|
HC D-DIMER QUANT
|
Facility
|
OP
|
$238.99
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
63001347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Aetna Commercial |
$201.71
|
| Rate for Payer: Aetna Medicare |
$76.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$10.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$109.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.12
|
| Rate for Payer: Cash Price |
$143.39
|
| Rate for Payer: Cash Price |
$143.39
|
| Rate for Payer: Centivo All Commercial |
$130.01
|
| Rate for Payer: Cigna All Commercial |
$206.25
|
| Rate for Payer: CORVEL All Commercial |
$222.26
|
| Rate for Payer: Coventry All Commercial |
$210.31
|
| Rate for Payer: Encore All Commercial |
$219.99
|
| Rate for Payer: Frontpath All Commercial |
$219.87
|
| Rate for Payer: Humana ChoiceCare |
$206.42
|
| Rate for Payer: Humana Medicare |
$76.48
|
| Rate for Payer: Lucent All Commercial |
$130.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.09
|
| Rate for Payer: Managed Health Services Medicaid |
$10.18
|
| Rate for Payer: MDWise Medicaid |
$10.18
|
| Rate for Payer: PHCS All Commercial |
$179.24
|
| Rate for Payer: PHP All Commercial |
$181.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.21
|
| Rate for Payer: Sagamore Health Network All Products |
$184.50
|
| Rate for Payer: Signature Care EPO |
$198.36
|
| Rate for Payer: Signature Care PPO |
$210.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.14
|
| Rate for Payer: United Healthcare Commercial |
$188.32
|
| Rate for Payer: United Healthcare Medicare |
$76.48
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE, MUSCLE, =20 SQ CM
|
Facility
|
IP
|
$1,065.08
|
|
| Hospital Charge Code |
1685522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.81 |
| Max. Negotiated Rate |
$990.52 |
| Rate for Payer: Aetna Commercial |
$920.23
|
| Rate for Payer: Cash Price |
$639.05
|
| Rate for Payer: Cigna All Commercial |
$919.16
|
| Rate for Payer: CORVEL All Commercial |
$990.52
|
| Rate for Payer: Coventry All Commercial |
$937.27
|
| Rate for Payer: Encore All Commercial |
$980.41
|
| Rate for Payer: Frontpath All Commercial |
$979.87
|
| Rate for Payer: Humana ChoiceCare |
$919.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$958.57
|
| Rate for Payer: PHCS All Commercial |
$798.81
|
| Rate for Payer: PHP All Commercial |
$807.76
|
| Rate for Payer: Sagamore Health Network All Products |
$822.24
|
| Rate for Payer: Signature Care EPO |
$884.02
|
| Rate for Payer: Signature Care PPO |
$937.27
|
| Rate for Payer: United Healthcare Commercial |
$839.28
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE, MUSCLE, =20 SQ CM
|
Facility
|
OP
|
$1,065.08
|
|
| Hospital Charge Code |
1685522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$990.52 |
| Rate for Payer: Aetna Commercial |
$898.93
|
| Rate for Payer: Aetna Medicare |
$340.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$330.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$611.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$665.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.91
|
| Rate for Payer: Cash Price |
$639.05
|
| Rate for Payer: Cash Price |
$639.05
|
| Rate for Payer: Centivo All Commercial |
$579.40
|
| Rate for Payer: Cigna All Commercial |
$919.16
|
| Rate for Payer: CORVEL All Commercial |
$990.52
|
| Rate for Payer: Coventry All Commercial |
$937.27
|
| Rate for Payer: Encore All Commercial |
$980.41
|
| Rate for Payer: Frontpath All Commercial |
$979.87
|
| Rate for Payer: Humana ChoiceCare |
$919.91
|
| Rate for Payer: Humana Medicare |
$340.83
|
| Rate for Payer: Lucent All Commercial |
$579.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$958.57
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$798.81
|
| Rate for Payer: PHP All Commercial |
$807.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$415.38
|
| Rate for Payer: Sagamore Health Network All Products |
$822.24
|
| Rate for Payer: Signature Care EPO |
$884.02
|
| Rate for Payer: Signature Care PPO |
$937.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$905.32
|
| Rate for Payer: United Healthcare Commercial |
$839.28
|
| Rate for Payer: United Healthcare Medicare |
$340.83
