|
HC COMPLEX STAIN-O&P
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
63002017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.41
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$59.86
|
| Rate for Payer: CORVEL All Commercial |
$64.50
|
| Rate for Payer: Coventry All Commercial |
$61.04
|
| Rate for Payer: Encore All Commercial |
$63.85
|
| Rate for Payer: Frontpath All Commercial |
$63.81
|
| Rate for Payer: Humana ChoiceCare |
$59.91
|
| Rate for Payer: Humana Medicare |
$22.20
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.42
|
| Rate for Payer: Managed Health Services Medicaid |
$17.98
|
| Rate for Payer: MDWise Medicaid |
$17.98
|
| Rate for Payer: PHCS All Commercial |
$52.02
|
| Rate for Payer: PHP All Commercial |
$52.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.05
|
| Rate for Payer: Sagamore Health Network All Products |
$53.55
|
| Rate for Payer: Signature Care EPO |
$57.57
|
| Rate for Payer: Signature Care PPO |
$61.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.96
|
| Rate for Payer: United Healthcare Commercial |
$54.66
|
| Rate for Payer: United Healthcare Medicare |
$22.20
|
|
|
HC COMPREHENSIVE METABOLIC
|
Facility
|
OP
|
$150.47
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
63001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$139.94 |
| Rate for Payer: Aetna Commercial |
$127.00
|
| Rate for Payer: Aetna Medicare |
$48.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$69.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.97
|
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Centivo All Commercial |
$81.86
|
| Rate for Payer: Cigna All Commercial |
$129.86
|
| Rate for Payer: CORVEL All Commercial |
$139.94
|
| Rate for Payer: Coventry All Commercial |
$132.41
|
| Rate for Payer: Encore All Commercial |
$138.51
|
| Rate for Payer: Frontpath All Commercial |
$138.43
|
| Rate for Payer: Humana ChoiceCare |
$129.96
|
| Rate for Payer: Humana Medicare |
$48.15
|
| Rate for Payer: Lucent All Commercial |
$81.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.42
|
| Rate for Payer: Managed Health Services Medicaid |
$10.56
|
| Rate for Payer: MDWise Medicaid |
$10.56
|
| Rate for Payer: PHCS All Commercial |
$112.85
|
| Rate for Payer: PHP All Commercial |
$114.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.68
|
| Rate for Payer: Sagamore Health Network All Products |
$116.16
|
| Rate for Payer: Signature Care EPO |
$124.89
|
| Rate for Payer: Signature Care PPO |
$132.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$127.90
|
| Rate for Payer: United Healthcare Commercial |
$118.57
|
| Rate for Payer: United Healthcare Medicare |
$48.15
|
|
|
HC COMPREHENSIVE METABOLIC
|
Facility
|
IP
|
$150.47
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
63001204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.85 |
| Max. Negotiated Rate |
$139.94 |
| Rate for Payer: Aetna Commercial |
$130.01
|
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Cigna All Commercial |
$129.86
|
| Rate for Payer: CORVEL All Commercial |
$139.94
|
| Rate for Payer: Coventry All Commercial |
$132.41
|
| Rate for Payer: Encore All Commercial |
$138.51
|
| Rate for Payer: Frontpath All Commercial |
$138.43
|
| Rate for Payer: Humana ChoiceCare |
$129.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.42
|
| Rate for Payer: PHCS All Commercial |
$112.85
|
| Rate for Payer: PHP All Commercial |
$114.12
|
| Rate for Payer: Sagamore Health Network All Products |
$116.16
|
| Rate for Payer: Signature Care EPO |
$124.89
|
| Rate for Payer: Signature Care PPO |
$132.41
|
| Rate for Payer: United Healthcare Commercial |
$118.57
|
|
|
HC CONT BRONCHODILATOR EA ADD HOU
|
Facility
|
OP
|
$311.47
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
1704645
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$289.67 |
| Rate for Payer: Aetna Commercial |
$262.88
|
| Rate for Payer: Aetna Medicare |
$99.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$178.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.64
|
| Rate for Payer: Cash Price |
$186.88
|
