|
HC DRAIN BLAKE 19FR W/TROCAR
|
Facility
|
IP
|
$470.76
|
|
| Hospital Charge Code |
41601909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.07 |
| Max. Negotiated Rate |
$437.81 |
| Rate for Payer: Aetna Commercial |
$406.74
|
| Rate for Payer: Cash Price |
$282.46
|
| Rate for Payer: Cigna All Commercial |
$406.27
|
| Rate for Payer: CORVEL All Commercial |
$437.81
|
| Rate for Payer: Coventry All Commercial |
$414.27
|
| Rate for Payer: Encore All Commercial |
$433.33
|
| Rate for Payer: Frontpath All Commercial |
$433.10
|
| Rate for Payer: Humana ChoiceCare |
$406.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$423.68
|
| Rate for Payer: PHCS All Commercial |
$353.07
|
| Rate for Payer: PHP All Commercial |
$357.02
|
| Rate for Payer: Sagamore Health Network All Products |
$363.43
|
| Rate for Payer: Signature Care EPO |
$390.73
|
| Rate for Payer: Signature Care PPO |
$414.27
|
| Rate for Payer: United Healthcare Commercial |
$370.96
|
|
|
HC DRAIN BLAKE 19FR W/TROCAR
|
Facility
|
OP
|
$470.76
|
|
| Hospital Charge Code |
41601909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$437.81 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Aetna Medicare |
$150.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$270.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.71
|
| Rate for Payer: Cash Price |
$282.46
|
| Rate for Payer: Cash Price |
$282.46
|
| Rate for Payer: Centivo All Commercial |
$256.09
|
| Rate for Payer: Cigna All Commercial |
$406.27
|
| Rate for Payer: CORVEL All Commercial |
$437.81
|
| Rate for Payer: Coventry All Commercial |
$414.27
|
| Rate for Payer: Encore All Commercial |
$433.33
|
| Rate for Payer: Frontpath All Commercial |
$433.10
|
| Rate for Payer: Humana ChoiceCare |
$406.60
|
| Rate for Payer: Humana Medicare |
$150.64
|
| Rate for Payer: Lucent All Commercial |
$256.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$423.68
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$353.07
|
| Rate for Payer: PHP All Commercial |
$357.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$183.60
|
| Rate for Payer: Sagamore Health Network All Products |
$363.43
|
| Rate for Payer: Signature Care EPO |
$390.73
|
| Rate for Payer: Signature Care PPO |
$414.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.15
|
| Rate for Payer: United Healthcare Commercial |
$370.96
|
| Rate for Payer: United Healthcare Medicare |
$150.64
|
|
|
HC DRAIN/INJ MAJOR JOINT/BURSA W/O US
|
Facility
|
IP
|
$361.52
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1680610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.14 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Commercial |
$312.35
|
| Rate for Payer: Cash Price |
$216.91
|
| Rate for Payer: Cigna All Commercial |
$311.99
|
| Rate for Payer: CORVEL All Commercial |
$336.21
|
| Rate for Payer: Coventry All Commercial |
$318.14
|
| Rate for Payer: Encore All Commercial |
$332.78
|
| Rate for Payer: Frontpath All Commercial |
$332.60
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.37
|
| Rate for Payer: PHCS All Commercial |
$271.14
|
| Rate for Payer: PHP All Commercial |
$274.18
|
| Rate for Payer: Sagamore Health Network All Products |
$279.09
|
| Rate for Payer: Signature Care EPO |
$300.06
|
| Rate for Payer: Signature Care PPO |
$318.14
|
| Rate for Payer: United Healthcare Commercial |
$284.88
|
|
|
HC DRAIN/INJ MAJOR JOINT/BURSA W/O US
|
Facility
|
OP
|
$361.52
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1680610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Commercial |
$305.12
|
| Rate for Payer: Aetna Medicare |
$115.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$207.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.26
|
| Rate for Payer: Cash Price |
$216.91
|
| Rate for Payer: Cash Price |
$216.91
|
| Rate for Payer: Centivo All Commercial |