|
|
|
HC DEBRIDE NAIL 6 OR MORE
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
1681721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$120.95 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cigna All Commercial |
$112.23
|
| Rate for Payer: CORVEL All Commercial |
$120.95
|
| Rate for Payer: Coventry All Commercial |
$114.44
|
| Rate for Payer: Encore All Commercial |
$119.71
|
| Rate for Payer: Frontpath All Commercial |
$119.65
|
| Rate for Payer: Humana ChoiceCare |
$112.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.05
|
| Rate for Payer: PHCS All Commercial |
$97.54
|
| Rate for Payer: PHP All Commercial |
$98.63
|
| Rate for Payer: Sagamore Health Network All Products |
$100.40
|
| Rate for Payer: Signature Care EPO |
$107.94
|
| Rate for Payer: Signature Care PPO |
$114.44
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
|
|
HC DEBRIDE NAIL 6 OR MORE
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
1681721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$120.95 |
| Rate for Payer: Aetna Commercial |
$109.76
|
| Rate for Payer: Aetna Medicare |
$41.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.78
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Centivo All Commercial |
$70.75
|
| Rate for Payer: Cigna All Commercial |
$112.23
|
| Rate for Payer: CORVEL All Commercial |
$120.95
|
| Rate for Payer: Coventry All Commercial |
$114.44
|
| Rate for Payer: Encore All Commercial |
$119.71
|
| Rate for Payer: Frontpath All Commercial |
$119.65
|
| Rate for Payer: Humana ChoiceCare |
$112.32
|
| Rate for Payer: Humana Medicare |
$41.62
|
| Rate for Payer: Lucent All Commercial |
$70.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.05
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$97.54
|
| Rate for Payer: PHP All Commercial |
$98.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.72
|
| Rate for Payer: Sagamore Health Network All Products |
$100.40
|
| Rate for Payer: Signature Care EPO |
$107.94
|
| Rate for Payer: Signature Care PPO |
$114.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.54
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
| Rate for Payer: United Healthcare Medicare |
$41.62
|
|
|
HC DECALCIFICATION PATH PROCEDURE
|
Facility
|
OP
|
$161.57
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
63001261
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.31 |
| 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 |
$12.31
|
| 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 |
$12.31
|
| 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 |
$12.31
|
| Rate for Payer: MDWise Medicaid |
$12.31
|
| 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 DECALCIFICATION PATH PROCEDURE
|
Facility
|
IP
|
$161.57
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
63001261
|
|
Hospital Revenue Code
|
310
|
| 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 DECALCIFICATION PATH PROCEDURE
|
Facility
|
IP
|
$99.79
|
|
|
Service Code
|
CPT 88311 59
|
| Hospital Charge Code |
63002184
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.84 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$86.22
|
| Rate for Payer: Cash Price |
$59.87
|
| Rate for Payer: Cigna All Commercial |
$86.12
|
| Rate for Payer: CORVEL All Commercial |
$92.80
|
| Rate for Payer: Coventry All Commercial |
$87.82
|
| Rate for Payer: Encore All Commercial |
$91.86
|
| Rate for Payer: Frontpath All Commercial |
$91.81
|
| Rate for Payer: Humana ChoiceCare |
$86.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.81
|
| Rate for Payer: PHCS All Commercial |
$74.84
|
| Rate for Payer: PHP All Commercial |
$75.68
|
| Rate for Payer: Sagamore Health Network All Products |
$77.04
|
| Rate for Payer: Signature Care EPO |
$82.83
|
| Rate for Payer: Signature Care PPO |
$87.82
|
| Rate for Payer: United Healthcare Commercial |
$78.63
|
|
|
HC DECALCIFICATION PATH PROCEDURE
|
Facility
|
OP
|
$99.79
|
|
|
Service Code
|
CPT 88311 59
|
| Hospital Charge Code |
63002184
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$84.22
|
| Rate for Payer: Aetna Medicare |
$31.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.13
|
| Rate for Payer: Cash Price |
$59.87
|
| Rate for Payer: Cash Price |