| Rate for Payer: Cash Price |
$186.88
|
| Rate for Payer: Centivo All Commercial |
$169.44
|
| Rate for Payer: Cigna All Commercial |
$268.80
|
| Rate for Payer: CORVEL All Commercial |
$289.67
|
| Rate for Payer: Coventry All Commercial |
$274.09
|
| Rate for Payer: Encore All Commercial |
$286.71
|
| Rate for Payer: Frontpath All Commercial |
$286.55
|
| Rate for Payer: Humana ChoiceCare |
$269.02
|
| Rate for Payer: Humana Medicare |
$99.67
|
| Rate for Payer: Lucent All Commercial |
$169.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.32
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$233.60
|
| Rate for Payer: PHP All Commercial |
$236.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.47
|
| Rate for Payer: Sagamore Health Network All Products |
$240.45
|
| Rate for Payer: Signature Care EPO |
$258.52
|
| Rate for Payer: Signature Care PPO |
$274.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.75
|
| Rate for Payer: United Healthcare Commercial |
$245.44
|
| Rate for Payer: United Healthcare Medicare |
$99.67
|
|
|
HC CONT BRONCHODILATOR EA ADD HOU
|
Facility
|
IP
|
$311.47
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
1704645
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$289.67 |
| Rate for Payer: Aetna Commercial |
$269.11
|
| Rate for Payer: Cash Price |
$186.88
|
| Rate for Payer: Cigna All Commercial |
$268.80
|
| Rate for Payer: CORVEL All Commercial |
$289.67
|
| Rate for Payer: Coventry All Commercial |
$274.09
|
| Rate for Payer: Encore All Commercial |
$286.71
|
| Rate for Payer: Frontpath All Commercial |
$286.55
|
| Rate for Payer: Humana ChoiceCare |
$269.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.32
|
| Rate for Payer: PHCS All Commercial |
$233.60
|
| Rate for Payer: PHP All Commercial |
$236.22
|
| Rate for Payer: Sagamore Health Network All Products |
$240.45
|
| Rate for Payer: Signature Care EPO |
$258.52
|
| Rate for Payer: Signature Care PPO |
$274.09
|
| Rate for Payer: United Healthcare Commercial |
$245.44
|
|
|
HC CONT BRONCHODILATOR INIT HOUR
|
Facility
|
OP
|
$437.72
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
1704644
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$407.08 |
| Rate for Payer: Aetna Commercial |
$369.44
|
| Rate for Payer: Aetna Medicare |
$140.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$251.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$273.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.08
|
| Rate for Payer: Cash Price |
$262.63
|
| Rate for Payer: Cash Price |
$262.63
|
| Rate for Payer: Centivo All Commercial |
$238.12
|
| Rate for Payer: Cigna All Commercial |
$377.75
|
| Rate for Payer: CORVEL All Commercial |
$407.08
|
| Rate for Payer: Coventry All Commercial |
$385.19
|
| Rate for Payer: Encore All Commercial |
$402.92
|
| Rate for Payer: Frontpath All Commercial |
$402.70
|
| Rate for Payer: Humana ChoiceCare |
$378.06
|
| Rate for Payer: Humana Medicare |
$140.07
|
| Rate for Payer: Lucent All Commercial |
$238.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$393.95
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$328.29
|
| Rate for Payer: PHP All Commercial |
$331.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.71
|
| Rate for Payer: Sagamore Health Network All Products |
$337.92
|
| Rate for Payer: Signature Care EPO |
$363.31
|
| Rate for Payer: Signature Care PPO |
$385.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.06
|
| Rate for Payer: United Healthcare Commercial |
$344.92
|
| Rate for Payer: United Healthcare Medicare |
$140.07
|
|
|
HC CONT BRONCHODILATOR INIT HOUR
|
Facility
|
IP
|
$437.72
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
1704644
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$407.08 |
| Rate for Payer: Aetna Commercial |
$378.19
|
| Rate for Payer: Cash Price |
$262.63
|
| Rate for Payer: Cigna All Commercial |
$377.75
|
| Rate for Payer: CORVEL All Commercial |
$407.08
|
| Rate for Payer: Coventry All Commercial |
$385.19
|
| Rate for Payer: Encore All Commercial |
$402.92
|
| Rate for Payer: Frontpath All Commercial |