$196.67
|
| Rate for Payer: Cigna All Commercial |
$311.99
|
| Rate for Payer: CORVEL All Commercial |
$336.21
|
| Rate for Payer: Coventry All Commercial |
$318.14
|
| Rate for Payer: Encore All Commercial |
$332.78
|
| Rate for Payer: Frontpath All Commercial |
$332.60
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Humana Medicare |
$115.69
|
| Rate for Payer: Lucent All Commercial |
$196.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.37
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
| Rate for Payer: PHCS All Commercial |
$271.14
|
| Rate for Payer: PHP All Commercial |
$274.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.99
|
| Rate for Payer: Sagamore Health Network All Products |
$279.09
|
| Rate for Payer: Signature Care EPO |
$300.06
|
| Rate for Payer: Signature Care PPO |
$318.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.29
|
| Rate for Payer: United Healthcare Commercial |
$284.88
|
| Rate for Payer: United Healthcare Medicare |
$115.69
|
|
|
HC DRESSING ALGISITE 4X4 WOUND CART
|
Facility
|
IP
|
$20.29
|
|
| Hospital Charge Code |
41601406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cigna All Commercial |
$17.51
|
| Rate for Payer: CORVEL All Commercial |
$18.87
|
| Rate for Payer: Coventry All Commercial |
$17.86
|
| Rate for Payer: Encore All Commercial |
$18.68
|
| Rate for Payer: Frontpath All Commercial |
$18.67
|
| Rate for Payer: Humana ChoiceCare |
$17.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.26
|
| Rate for Payer: PHCS All Commercial |
$15.22
|
| Rate for Payer: PHP All Commercial |
$15.39
|
| Rate for Payer: Sagamore Health Network All Products |
$15.66
|
| Rate for Payer: Signature Care EPO |
$16.84
|
| Rate for Payer: Signature Care PPO |
$17.86
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
|
|
HC DRESSING ALGISITE 4X4 WOUND CART
|
Facility
|
OP
|
$20.29
|
|
| Hospital Charge Code |
41601406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.12
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.14
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Centivo All Commercial |
$11.04
|
| Rate for Payer: Cigna All Commercial |
$17.51
|
| Rate for Payer: CORVEL All Commercial |
$18.87
|
| Rate for Payer: Coventry All Commercial |
$17.86
|
| Rate for Payer: Encore All Commercial |
$18.68
|
| Rate for Payer: Frontpath All Commercial |
$18.67
|
| Rate for Payer: Humana ChoiceCare |
$17.52
|
| Rate for Payer: Humana Medicare |
$6.49
|
| Rate for Payer: Lucent All Commercial |
$11.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.26
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.22
|
| Rate for Payer: PHP All Commercial |
$15.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.91
|
| Rate for Payer: Sagamore Health Network All Products |
$15.66
|
| Rate for Payer: Signature Care EPO |
$16.84
|
| Rate for Payer: Signature Care PPO |
$17.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$6.49
|
|
|
HC DRESSING CHANGE TRAY CENTRAL LINE/PICC
|
Facility
|
OP
|
$84.07
|
|
| Hospital Charge Code |
41601216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$78.19 |
| Rate for Payer: Aetna Commercial |
$70.96
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.59
|
| Rate for Payer: Cash Price |
$50.44
|
| Rate for Payer: Cash Price |
$50.44
|
| Rate for Payer: Centivo All Commercial |
$45.73
|
| Rate for Payer: Cigna All Commercial |
$72.55
|
| Rate for Payer: CORVEL All Commercial |
$78.19
|
| Rate for Payer: Coventry All Commercial |
$73.98
|
| Rate for Payer: Encore All Commercial |
$77.39
|
| Rate for Payer: Frontpath All Commercial |
$77.34
|
| Rate for Payer: Humana ChoiceCare |
$72.61
|
| Rate for Payer: Humana Medicare |
$26.90
|
| Rate for Payer: Lucent All Commercial |
$45.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.66