$59.87
|
| Rate for Payer: Centivo All Commercial |
$54.29
|
| Rate for Payer: Cigna All Commercial |
$86.12
|
| Rate for Payer: CORVEL All Commercial |
$92.80
|
| Rate for Payer: Coventry All Commercial |
$87.82
|
| Rate for Payer: Encore All Commercial |
$91.86
|
| Rate for Payer: Frontpath All Commercial |
$91.81
|
| Rate for Payer: Humana ChoiceCare |
$86.19
|
| Rate for Payer: Humana Medicare |
$31.93
|
| Rate for Payer: Lucent All Commercial |
$54.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.81
|
| Rate for Payer: Managed Health Services Medicaid |
$12.31
|
| Rate for Payer: MDWise Medicaid |
$12.31
|
| Rate for Payer: PHCS All Commercial |
$74.84
|
| Rate for Payer: PHP All Commercial |
$75.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.92
|
| Rate for Payer: Sagamore Health Network All Products |
$77.04
|
| Rate for Payer: Signature Care EPO |
$82.83
|
| Rate for Payer: Signature Care PPO |
$87.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.82
|
| Rate for Payer: United Healthcare Commercial |
$78.63
|
| Rate for Payer: United Healthcare Medicare |
$31.93
|
|
|
HC DECLOT W/THROMBOLYTIC AGENT
|
Facility
|
OP
|
$685.81
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
956550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$637.80 |
| Rate for Payer: Aetna Commercial |
$578.82
|
| Rate for Payer: Aetna Medicare |
$219.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$212.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$393.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$428.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$252.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$241.41
|
| Rate for Payer: Cash Price |
$411.49
|
| Rate for Payer: Centivo All Commercial |
$373.08
|
| Rate for Payer: Cigna All Commercial |
$591.85
|
| Rate for Payer: CORVEL All Commercial |
$637.80
|
| Rate for Payer: Coventry All Commercial |
$603.51
|
| Rate for Payer: Encore All Commercial |
$631.29
|
| Rate for Payer: Frontpath All Commercial |
$630.95
|
| Rate for Payer: Humana ChoiceCare |
$592.33
|
| Rate for Payer: Humana Medicare |
$219.46
|
| Rate for Payer: Lucent All Commercial |
$373.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$617.23
|
| Rate for Payer: PHCS All Commercial |
$514.36
|
| Rate for Payer: PHP All Commercial |
$520.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$267.47
|
| Rate for Payer: Sagamore Health Network All Products |
$529.45
|
| Rate for Payer: Signature Care EPO |
$569.22
|
| Rate for Payer: Signature Care PPO |
$603.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$582.94
|
| Rate for Payer: United Healthcare Commercial |
$540.42
|
| Rate for Payer: United Healthcare Medicare |
$219.46
|
|
|
HC DECLOT W/THROMBOLYTIC AGENT
|
Facility
|
IP
|
$685.81
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
956550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$514.36 |
| Max. Negotiated Rate |
$637.80 |
| Rate for Payer: Aetna Commercial |
$592.54
|
| Rate for Payer: Cash Price |
$411.49
|
| Rate for Payer: Cigna All Commercial |
$591.85
|
| Rate for Payer: CORVEL All Commercial |
$637.80
|
| Rate for Payer: Coventry All Commercial |
$603.51
|
| Rate for Payer: Encore All Commercial |
$631.29
|
| Rate for Payer: Frontpath All Commercial |
$630.95
|
| Rate for Payer: Humana ChoiceCare |
$592.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$617.23
|
| Rate for Payer: PHCS All Commercial |
$514.36
|
| Rate for Payer: PHP All Commercial |
$520.12
|
| Rate for Payer: Sagamore Health Network All Products |
$529.45
|
| Rate for Payer: Signature Care EPO |
$569.22
|
| Rate for Payer: Signature Care PPO |
$603.51
|
| Rate for Payer: United Healthcare Commercial |
$540.42
|
|
|
HC DEPAKANE
|
Facility
|
IP
|
$242.10
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
63001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.57 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$209.17
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Cigna All Commercial |
$208.93
|
| Rate for Payer: CORVEL All Commercial |
$225.15
|
| Rate for Payer: Coventry All Commercial |
$213.05
|
| Rate for Payer: Encore All Commercial |
$222.85
|
| Rate for Payer: Frontpath All Commercial |