$402.70
|
| Rate for Payer: Humana ChoiceCare |
$378.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$393.95
|
| Rate for Payer: PHCS All Commercial |
$328.29
|
| Rate for Payer: PHP All Commercial |
$331.97
|
| Rate for Payer: Sagamore Health Network All Products |
$337.92
|
| Rate for Payer: Signature Care EPO |
$363.31
|
| Rate for Payer: Signature Care PPO |
$385.19
|
| Rate for Payer: United Healthcare Commercial |
$344.92
|
|
|
HC CONTINUED RADIATION PHYSICS
|
Facility
|
IP
|
$1,113.84
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
1547336
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$835.38 |
| Max. Negotiated Rate |
$1,035.87 |
| Rate for Payer: Aetna Commercial |
$962.36
|
| Rate for Payer: Cash Price |
$668.30
|
| Rate for Payer: Cigna All Commercial |
$961.24
|
| Rate for Payer: CORVEL All Commercial |
$1,035.87
|
| Rate for Payer: Coventry All Commercial |
$980.18
|
| Rate for Payer: Encore All Commercial |
$1,025.29
|
| Rate for Payer: Frontpath All Commercial |
$1,024.73
|
| Rate for Payer: Humana ChoiceCare |
$962.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,002.46
|
| Rate for Payer: PHCS All Commercial |
$835.38
|
| Rate for Payer: PHP All Commercial |
$844.74
|
| Rate for Payer: Sagamore Health Network All Products |
$859.88
|
| Rate for Payer: Signature Care EPO |
$924.49
|
| Rate for Payer: Signature Care PPO |
$980.18
|
| Rate for Payer: United Healthcare Commercial |
$877.71
|
|
|
HC CONTINUED RADIATION PHYSICS
|
Facility
|
OP
|
$1,113.84
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
1547336
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$1,035.87 |
| Rate for Payer: Aetna Commercial |
$940.08
|
| Rate for Payer: Aetna Medicare |
$356.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$78.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$345.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$639.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$696.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$78.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$409.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$392.07
|
| Rate for Payer: Cash Price |
$668.30
|
| Rate for Payer: Cash Price |
$668.30
|
| Rate for Payer: Centivo All Commercial |
$605.93
|
| Rate for Payer: Cigna All Commercial |
$961.24
|
| Rate for Payer: CORVEL All Commercial |
$1,035.87
|
| Rate for Payer: Coventry All Commercial |
$980.18
|
| Rate for Payer: Encore All Commercial |
$1,025.29
|
| Rate for Payer: Frontpath All Commercial |
$1,024.73
|
| Rate for Payer: Humana ChoiceCare |
$962.02
|
| Rate for Payer: Humana Medicare |
$356.43
|
| Rate for Payer: Lucent All Commercial |
$605.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,002.46
|
| Rate for Payer: Managed Health Services Medicaid |
$78.68
|
| Rate for Payer: MDWise Medicaid |
$78.68
|
| Rate for Payer: PHCS All Commercial |
$835.38
|
| Rate for Payer: PHP All Commercial |
$844.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.40
|
| Rate for Payer: Sagamore Health Network All Products |
$859.88
|
| Rate for Payer: Signature Care EPO |
$924.49
|
| Rate for Payer: Signature Care PPO |
$980.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$946.76
|
| Rate for Payer: United Healthcare Commercial |
$877.71
|
| Rate for Payer: United Healthcare Medicare |
$356.43
|
|
|
HC CONTRAST BATH/15 MIN-OT
|
Facility
|
IP
|
$192.63
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
1738012
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.47 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Aetna Commercial |
$166.43
|
| Rate for Payer: Cash Price |
$115.58
|
| Rate for Payer: Cigna All Commercial |
$166.24
|
| Rate for Payer: CORVEL All Commercial |
$179.15
|
| Rate for Payer: Coventry All Commercial |
$169.51
|
| Rate for Payer: Encore All Commercial |
$177.32
|
| Rate for Payer: Frontpath All Commercial |
$177.22
|
| Rate for Payer: Humana ChoiceCare |
$166.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.37
|
| Rate for Payer: PHCS All Commercial |
$144.47
|
| Rate for Payer: PHP All Commercial |
$146.09
