|
HC DVT GARMENT 32 IN CALF MAX
|
Facility
|
IP
|
$233.66
|
|
| Hospital Charge Code |
41601060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.25 |
| Max. Negotiated Rate |
$217.30 |
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Cash Price |
$140.20
|
| Rate for Payer: Cigna All Commercial |
$201.65
|
| Rate for Payer: CORVEL All Commercial |
$217.30
|
| Rate for Payer: Coventry All Commercial |
$205.62
|
| Rate for Payer: Encore All Commercial |
$215.08
|
| Rate for Payer: Frontpath All Commercial |
$214.97
|
| Rate for Payer: Humana ChoiceCare |
$201.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.29
|
| Rate for Payer: PHCS All Commercial |
$175.25
|
| Rate for Payer: PHP All Commercial |
$177.21
|
| Rate for Payer: Sagamore Health Network All Products |
$180.39
|
| Rate for Payer: Signature Care EPO |
$193.94
|
| Rate for Payer: Signature Care PPO |
$205.62
|
| Rate for Payer: United Healthcare Commercial |
$184.12
|
|
|
HC DVT GARMENT 32 IN CALF MAX
|
Facility
|
OP
|
$233.66
|
|
| Hospital Charge Code |
41601060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$217.30 |
| Rate for Payer: Aetna Commercial |
$197.21
|
| Rate for Payer: Aetna Medicare |
$74.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.25
|
| Rate for Payer: Cash Price |
$140.20
|
| Rate for Payer: Cash Price |
$140.20
|
| Rate for Payer: Centivo All Commercial |
$127.11
|
| Rate for Payer: Cigna All Commercial |
$201.65
|
| Rate for Payer: CORVEL All Commercial |
$217.30
|
| Rate for Payer: Coventry All Commercial |
$205.62
|
| Rate for Payer: Encore All Commercial |
$215.08
|
| Rate for Payer: Frontpath All Commercial |
$214.97
|
| Rate for Payer: Humana ChoiceCare |
$201.81
|
| Rate for Payer: Humana Medicare |
$74.77
|
| Rate for Payer: Lucent All Commercial |
$127.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.29
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$175.25
|
| Rate for Payer: PHP All Commercial |
$177.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.13
|
| Rate for Payer: Sagamore Health Network All Products |
$180.39
|
| Rate for Payer: Signature Care EPO |
$193.94
|
| Rate for Payer: Signature Care PPO |
$205.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.61
|
| Rate for Payer: United Healthcare Commercial |
$184.12
|
| Rate for Payer: United Healthcare Medicare |
$74.77
|
|
|
HC DX LMBR SPI PNXR W/FLUOR
|
Facility
|
IP
|
$663.00
|
|
| Hospital Charge Code |
1612328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
|
|
HC DX LMBR SPI PNXR W/FLUOR
|
Facility
|
OP
|
$663.00
|
|
| Hospital Charge Code |
1612328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.53 |
| Max. Negotiated Rate |
$616.59 |
| Rate for Payer: Aetna Commercial |
$559.57
|
| Rate for Payer: Aetna Medicare |
$212.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$380.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$414.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$233.38
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Centivo All Commercial |
$360.67
|
| Rate for Payer: Cigna All Commercial |
$572.17
|
| Rate for Payer: CORVEL All Commercial |
$616.59
|
| Rate for Payer: Coventry All Commercial |
$583.44
|
| Rate for Payer: Encore All Commercial |
$610.29
|
| Rate for Payer: Frontpath All Commercial |
$609.96
|
| Rate for Payer: Humana ChoiceCare |
$572.63
|
| Rate for Payer: Humana Medicare |
$212.16
|
| Rate for Payer: Lucent All Commercial |
$360.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.70
|
| Rate for Payer: PHCS All Commercial |
$497.25
|
| Rate for Payer: PHP All Commercial |
$502.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$258.57
|
| Rate for Payer: Sagamore Health Network All Products |
$511.84
|
| Rate for Payer: Signature Care EPO |
$550.29
|
| Rate for Payer: Signature Care PPO |
$583.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$563.55
|
| Rate for Payer: United Healthcare Commercial |
$522.44
|
| Rate for Payer: United Healthcare Medicare |
$212.16
|
|
|
HC DYE SPOT SYR
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
41601911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$229.82
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
|
|
HC DYE SPOT SYR