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$63.05
|
| Rate for Payer: PHP All Commercial |
$63.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.79
|
| Rate for Payer: Sagamore Health Network All Products |
$64.90
|
| Rate for Payer: Signature Care EPO |
$69.78
|
| Rate for Payer: Signature Care PPO |
$73.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.46
|
| Rate for Payer: United Healthcare Commercial |
$66.25
|
| Rate for Payer: United Healthcare Medicare |
$26.90
|
|
|
HC DRESSING CHANGE TRAY CENTRAL LINE/PICC
|
Facility
|
IP
|
$84.07
|
|
| Hospital Charge Code |
41601216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$78.19 |
| Rate for Payer: Aetna Commercial |
$72.64
|
| Rate for Payer: Cash Price |
$50.44
|
| Rate for Payer: Cigna All Commercial |
$72.55
|
| Rate for Payer: CORVEL All Commercial |
$78.19
|
| Rate for Payer: Coventry All Commercial |
$73.98
|
| Rate for Payer: Encore All Commercial |
$77.39
|
| Rate for Payer: Frontpath All Commercial |
$77.34
|
| Rate for Payer: Humana ChoiceCare |
$72.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.66
|
| Rate for Payer: PHCS All Commercial |
$63.05
|
| Rate for Payer: PHP All Commercial |
$63.76
|
| Rate for Payer: Sagamore Health Network All Products |
$64.90
|
| Rate for Payer: Signature Care EPO |
$69.78
|
| Rate for Payer: Signature Care PPO |
$73.98
|
| Rate for Payer: United Healthcare Commercial |
$66.25
|
|
|
HC DRESSING CHANGE TRAY INFUSAPORT
|
Facility
|
OP
|
$43.75
|
|
| Hospital Charge Code |
41601217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Aetna Commercial |
$36.92
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.40
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Centivo All Commercial |
$23.80
|
| Rate for Payer: Cigna All Commercial |
$37.76
|
| Rate for Payer: CORVEL All Commercial |
$40.69
|
| Rate for Payer: Coventry All Commercial |
$38.50
|
| Rate for Payer: Encore All Commercial |
$40.27
|
| Rate for Payer: Frontpath All Commercial |
$40.25
|
| Rate for Payer: Humana ChoiceCare |
$37.79
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Lucent All Commercial |
$23.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$32.81
|
| Rate for Payer: PHP All Commercial |
$33.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.06
|
| Rate for Payer: Sagamore Health Network All Products |
$33.77
|
| Rate for Payer: Signature Care EPO |
$36.31
|
| Rate for Payer: Signature Care PPO |
$38.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.19
|
| Rate for Payer: United Healthcare Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
|
|
HC DRESSING CHANGE TRAY INFUSAPORT
|
Facility
|
IP
|
$43.75
|
|
| Hospital Charge Code |
41601217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cigna All Commercial |
$37.76
|
| Rate for Payer: CORVEL All Commercial |
$40.69
|
| Rate for Payer: Coventry All Commercial |
$38.50
|
| Rate for Payer: Encore All Commercial |
$40.27
|
| Rate for Payer: Frontpath All Commercial |
$40.25
|
| Rate for Payer: Humana ChoiceCare |
$37.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.38
|
| Rate for Payer: PHCS All Commercial |
$32.81
|
| Rate for Payer: PHP All Commercial |
$33.18
|
| Rate for Payer: Sagamore Health Network All Products |
$33.77
|
| Rate for Payer: Signature Care EPO |
$36.31
|
| Rate for Payer: Signature Care PPO |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$34.48
|
|
|
HC DRESSING MEPILEX 4X4
|
Facility
|
OP
|
$18.16
|
|
| Hospital Charge Code |
41607727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.39
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Centivo All Commercial |
$9.88
|
| Rate for Payer: Cigna All Commercial |
$15.67
|
| Rate for Payer: CORVEL All Commercial |
$16.89
|
| Rate for Payer: Coventry All Commercial |
$15.98
|
| Rate for Payer: Encore All Commercial |
$16.72
|