|
| Rate for Payer: Sagamore Health Network All Products |
$148.71
|
| Rate for Payer: Signature Care EPO |
$159.88
|
| Rate for Payer: Signature Care PPO |
$169.51
|
| Rate for Payer: United Healthcare Commercial |
$151.79
|
|
|
HC CONTRAST BATH/15 MIN-OT
|
Facility
|
OP
|
$192.63
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
1738012
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Aetna Commercial |
$162.58
|
| Rate for Payer: Aetna Medicare |
$61.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.81
|
| Rate for Payer: Cash Price |
$115.58
|
| Rate for Payer: Cash Price |
$115.58
|
| Rate for Payer: Centivo All Commercial |
$104.79
|
| Rate for Payer: Cigna All Commercial |
$166.24
|
| Rate for Payer: CORVEL All Commercial |
$179.15
|
| Rate for Payer: Coventry All Commercial |
$169.51
|
| Rate for Payer: Encore All Commercial |
$177.32
|
| Rate for Payer: Frontpath All Commercial |
$177.22
|
| Rate for Payer: Humana ChoiceCare |
$166.37
|
| Rate for Payer: Humana Medicare |
$61.64
|
| Rate for Payer: Lucent All Commercial |
$104.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.37
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$144.47
|
| Rate for Payer: PHP All Commercial |
$146.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.13
|
| Rate for Payer: Sagamore Health Network All Products |
$148.71
|
| Rate for Payer: Signature Care EPO |
$159.88
|
| Rate for Payer: Signature Care PPO |
$169.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.74
|
| Rate for Payer: United Healthcare Commercial |
$151.79
|
| Rate for Payer: United Healthcare Medicare |
$61.64
|
|
|
HC CONVEX FLEXTEND COLOSTOMY DRESSING
|
Facility
|
OP
|
$5.63
|
|
| Hospital Charge Code |
41601407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.98
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Centivo All Commercial |
$3.06
|
| Rate for Payer: Cigna All Commercial |
$4.86
|
| Rate for Payer: CORVEL All Commercial |
$5.24
|
| Rate for Payer: Coventry All Commercial |
$4.95
|
| Rate for Payer: Encore All Commercial |
$5.18
|
| Rate for Payer: Frontpath All Commercial |
$5.18
|
| Rate for Payer: Humana ChoiceCare |
$4.86
|
| Rate for Payer: Humana Medicare |
$1.80
|
| Rate for Payer: Lucent All Commercial |
$3.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.07
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$4.22
|
| Rate for Payer: PHP All Commercial |
$4.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4.35
|
| Rate for Payer: Signature Care EPO |
$4.67
|
| Rate for Payer: Signature Care PPO |
$4.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.79
|
| Rate for Payer: United Healthcare Commercial |
$4.44
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
|
|
HC CONVEX FLEXTEND COLOSTOMY DRESSING
|
Facility
|
IP
|
$5.63
|
|
| Hospital Charge Code |
41601407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna All Commercial |
$4.86
|
| Rate for Payer: CORVEL All Commercial |
$5.24
|
| Rate for Payer: Coventry All Commercial |
$4.95
|
| Rate for Payer: Encore All Commercial |
$5.18
|
| Rate for Payer: Frontpath All Commercial |
$5.18
|
| Rate for Payer: Humana ChoiceCare |
$4.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.07
|
| Rate for Payer: PHCS All Commercial |
$4.22
|
| Rate for Payer: PHP All Commercial |
$4.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4.35
|
| Rate for Payer: Signature Care EPO |
$4.67
|
| Rate for Payer: Signature Care PPO |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$4.44
|
|
|
HC COOLER & COLD PAD COMBO BREG
|
Facility
|
IP
|
$871.22
|
|
| Hospital Charge Code |
41607038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$810.23 |
| Rate for Payer: Aetna Commercial |
$752.73
|
| Rate for Payer: Cash Price |
$522.73
|
| Rate for Payer: Cigna All Commercial |
$751.86
|
| Rate for Payer: CORVEL All Commercial |
$810.23
|
| Rate for Payer: Coventry All Commercial |
$766.67
|
| Rate for Payer: Encore All Commercial |
$801.96
|
| Rate for Payer: Frontpath All Commercial |
$801.52
|
| Rate for Payer: Humana ChoiceCare |