$222.73
|
| Rate for Payer: Humana ChoiceCare |
$209.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.89
|
| Rate for Payer: PHCS All Commercial |
$181.57
|
| Rate for Payer: PHP All Commercial |
$183.61
|
| Rate for Payer: Sagamore Health Network All Products |
$186.90
|
| Rate for Payer: Signature Care EPO |
$200.94
|
| Rate for Payer: Signature Care PPO |
$213.05
|
| Rate for Payer: United Healthcare Commercial |
$190.77
|
|
|
HC DEPAKANE
|
Facility
|
OP
|
$242.10
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
63001192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$204.33
|
| Rate for Payer: Aetna Medicare |
$77.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.22
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Centivo All Commercial |
$131.70
|
| Rate for Payer: Cigna All Commercial |
$208.93
|
| Rate for Payer: CORVEL All Commercial |
$225.15
|
| Rate for Payer: Coventry All Commercial |
$213.05
|
| Rate for Payer: Encore All Commercial |
$222.85
|
| Rate for Payer: Frontpath All Commercial |
$222.73
|
| Rate for Payer: Humana ChoiceCare |
$209.10
|
| Rate for Payer: Humana Medicare |
$77.47
|
| Rate for Payer: Lucent All Commercial |
$131.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.89
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$181.57
|
| Rate for Payer: PHP All Commercial |
$183.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.42
|
| Rate for Payer: Sagamore Health Network All Products |
$186.90
|
| Rate for Payer: Signature Care EPO |
$200.94
|
| Rate for Payer: Signature Care PPO |
$213.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$205.78
|
| Rate for Payer: United Healthcare Commercial |
$190.77
|
| Rate for Payer: United Healthcare Medicare |
$77.47
|
|
|
HC DERMABOND PRINEO 22CM
|
Facility
|
OP
|
$493.22
|
|
| Hospital Charge Code |
41607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Aetna Commercial |
$416.28
|
| Rate for Payer: Aetna Medicare |
$157.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$283.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$308.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.61
|
| Rate for Payer: Cash Price |
$295.93
|
| Rate for Payer: Cash Price |
$295.93
|
| Rate for Payer: Centivo All Commercial |
$268.31
|
| Rate for Payer: Cigna All Commercial |
$425.65
|
| Rate for Payer: CORVEL All Commercial |
$458.69
|
| Rate for Payer: Coventry All Commercial |
$434.03
|
| Rate for Payer: Encore All Commercial |
$454.01
|
| Rate for Payer: Frontpath All Commercial |
$453.76
|
| Rate for Payer: Humana ChoiceCare |
$425.99
|
| Rate for Payer: Humana Medicare |
$157.83
|
| Rate for Payer: Lucent All Commercial |
$268.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$369.92
|
| Rate for Payer: PHP All Commercial |
$374.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.36
|
| Rate for Payer: Sagamore Health Network All Products |
$380.77
|
| Rate for Payer: Signature Care EPO |
$409.37
|
| Rate for Payer: Signature Care PPO |
$434.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$419.24
|
| Rate for Payer: United Healthcare Commercial |
$388.66
|
| Rate for Payer: United Healthcare Medicare |
$157.83
|
|
|
HC DERMABOND PRINEO 22CM
|
Facility
|
IP
|
$493.22
|
|
| Hospital Charge Code |
41607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.92 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Aetna Commercial |
$426.14
|
| Rate for Payer: Cash Price |
$295.93
|
| Rate for Payer: Cigna All Commercial |
$425.65
|
| Rate for Payer: CORVEL All Commercial |
$458.69
|
| Rate for Payer: Coventry All Commercial |
$434.03
|
| Rate for Payer: Encore All Commercial |
$454.01
|
| Rate for Payer: Frontpath All Commercial |
$453.76
|
| Rate for Payer: Humana ChoiceCare |
$425.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.90
|
| Rate for Payer: PHCS All Commercial |
$369.92
|
| Rate for Payer: PHP All Commercial |
$374.06
|
| Rate for Payer: Sagamore Health Network All Products |
$380.77
|
| Rate for Payer: Signature Care EPO |
$409.37
|
| Rate for Payer: Signature Care PPO |
$434.03
|
| Rate for Payer: United Healthcare Commercial |
$388.66
|
|
|
HC DERMABOND PRINEO 42CM
|
Facility
|
IP
|
$772.98
|
|
| Hospital Charge Code |