| Rate for Payer: Frontpath All Commercial |
$16.71
|
| Rate for Payer: Humana ChoiceCare |
$15.68
|
| Rate for Payer: Humana Medicare |
$5.81
|
| Rate for Payer: Lucent All Commercial |
$9.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.34
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.62
|
| Rate for Payer: PHP All Commercial |
$13.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.08
|
| Rate for Payer: Sagamore Health Network All Products |
$14.02
|
| Rate for Payer: Signature Care EPO |
$15.07
|
| Rate for Payer: Signature Care PPO |
$15.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.44
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
| Rate for Payer: United Healthcare Medicare |
$5.81
|
|
|
HC DRESSING MEPILEX 4X4
|
Facility
|
IP
|
$18.16
|
|
| Hospital Charge Code |
41607727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: Cigna All Commercial |
$15.67
|
| Rate for Payer: CORVEL All Commercial |
$16.89
|
| Rate for Payer: Coventry All Commercial |
$15.98
|
| Rate for Payer: Encore All Commercial |
$16.72
|
| Rate for Payer: Frontpath All Commercial |
$16.71
|
| Rate for Payer: Humana ChoiceCare |
$15.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.34
|
| Rate for Payer: PHCS All Commercial |
$13.62
|
| Rate for Payer: PHP All Commercial |
$13.77
|
| Rate for Payer: Sagamore Health Network All Products |
$14.02
|
| Rate for Payer: Signature Care EPO |
$15.07
|
| Rate for Payer: Signature Care PPO |
$15.98
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
|
|
HC DRESSING MEPILEX BORDER HEEL
|
Facility
|
OP
|
$67.12
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
41607647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.65
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Centivo All Commercial |
$36.51
|
| Rate for Payer: Cigna All Commercial |
$57.92
|
| Rate for Payer: CORVEL All Commercial |
$62.42
|
| Rate for Payer: Coventry All Commercial |
$59.07
|
| Rate for Payer: Encore All Commercial |
$61.78
|
| Rate for Payer: Frontpath All Commercial |
$61.75
|
| Rate for Payer: Humana ChoiceCare |
$57.97
|
| Rate for Payer: Humana Medicare |
$21.48
|
| Rate for Payer: Lucent All Commercial |
$36.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$50.34
|
| Rate for Payer: PHP All Commercial |
$50.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.18
|
| Rate for Payer: Sagamore Health Network All Products |
$51.82
|
| Rate for Payer: Signature Care EPO |
$55.71
|
| Rate for Payer: Signature Care PPO |
$59.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.05
|
| Rate for Payer: United Healthcare Commercial |
$52.89
|
| Rate for Payer: United Healthcare Medicare |
$21.48
|
|
|
HC DRESSING MEPILEX BORDER HEEL
|
Facility
|
IP
|
$67.12
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
41607647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$57.99
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cigna All Commercial |
$57.92
|
| Rate for Payer: CORVEL All Commercial |
$62.42
|
| Rate for Payer: Coventry All Commercial |
$59.07
|
| Rate for Payer: Encore All Commercial |
$61.78
|
| Rate for Payer: Frontpath All Commercial |
$61.75
|
| Rate for Payer: Humana ChoiceCare |
$57.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.41
|
| Rate for Payer: PHCS All Commercial |
$50.34
|
| Rate for Payer: PHP All Commercial |
$50.90
|
| Rate for Payer: Sagamore Health Network All Products |
$51.82
|
| Rate for Payer: Signature Care EPO |
$55.71
|
| Rate for Payer: Signature Care PPO |
$59.07
|
| Rate for Payer: United Healthcare Commercial |
$52.89
|
|
|
HC DRESSING MEPILEX OVAL 3.1X4
|
Facility
|
OP
|
$17.69
|
|
| Hospital Charge Code |
41607726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Centivo All Commercial |
$9.62
|
| Rate for Payer: Cigna All Commercial |
$15.27
|
| Rate for Payer: CORVEL All Commercial |