$752.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$784.10
|
| Rate for Payer: PHCS All Commercial |
$653.41
|
| Rate for Payer: PHP All Commercial |
$660.73
|
| Rate for Payer: Sagamore Health Network All Products |
$672.58
|
| Rate for Payer: Signature Care EPO |
$723.11
|
| Rate for Payer: Signature Care PPO |
$766.67
|
| Rate for Payer: United Healthcare Commercial |
$686.52
|
|
|
HC COOLER & COLD PAD COMBO BREG
|
Facility
|
OP
|
$871.22
|
|
| Hospital Charge Code |
41607038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$810.23 |
| Rate for Payer: Aetna Commercial |
$735.31
|
| Rate for Payer: Aetna Medicare |
$278.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$500.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$544.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$320.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$306.67
|
| Rate for Payer: Cash Price |
$522.73
|
| Rate for Payer: Cash Price |
$522.73
|
| Rate for Payer: Centivo All Commercial |
$473.94
|
| Rate for Payer: Cigna All Commercial |
$751.86
|
| Rate for Payer: CORVEL All Commercial |
$810.23
|
| Rate for Payer: Coventry All Commercial |
$766.67
|
| Rate for Payer: Encore All Commercial |
$801.96
|
| Rate for Payer: Frontpath All Commercial |
$801.52
|
| Rate for Payer: Humana ChoiceCare |
$752.47
|
| Rate for Payer: Humana Medicare |
$278.79
|
| Rate for Payer: Lucent All Commercial |
$473.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$784.10
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$653.41
|
| Rate for Payer: PHP All Commercial |
$660.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.78
|
| Rate for Payer: Sagamore Health Network All Products |
$672.58
|
| Rate for Payer: Signature Care EPO |
$723.11
|
| Rate for Payer: Signature Care PPO |
$766.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$740.54
|
| Rate for Payer: United Healthcare Commercial |
$686.52
|
| Rate for Payer: United Healthcare Medicare |
$278.79
|
|
|
HC COOMBS-DIRECT
|
Facility
|
OP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$83.82
|
| Rate for Payer: Aetna Medicare |
$31.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.96
|
| Rate for Payer: Cash Price |
$59.59
|
| Rate for Payer: Cash Price |
$59.59
|
| Rate for Payer: Centivo All Commercial |
$54.02
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.37
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Humana Medicare |
$31.78
|
| Rate for Payer: Lucent All Commercial |
$54.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: Managed Health Services Medicaid |
$5.39
|
| Rate for Payer: MDWise Medicaid |
$5.39
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.73
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.43
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.41
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$31.78
|
|
|
HC COOMBS-DIRECT
|
Facility
|
IP
|
$99.31
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
63001342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$59.59
|
| Rate for Payer: Cigna All Commercial |
$85.70
|
| Rate for Payer: CORVEL All Commercial |
$92.36
|
| Rate for Payer: Coventry All Commercial |
$87.39
|
| Rate for Payer: Encore All Commercial |
$91.41
|
| Rate for Payer: Frontpath All Commercial |
$91.37
|
| Rate for Payer: Humana ChoiceCare |
$85.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.38
|
| Rate for Payer: PHCS All Commercial |
$74.48
|
| Rate for Payer: PHP All Commercial |
$75.32
|
| Rate for Payer: Sagamore Health Network All Products |
$76.67
|
| Rate for Payer: Signature Care EPO |
$82.43
|
| Rate for Payer: Signature Care PPO |
$87.39
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
|
|
HC COPPER SERUM
|
Facility
|
OP
|
$161.57
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$150.26 |
| Rate for Payer: Aetna Commercial |
$136.37
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.87
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Centivo All Commercial |
$87.89
|
| Rate for Payer: Cigna All Commercial |
$139.43
|
| Rate for Payer: CORVEL All Commercial |
$150.26
|
| Rate for Payer: Coventry All Commercial |