41607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.74 |
| Max. Negotiated Rate |
$718.87 |
| Rate for Payer: Aetna Commercial |
$667.85
|
| Rate for Payer: Cash Price |
$463.79
|
| Rate for Payer: Cigna All Commercial |
$667.08
|
| Rate for Payer: CORVEL All Commercial |
$718.87
|
| Rate for Payer: Coventry All Commercial |
$680.22
|
| Rate for Payer: Encore All Commercial |
$711.53
|
| Rate for Payer: Frontpath All Commercial |
$711.14
|
| Rate for Payer: Humana ChoiceCare |
$667.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.68
|
| Rate for Payer: PHCS All Commercial |
$579.74
|
| Rate for Payer: PHP All Commercial |
$586.23
|
| Rate for Payer: Sagamore Health Network All Products |
$596.74
|
| Rate for Payer: Signature Care EPO |
$641.57
|
| Rate for Payer: Signature Care PPO |
$680.22
|
| Rate for Payer: United Healthcare Commercial |
$609.11
|
|
|
HC DERMABOND PRINEO 42CM
|
Facility
|
OP
|
$772.98
|
|
| Hospital Charge Code |
41607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$718.87 |
| Rate for Payer: Aetna Commercial |
$652.40
|
| Rate for Payer: Aetna Medicare |
$247.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$443.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$483.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$284.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$272.09
|
| Rate for Payer: Cash Price |
$463.79
|
| Rate for Payer: Cash Price |
$463.79
|
| Rate for Payer: Centivo All Commercial |
$420.50
|
| Rate for Payer: Cigna All Commercial |
$667.08
|
| Rate for Payer: CORVEL All Commercial |
$718.87
|
| Rate for Payer: Coventry All Commercial |
$680.22
|
| Rate for Payer: Encore All Commercial |
$711.53
|
| Rate for Payer: Frontpath All Commercial |
$711.14
|
| Rate for Payer: Humana ChoiceCare |
$667.62
|
| Rate for Payer: Humana Medicare |
$247.35
|
| Rate for Payer: Lucent All Commercial |
$420.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.68
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$579.74
|
| Rate for Payer: PHP All Commercial |
$586.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$301.46
|
| Rate for Payer: Sagamore Health Network All Products |
$596.74
|
| Rate for Payer: Signature Care EPO |
$641.57
|
| Rate for Payer: Signature Care PPO |
$680.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$657.03
|
| Rate for Payer: United Healthcare Commercial |
$609.11
|
| Rate for Payer: United Healthcare Medicare |
$247.35
|
|
|
HC DERMABOND PRO PEN
|
Facility
|
OP
|
$113.18
|
|
| Hospital Charge Code |
41601087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna Commercial |
$95.52
|
| Rate for Payer: Aetna Medicare |
$36.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.84
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Centivo All Commercial |
$61.57
|
| Rate for Payer: Cigna All Commercial |
$97.67
|
| Rate for Payer: CORVEL All Commercial |
$105.26
|
| Rate for Payer: Coventry All Commercial |
$99.60
|
| Rate for Payer: Encore All Commercial |
$104.18
|
| Rate for Payer: Frontpath All Commercial |
$104.13
|
| Rate for Payer: Humana ChoiceCare |
$97.75
|
| Rate for Payer: Humana Medicare |
$36.22
|
| Rate for Payer: Lucent All Commercial |
$61.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.86
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$84.89
|
| Rate for Payer: PHP All Commercial |
$85.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.14
|
| Rate for Payer: Sagamore Health Network All Products |
$87.37
|
| Rate for Payer: Signature Care EPO |
$93.94
|
| Rate for Payer: Signature Care PPO |
$99.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.20
|
| Rate for Payer: United Healthcare Commercial |
$89.19
|
| Rate for Payer: United Healthcare Medicare |
$36.22
|
|
|
HC DERMABOND PRO PEN
|
Facility
|
IP
|
$113.18
|
|
| Hospital Charge Code |
41601087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cigna All Commercial |
$97.67
|
| Rate for Payer: CORVEL All Commercial |
$105.26
|
| Rate for Payer: Coventry All Commercial |
$99.60
|
| Rate for Payer: Encore All Commercial |
$104.18
|
| Rate for Payer: Frontpath All Commercial |
$104.13
|
| Rate for Payer: Humana ChoiceCare |
$97.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.86