$16.45
|
| Rate for Payer: Coventry All Commercial |
$15.57
|
| Rate for Payer: Encore All Commercial |
$16.28
|
| Rate for Payer: Frontpath All Commercial |
$16.27
|
| Rate for Payer: Humana ChoiceCare |
$15.28
|
| Rate for Payer: Humana Medicare |
$5.66
|
| Rate for Payer: Lucent All Commercial |
$9.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.92
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.27
|
| Rate for Payer: PHP All Commercial |
$13.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.90
|
| Rate for Payer: Sagamore Health Network All Products |
$13.66
|
| Rate for Payer: Signature Care EPO |
$14.68
|
| Rate for Payer: Signature Care PPO |
$15.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.04
|
| Rate for Payer: United Healthcare Commercial |
$13.94
|
| Rate for Payer: United Healthcare Medicare |
$5.66
|
|
|
HC DRESSING MEPILEX OVAL 3.1X4
|
Facility
|
IP
|
$17.69
|
|
| Hospital Charge Code |
41607726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cigna All Commercial |
$15.27
|
| Rate for Payer: CORVEL All Commercial |
$16.45
|
| Rate for Payer: Coventry All Commercial |
$15.57
|
| Rate for Payer: Encore All Commercial |
$16.28
|
| Rate for Payer: Frontpath All Commercial |
$16.27
|
| Rate for Payer: Humana ChoiceCare |
$15.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.92
|
| Rate for Payer: PHCS All Commercial |
$13.27
|
| Rate for Payer: PHP All Commercial |
$13.42
|
| Rate for Payer: Sagamore Health Network All Products |
$13.66
|
| Rate for Payer: Signature Care EPO |
$14.68
|
| Rate for Payer: Signature Care PPO |
$15.57
|
| Rate for Payer: United Healthcare Commercial |
$13.94
|
|
|
HC DRESSING MEPILEX OVAL 5.1X6.3
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
41607728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$33.94 |
| Rate for Payer: Aetna Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cigna All Commercial |
$31.49
|
| Rate for Payer: CORVEL All Commercial |
$33.94
|
| Rate for Payer: Coventry All Commercial |
$32.11
|
| Rate for Payer: Encore All Commercial |
$33.59
|
| Rate for Payer: Frontpath All Commercial |
$33.57
|
| Rate for Payer: Humana ChoiceCare |
$31.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.84
|
| Rate for Payer: PHCS All Commercial |
$27.37
|
| Rate for Payer: PHP All Commercial |
$27.67
|
| Rate for Payer: Sagamore Health Network All Products |
$28.17
|
| Rate for Payer: Signature Care EPO |
$30.29
|
| Rate for Payer: Signature Care PPO |
$32.11
|
| Rate for Payer: United Healthcare Commercial |
$28.75
|
|
|
HC DRESSING MEPILEX OVAL 5.1X6.3
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
41607728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$33.94 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Medicare |
$11.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.84
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Centivo All Commercial |
$19.85
|
| Rate for Payer: Cigna All Commercial |
$31.49
|
| Rate for Payer: CORVEL All Commercial |
$33.94
|
| Rate for Payer: Coventry All Commercial |
$32.11
|
| Rate for Payer: Encore All Commercial |
$33.59
|
| Rate for Payer: Frontpath All Commercial |
$33.57
|
| Rate for Payer: Humana ChoiceCare |
$31.52
|
| Rate for Payer: Humana Medicare |
$11.68
|
| Rate for Payer: Lucent All Commercial |
$19.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.84
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$27.37
|
| Rate for Payer: PHP All Commercial |
$27.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.23
|
| Rate for Payer: Sagamore Health Network All Products |
$28.17
|
| Rate for Payer: Signature Care EPO |
$30.29
|
| Rate for Payer: Signature Care PPO |
$32.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.02
|
| Rate for Payer: United Healthcare Commercial |
$28.75
|