$142.18
|
| Rate for Payer: Encore All Commercial |
$148.73
|
| Rate for Payer: Frontpath All Commercial |
$148.64
|
| Rate for Payer: Humana ChoiceCare |
$139.55
|
| Rate for Payer: Humana Medicare |
$51.70
|
| Rate for Payer: Lucent All Commercial |
$87.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12.41
|
| Rate for Payer: MDWise Medicaid |
$12.41
|
| Rate for Payer: PHCS All Commercial |
$121.18
|
| Rate for Payer: PHP All Commercial |
$122.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.01
|
| Rate for Payer: Sagamore Health Network All Products |
$124.73
|
| Rate for Payer: Signature Care EPO |
$134.10
|
| Rate for Payer: Signature Care PPO |
$142.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.33
|
| Rate for Payer: United Healthcare Commercial |
$127.32
|
| Rate for Payer: United Healthcare Medicare |
$51.70
|
|
|
HC COPPER SERUM
|
Facility
|
IP
|
$161.57
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$150.26 |
| Rate for Payer: Aetna Commercial |
$139.60
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cigna All Commercial |
$139.43
|
| Rate for Payer: CORVEL All Commercial |
$150.26
|
| Rate for Payer: Coventry All Commercial |
$142.18
|
| Rate for Payer: Encore All Commercial |
$148.73
|
| Rate for Payer: Frontpath All Commercial |
$148.64
|
| Rate for Payer: Humana ChoiceCare |
$139.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.41
|
| Rate for Payer: PHCS All Commercial |
$121.18
|
| Rate for Payer: PHP All Commercial |
$122.53
|
| Rate for Payer: Sagamore Health Network All Products |
$124.73
|
| Rate for Payer: Signature Care EPO |
$134.10
|
| Rate for Payer: Signature Care PPO |
$142.18
|
| Rate for Payer: United Healthcare Commercial |
$127.32
|
|
|
HC COPPER, URINE
|
Facility
|
OP
|
$34.30
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63044036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$28.95
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.07
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Centivo All Commercial |
$18.66
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$31.90
|
| Rate for Payer: Coventry All Commercial |
$30.18
|
| Rate for Payer: Encore All Commercial |
$31.57
|
| Rate for Payer: Frontpath All Commercial |
$31.56
|
| Rate for Payer: Humana ChoiceCare |
$29.62
|
| Rate for Payer: Humana Medicare |
$10.98
|
| Rate for Payer: Lucent All Commercial |
$18.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.87
|
| Rate for Payer: Managed Health Services Medicaid |
$12.41
|
| Rate for Payer: MDWise Medicaid |
$12.41
|
| Rate for Payer: PHCS All Commercial |
$25.73
|
| Rate for Payer: PHP All Commercial |
$26.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.38
|
| Rate for Payer: Sagamore Health Network All Products |
$26.48
|
| Rate for Payer: Signature Care EPO |
$28.47
|
| Rate for Payer: Signature Care PPO |
$30.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.16
|
| Rate for Payer: United Healthcare Commercial |
$27.03
|
| Rate for Payer: United Healthcare Medicare |
$10.98
|
|
|
HC COPPER, URINE
|
Facility
|
IP
|
$34.30
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
63044036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Cash Price |
$20.58
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$31.90
|
| Rate for Payer: Coventry All Commercial |
$30.18
|
| Rate for Payer: Encore All Commercial |
$31.57
|
| Rate for Payer: Frontpath All Commercial |
$31.56
|
| Rate for Payer: Humana ChoiceCare |
$29.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.87
|
| Rate for Payer: PHCS All Commercial |
$25.73
|
| Rate for Payer: PHP All Commercial |
$26.01
|
| Rate for Payer: Sagamore Health Network All Products |
$26.48
|
| Rate for Payer: Signature Care EPO |
$28.47
|
| Rate for Payer: Signature Care PPO |
$30.18
|
| Rate for Payer: United Healthcare Commercial |
$27.03
|
|
|
HC CORE NDL BX LNG/MED PERQ CT GUIDANCE
|
Facility
|
OP
|
$4,512.00
|
|
| Hospital Charge Code |
1662408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,398.72 |
| Max. Negotiated Rate |
$4,196.16 |
