: Signature Care PPO |
$375.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$362.41
|
| Rate for Payer: United Healthcare Commercial |
$335.98
|
| Rate for Payer: United Healthcare Medicare |
$136.44
|
|