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
41601911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.46 |
| Max. Negotiated Rate |
$247.38 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Aetna Medicare |
$85.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$152.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.63
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Centivo All Commercial |
$144.70
|
| Rate for Payer: Cigna All Commercial |
$229.56
|
| Rate for Payer: CORVEL All Commercial |
$247.38
|
| Rate for Payer: Coventry All Commercial |
$234.08
|
| Rate for Payer: Encore All Commercial |
$244.85
|
| Rate for Payer: Frontpath All Commercial |
$244.72
|
| Rate for Payer: Humana ChoiceCare |
$229.74
|
| Rate for Payer: Humana Medicare |
$85.12
|
| Rate for Payer: Lucent All Commercial |
$144.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.40
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$199.50
|
| Rate for Payer: PHP All Commercial |
$201.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.74
|
| Rate for Payer: Sagamore Health Network All Products |
$205.35
|
| Rate for Payer: Signature Care EPO |
$220.78
|
| Rate for Payer: Signature Care PPO |
$234.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.10
|
| Rate for Payer: United Healthcare Commercial |
$209.61
|
| Rate for Payer: United Healthcare Medicare |
$85.12
|
|
|
HC DYSPHAGIA TREATMENT - SP
|
Facility
|
IP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
1742526
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$281.43
|
| Rate for Payer: Cash Price |
$195.44
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.16
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.36
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: United Healthcare Commercial |
$256.68
|
|
|
HC DYSPHAGIA TREATMENT - SP
|
Facility
|
OP
|
$325.73
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
1742526
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$302.93 |
| Rate for Payer: Aetna Commercial |
$274.92
|
| Rate for Payer: Aetna Medicare |
$104.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.66
|
| Rate for Payer: Cash Price |
$195.44
|
| Rate for Payer: Cash Price |
$195.44
|
| Rate for Payer: Centivo All Commercial |
$177.20
|
| Rate for Payer: Cigna All Commercial |
$281.10
|
| Rate for Payer: CORVEL All Commercial |
$302.93
|
| Rate for Payer: Coventry All Commercial |
$286.64
|
| Rate for Payer: Encore All Commercial |
$299.83
|
| Rate for Payer: Frontpath All Commercial |
$299.67
|
| Rate for Payer: Humana ChoiceCare |
$281.33
|
| Rate for Payer: Humana Medicare |
$104.23
|
| Rate for Payer: Lucent All Commercial |
$177.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.16
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$244.30
|
| Rate for Payer: PHP All Commercial |
$247.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.03
|
| Rate for Payer: Sagamore Health Network All Products |
$251.46
|
| Rate for Payer: Signature Care EPO |
$270.36
|
| Rate for Payer: Signature Care PPO |
$286.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.87
|
| Rate for Payer: United Healthcare Commercial |
$256.68
|
| Rate for Payer: United Healthcare Medicare |
$104.23
|
|
|
HC EAR CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$184.19
|
| Rate for Payer: Aetna Medicare |
$69.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$100.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.82
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Centivo All Commercial |
$118.72
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Humana Medicare |
$69.84
|
| Rate for Payer: Lucent All Commercial |
$118.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.11
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$185.50
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
| Rate for Payer: United Healthcare Medicare |
$69.84
|
|
|
HC EAR CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$130.94
|
| Rate for Payer: Cigna All Commercial |
$188.34
|
| Rate for Payer: CORVEL All Commercial |
$202.96
|
| Rate for Payer: Coventry All Commercial |
$192.05
|
| Rate for Payer: Encore All Commercial |
$200.89
|
| Rate for Payer: Frontpath All Commercial |
$200.78
|