| Rate for Payer: Aetna Commercial |
$3,808.13
|
| Rate for Payer: Aetna Medicare |
$1,443.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,398.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,591.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,820.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,660.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,588.22
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Centivo All Commercial |
$2,454.53
|
| Rate for Payer: Cigna All Commercial |
$3,893.86
|
| Rate for Payer: CORVEL All Commercial |
$4,196.16
|
| Rate for Payer: Coventry All Commercial |
$3,970.56
|
| Rate for Payer: Encore All Commercial |
$4,153.30
|
| Rate for Payer: Frontpath All Commercial |
$4,151.04
|
| Rate for Payer: Humana ChoiceCare |
$3,897.01
|
| Rate for Payer: Humana Medicare |
$1,443.84
|
| Rate for Payer: Lucent All Commercial |
$2,454.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,060.80
|
| Rate for Payer: PHCS All Commercial |
$3,384.00
|
| Rate for Payer: PHP All Commercial |
$3,421.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,759.68
|
| Rate for Payer: Sagamore Health Network All Products |
$3,483.26
|
| Rate for Payer: Signature Care EPO |
$3,744.96
|
| Rate for Payer: Signature Care PPO |
$3,970.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,835.20
|
| Rate for Payer: United Healthcare Commercial |
$3,555.46
|
| Rate for Payer: United Healthcare Medicare |
$1,443.84
|
|
|
HC CORE NDL BX LNG/MED PERQ CT GUIDANCE
|
Facility
|
IP
|
$4,512.00
|
|
| Hospital Charge Code |
1662408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,384.00 |
| Max. Negotiated Rate |
$4,196.16 |
| Rate for Payer: Aetna Commercial |
$3,898.37
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cigna All Commercial |
$3,893.86
|
| Rate for Payer: CORVEL All Commercial |
$4,196.16
|
| Rate for Payer: Coventry All Commercial |
$3,970.56
|
| Rate for Payer: Encore All Commercial |
$4,153.30
|
| Rate for Payer: Frontpath All Commercial |
$4,151.04
|
| Rate for Payer: Humana ChoiceCare |
$3,897.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,060.80
|
| Rate for Payer: PHCS All Commercial |
$3,384.00
|
| Rate for Payer: PHP All Commercial |
$3,421.90
|
| Rate for Payer: Sagamore Health Network All Products |
$3,483.26
|
| Rate for Payer: Signature Care EPO |
$3,744.96
|
| Rate for Payer: Signature Care PPO |
$3,970.56
|
| Rate for Payer: United Healthcare Commercial |
$3,555.46
|
|
|
HC CORTISOL-AM
|
Facility
|
OP
|
$235.62
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$198.86
|
| Rate for Payer: Aetna Medicare |
$75.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.94
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Centivo All Commercial |
$128.18
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Humana Medicare |
$75.40
|
| Rate for Payer: Lucent All Commercial |
$128.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16.30
|
| Rate for Payer: MDWise Medicaid |
$16.30
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.89
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.28
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
|
|
HC CORTISOL-AM
|
Facility
|
IP
|
$235.62
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
63001309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$219.13 |
| Rate for Payer: Aetna Commercial |
$203.58
|
| Rate for Payer: Cash Price |
$141.37
|
| Rate for Payer: Cigna All Commercial |
$203.34
|
| Rate for Payer: CORVEL All Commercial |
$219.13
|
| Rate for Payer: Coventry All Commercial |
$207.35
|
| Rate for Payer: Encore All Commercial |
$216.89
|
| Rate for Payer: Frontpath All Commercial |
$216.77
|
| Rate for Payer: Humana ChoiceCare |
$203.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.06
|
| Rate for Payer: PHCS All Commercial |
$176.72
|
| Rate for Payer: PHP All Commercial |
$178.69
|
| Rate for Payer: Sagamore Health Network All Products |
$181.90
|
| Rate for Payer: Signature Care EPO |
$195.56
|
| Rate for Payer: Signature Care PPO |
$207.35
|
| Rate for Payer: United Healthcare Commercial |
$185.67
|
|