| Rate for Payer: United Healthcare Medicare |
$11.68
|
|
|
HC DRESSING MEPILEX SACRAL BORDER
|
Facility
|
OP
|
$63.76
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
41607646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$53.81
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.44
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Centivo All Commercial |
$34.69
|
| Rate for Payer: Cigna All Commercial |
$55.02
|
| Rate for Payer: CORVEL All Commercial |
$59.30
|
| Rate for Payer: Coventry All Commercial |
$56.11
|
| Rate for Payer: Encore All Commercial |
$58.69
|
| Rate for Payer: Frontpath All Commercial |
$58.66
|
| Rate for Payer: Humana ChoiceCare |
$55.07
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Lucent All Commercial |
$34.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$47.82
|
| Rate for Payer: PHP All Commercial |
$48.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.87
|
| Rate for Payer: Sagamore Health Network All Products |
$49.22
|
| Rate for Payer: Signature Care EPO |
$52.92
|
| Rate for Payer: Signature Care PPO |
$56.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.20
|
| Rate for Payer: United Healthcare Commercial |
$50.24
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
|
|
HC DRESSING MEPILEX SACRAL BORDER
|
Facility
|
IP
|
$63.76
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
41607646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$55.09
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna All Commercial |
$55.02
|
| Rate for Payer: CORVEL All Commercial |
$59.30
|
| Rate for Payer: Coventry All Commercial |
$56.11
|
| Rate for Payer: Encore All Commercial |
$58.69
|
| Rate for Payer: Frontpath All Commercial |
$58.66
|
| Rate for Payer: Humana ChoiceCare |
$55.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.38
|
| Rate for Payer: PHCS All Commercial |
$47.82
|
| Rate for Payer: PHP All Commercial |
$48.36
|
| Rate for Payer: Sagamore Health Network All Products |
$49.22
|
| Rate for Payer: Signature Care EPO |
$52.92
|
| Rate for Payer: Signature Care PPO |
$56.11
|
| Rate for Payer: United Healthcare Commercial |
$50.24
|
|
|
HC DRESSING POLYMEM 4X4 NON-ADHESIVE
|
Facility
|
IP
|
$20.17
|
|
| Hospital Charge Code |
41601886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: Aetna Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna All Commercial |
$17.41
|
| Rate for Payer: CORVEL All Commercial |
$18.76
|
| Rate for Payer: Coventry All Commercial |
$17.75
|
| Rate for Payer: Encore All Commercial |
$18.57
|
| Rate for Payer: Frontpath All Commercial |
$18.56
|
| Rate for Payer: Humana ChoiceCare |
$17.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.15
|
| Rate for Payer: PHCS All Commercial |
$15.13
|
| Rate for Payer: PHP All Commercial |
$15.30
|
| Rate for Payer: Sagamore Health Network All Products |
$15.57
|
| Rate for Payer: Signature Care EPO |
$16.74
|
| Rate for Payer: Signature Care PPO |
$17.75
|
| Rate for Payer: United Healthcare Commercial |
$15.89
|
|
|
HC DRESSING POLYMEM 4X4 NON-ADHESIVE
|
Facility
|
OP
|
$20.17
|
|
| Hospital Charge Code |
41601886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.02
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Centivo All Commercial |
$10.97
|
| Rate for Payer: Cigna All Commercial |
$17.41
|
| Rate for Payer: CORVEL All Commercial |
$18.76
|
| Rate for Payer: Coventry All Commercial |
$17.75
|
| Rate for Payer: Encore All Commercial |
$18.57
|
| Rate for Payer: Frontpath All Commercial |
$18.56
|
| Rate for Payer: Humana ChoiceCare |
$17.42
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: Lucent All Commercial |
$10.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.15
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.13
|
| Rate for Payer: PHP All Commercial |