|
| Rate for Payer: PHCS All Commercial |
$84.89
|
| Rate for Payer: PHP All Commercial |
$85.84
|
| Rate for Payer: Sagamore Health Network All Products |
$87.37
|
| Rate for Payer: Signature Care EPO |
$93.94
|
| Rate for Payer: Signature Care PPO |
$99.60
|
| Rate for Payer: United Healthcare Commercial |
$89.19
|
|
|
HC DESIGN MOLDS/MASK - COMPLEX
|
Facility
|
OP
|
$1,379.04
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
1547334
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$1,282.51 |
| Rate for Payer: Aetna Commercial |
$1,163.91
|
| Rate for Payer: Aetna Medicare |
$441.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$59.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$427.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$791.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$862.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$59.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$507.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$485.42
|
| Rate for Payer: Cash Price |
$827.42
|
| Rate for Payer: Cash Price |
$827.42
|
| Rate for Payer: Centivo All Commercial |
$750.20
|
| Rate for Payer: Cigna All Commercial |
$1,190.11
|
| Rate for Payer: CORVEL All Commercial |
$1,282.51
|
| Rate for Payer: Coventry All Commercial |
$1,213.56
|
| Rate for Payer: Encore All Commercial |
$1,269.41
|
| Rate for Payer: Frontpath All Commercial |
$1,268.72
|
| Rate for Payer: Humana ChoiceCare |
$1,191.08
|
| Rate for Payer: Humana Medicare |
$441.29
|
| Rate for Payer: Lucent All Commercial |
$750.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,241.14
|
| Rate for Payer: Managed Health Services Medicaid |
$59.62
|
| Rate for Payer: MDWise Medicaid |
$59.62
|
| Rate for Payer: PHCS All Commercial |
$1,034.28
|
| Rate for Payer: PHP All Commercial |
$1,045.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$537.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,064.62
|
| Rate for Payer: Signature Care EPO |
$1,144.60
|
| Rate for Payer: Signature Care PPO |
$1,213.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,172.18
|
| Rate for Payer: United Healthcare Commercial |
$1,086.68
|
| Rate for Payer: United Healthcare Medicare |
$441.29
|
|
|
HC DESIGN MOLDS/MASK - COMPLEX
|
Facility
|
IP
|
$1,379.04
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
1547334
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,034.28 |
| Max. Negotiated Rate |
$1,282.51 |
| Rate for Payer: Aetna Commercial |
$1,191.49
|
| Rate for Payer: Cash Price |
$827.42
|
| Rate for Payer: Cigna All Commercial |
$1,190.11
|
| Rate for Payer: CORVEL All Commercial |
$1,282.51
|
| Rate for Payer: Coventry All Commercial |
$1,213.56
|
| Rate for Payer: Encore All Commercial |
$1,269.41
|
| Rate for Payer: Frontpath All Commercial |
$1,268.72
|
| Rate for Payer: Humana ChoiceCare |
$1,191.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,241.14
|
| Rate for Payer: PHCS All Commercial |
$1,034.28
|
| Rate for Payer: PHP All Commercial |
$1,045.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,064.62
|
| Rate for Payer: Signature Care EPO |
$1,144.60
|
| Rate for Payer: Signature Care PPO |
$1,213.56
|
| Rate for Payer: United Healthcare Commercial |
$1,086.68
|
|
|
HC DESIGN MOLDS/MASK-INTERM
|
Facility
|
IP
|
$1,166.88
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
1547333
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$875.16 |
| Max. Negotiated Rate |
$1,085.20 |
| Rate for Payer: Aetna Commercial |
$1,008.18
|
| Rate for Payer: Cash Price |
$700.13
|
| Rate for Payer: Cigna All Commercial |
$1,007.02
|
| Rate for Payer: CORVEL All Commercial |
$1,085.20
|
| Rate for Payer: Coventry All Commercial |
$1,026.85
|
| Rate for Payer: Encore All Commercial |
$1,074.11
|
| Rate for Payer: Frontpath All Commercial |
$1,073.53
|
| Rate for Payer: Humana ChoiceCare |
$1,007.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.19
|
| Rate for Payer: PHCS All Commercial |
$875.16
|
| Rate for Payer: PHP All Commercial |
$884.96
|
| Rate for Payer: Sagamore Health Network All Products |
$900.83
|
| Rate for Payer: Signature Care EPO |
$968.51
|
| Rate for Payer: Signature Care PPO |
$1,026.85
|