$15.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.87
|
| Rate for Payer: Sagamore Health Network All Products |
$15.57
|
| Rate for Payer: Signature Care EPO |
$16.74
|
| Rate for Payer: Signature Care PPO |
$17.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.14
|
| Rate for Payer: United Healthcare Commercial |
$15.89
|
| Rate for Payer: United Healthcare Medicare |
$6.45
|
|
|
HC DRESSING POLYMEM 4X4 SILVER
|
Facility
|
IP
|
$26.55
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
41601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$24.69 |
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cigna All Commercial |
$22.91
|
| Rate for Payer: CORVEL All Commercial |
$24.69
|
| Rate for Payer: Coventry All Commercial |
$23.36
|
| Rate for Payer: Encore All Commercial |
$24.44
|
| Rate for Payer: Frontpath All Commercial |
$24.43
|
| Rate for Payer: Humana ChoiceCare |
$22.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.89
|
| Rate for Payer: PHCS All Commercial |
$19.91
|
| Rate for Payer: PHP All Commercial |
$20.14
|
| Rate for Payer: Sagamore Health Network All Products |
$20.50
|
| Rate for Payer: Signature Care EPO |
$22.04
|
| Rate for Payer: Signature Care PPO |
$23.36
|
| Rate for Payer: United Healthcare Commercial |
$20.92
|
|
|
HC DRESSING POLYMEM 4X4 SILVER
|
Facility
|
OP
|
$26.55
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
41601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.35
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Centivo All Commercial |
$14.44
|
| Rate for Payer: Cigna All Commercial |
$22.91
|
| Rate for Payer: CORVEL All Commercial |
$24.69
|
| Rate for Payer: Coventry All Commercial |
$23.36
|
| Rate for Payer: Encore All Commercial |
$24.44
|
| Rate for Payer: Frontpath All Commercial |
$24.43
|
| Rate for Payer: Humana ChoiceCare |
$22.93
|
| Rate for Payer: Humana Medicare |
$8.50
|
| Rate for Payer: Lucent All Commercial |
$14.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.89
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$19.91
|
| Rate for Payer: PHP All Commercial |
$20.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.35
|
| Rate for Payer: Sagamore Health Network All Products |
$20.50
|
| Rate for Payer: Signature Care EPO |
$22.04
|
| Rate for Payer: Signature Care PPO |
$23.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.57
|
| Rate for Payer: United Healthcare Commercial |
$20.92
|
| Rate for Payer: United Healthcare Medicare |
$8.50
|
|
|
HC DRESSING POLYWIC 3X3 SILVER
|
Facility
|
OP
|
$47.29
|
|
|
Service Code
|
CPT A6215
|
| Hospital Charge Code |
41601881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$43.98 |
| Rate for Payer: Aetna Commercial |
$39.91
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.65
|
| Rate for Payer: Cash Price |
$28.37
|
| Rate for Payer: Cash Price |
$28.37
|
| Rate for Payer: Centivo All Commercial |
$25.73
|
| Rate for Payer: Cigna All Commercial |
$40.81
|
| Rate for Payer: CORVEL All Commercial |
$43.98
|
| Rate for Payer: Coventry All Commercial |
$41.62
|
| Rate for Payer: Encore All Commercial |
$43.53
|
| Rate for Payer: Frontpath All Commercial |
$43.51
|
| Rate for Payer: Humana ChoiceCare |
$40.84
|
| Rate for Payer: Humana Medicare |
$15.13
|
| Rate for Payer: Lucent All Commercial |
$25.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.56
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$35.47
|
| Rate for Payer: PHP All Commercial |
$35.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.44
|
| Rate for Payer: Sagamore Health Network All Products |
$36.51
|
| Rate for Payer: Signature Care EPO |
$39.25
|
| Rate for Payer: Signature Care PPO |
$41.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.20
|
| Rate for Payer: United Healthcare Commercial |
$37.26
|
| Rate for Payer: United Healthcare Medicare |
$15.13
|
|