| Rate for Payer: United Healthcare Commercial |
$919.50
|
|
|
HC DESIGN MOLDS/MASK-INTERM
|
Facility
|
OP
|
$1,166.88
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
1547333
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$1,085.20 |
| Rate for Payer: Aetna Commercial |
$984.85
|
| Rate for Payer: Aetna Medicare |
$373.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$670.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$729.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.74
|
| Rate for Payer: Cash Price |
$700.13
|
| Rate for Payer: Cash Price |
$700.13
|
| Rate for Payer: Centivo All Commercial |
$634.78
|
| Rate for Payer: Cigna All Commercial |
$1,007.02
|
| Rate for Payer: CORVEL All Commercial |
$1,085.20
|
| Rate for Payer: Coventry All Commercial |
$1,026.85
|
| Rate for Payer: Encore All Commercial |
$1,074.11
|
| Rate for Payer: Frontpath All Commercial |
$1,073.53
|
| Rate for Payer: Humana ChoiceCare |
$1,007.83
|
| Rate for Payer: Humana Medicare |
$373.40
|
| Rate for Payer: Lucent All Commercial |
$634.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.19
|
| Rate for Payer: Managed Health Services Medicaid |
$6.36
|
| Rate for Payer: MDWise Medicaid |
$6.36
|
| Rate for Payer: PHCS All Commercial |
$875.16
|
| Rate for Payer: PHP All Commercial |
$884.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$455.08
|
| Rate for Payer: Sagamore Health Network All Products |
$900.83
|
| Rate for Payer: Signature Care EPO |
$968.51
|
| Rate for Payer: Signature Care PPO |
$1,026.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.85
|
| Rate for Payer: United Healthcare Commercial |
$919.50
|
| Rate for Payer: United Healthcare Medicare |
$373.40
|
|
|
HC DESIGN MOLDS/MASK - SIMPLE
|
Facility
|
OP
|
$689.52
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
1547332
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$581.95
|
| Rate for Payer: Aetna Medicare |
$220.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$395.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$431.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.71
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Centivo All Commercial |
$375.10
|
| Rate for Payer: Cigna All Commercial |
$595.06
|
| Rate for Payer: CORVEL All Commercial |
$641.25
|
| Rate for Payer: Coventry All Commercial |
$606.78
|
| Rate for Payer: Encore All Commercial |
$634.70
|
| Rate for Payer: Frontpath All Commercial |
$634.36
|
| Rate for Payer: Humana ChoiceCare |
$595.54
|
| Rate for Payer: Humana Medicare |
$220.65
|
| Rate for Payer: Lucent All Commercial |
$375.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.57
|
| Rate for Payer: Managed Health Services Medicaid |
$36.08
|
| Rate for Payer: MDWise Medicaid |
$36.08
|
| Rate for Payer: PHCS All Commercial |
$517.14
|
| Rate for Payer: PHP All Commercial |
$522.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$268.91
|
| Rate for Payer: Sagamore Health Network All Products |
$532.31
|
| Rate for Payer: Signature Care EPO |
$572.30
|
| Rate for Payer: Signature Care PPO |
$606.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$586.09
|
| Rate for Payer: United Healthcare Commercial |
$543.34
|
| Rate for Payer: United Healthcare Medicare |
$220.65
|
|
|
HC DESIGN MOLDS/MASK - SIMPLE
|
Facility
|
IP
|
$689.52
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
1547332
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$517.14 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$595.75
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cigna All Commercial |
$595.06
|
| Rate for Payer: CORVEL All Commercial |
$641.25
|
| Rate for Payer: Coventry All Commercial |
$606.78
|
| Rate for Payer: Encore All Commercial |
$634.70
|
| Rate for Payer: Frontpath All Commercial |
$634.36
|
| Rate for Payer: Humana ChoiceCare |
$595.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.57
|
| Rate for Payer: PHCS All Commercial |
$517.14
|
| Rate for Payer: PHP All Commercial |
$522.93
|
| Rate for Payer: Sagamore Health Network All Products |
$532.31
|
| Rate for Payer: Signature Care EPO |
$572.30
|
| Rate for Payer: Signature Care PPO |
$606.78
|
| Rate for Payer: United Healthcare Commercial |
$543.34
|
|