| Rate for Payer: Humana ChoiceCare |
$188.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.42
|
| Rate for Payer: PHCS All Commercial |
$163.68
|
| Rate for Payer: PHP All Commercial |
$165.51
|
| Rate for Payer: Sagamore Health Network All Products |
$168.48
|
| Rate for Payer: Signature Care EPO |
$181.14
|
| Rate for Payer: Signature Care PPO |
$192.05
|
| Rate for Payer: United Healthcare Commercial |
$171.97
|
|
|
HC EBV EARLY ANTIGEN
|
Facility
|
OP
|
$108.27
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
63001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$100.69 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.11
|
| Rate for Payer: Cash Price |
$64.96
|
| Rate for Payer: Cash Price |
$64.96
|
| Rate for Payer: Centivo All Commercial |
$58.90
|
| Rate for Payer: Cigna All Commercial |
$93.44
|
| Rate for Payer: CORVEL All Commercial |
$100.69
|
| Rate for Payer: Coventry All Commercial |
$95.28
|
| Rate for Payer: Encore All Commercial |
$99.66
|
| Rate for Payer: Frontpath All Commercial |
$99.61
|
| Rate for Payer: Humana ChoiceCare |
$93.51
|
| Rate for Payer: Humana Medicare |
$34.65
|
| Rate for Payer: Lucent All Commercial |
$58.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.44
|
| Rate for Payer: Managed Health Services Medicaid |
$13.12
|
| Rate for Payer: MDWise Medicaid |
$13.12
|
| Rate for Payer: PHCS All Commercial |
$81.20
|
| Rate for Payer: PHP All Commercial |
$82.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.23
|
| Rate for Payer: Sagamore Health Network All Products |
$83.58
|
| Rate for Payer: Signature Care EPO |
$89.86
|
| Rate for Payer: Signature Care PPO |
$95.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.03
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
|
|
HC EBV EARLY ANTIGEN
|
Facility
|
IP
|
$108.27
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
63001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$100.69 |
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Cash Price |
$64.96
|
| Rate for Payer: Cigna All Commercial |
$93.44
|
| Rate for Payer: CORVEL All Commercial |
$100.69
|
| Rate for Payer: Coventry All Commercial |
$95.28
|
| Rate for Payer: Encore All Commercial |
$99.66
|
| Rate for Payer: Frontpath All Commercial |
$99.61
|
| Rate for Payer: Humana ChoiceCare |
$93.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.44
|
| Rate for Payer: PHCS All Commercial |
$81.20
|
| Rate for Payer: PHP All Commercial |
$82.11
|
| Rate for Payer: Sagamore Health Network All Products |
$83.58
|
| Rate for Payer: Signature Care EPO |
$89.86
|
| Rate for Payer: Signature Care PPO |
$95.28
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
|
|
HC EBV EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63087807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$27.32
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cigna All Commercial |
$27.29
|
| Rate for Payer: CORVEL All Commercial |
$29.41
|
| Rate for Payer: Coventry All Commercial |
$27.83
|
| Rate for Payer: Encore All Commercial |
$29.11
|
| Rate for Payer: Frontpath All Commercial |
$29.09
|
| Rate for Payer: Humana ChoiceCare |
$27.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.46
|
| Rate for Payer: PHCS All Commercial |
$23.71
|
| Rate for Payer: PHP All Commercial |
$23.98
|
| Rate for Payer: Sagamore Health Network All Products |
$24.41
|
| Rate for Payer: Signature Care EPO |
$26.24
|
| Rate for Payer: Signature Care PPO |
$27.83
|
| Rate for Payer: United Healthcare Commercial |
$24.92
|
|
|
HC EBV EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63087807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$26.69
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$14.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.13
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Centivo All Commercial |
$17.20
|
| Rate for Payer: Cigna All Commercial |
$27.29
|
| Rate for Payer: CORVEL All Commercial |
$29.41
|
| Rate for Payer: Coventry All Commercial |
$27.83
|
| Rate for Payer: Encore All Commercial |
$29.11
|
| Rate for Payer: Frontpath All Commercial |
$29.09
|
| Rate for Payer: Humana ChoiceCare |
$27.31
|
| Rate for Payer: Humana Medicare |
$10.12
|
| Rate for Payer: Lucent All Commercial |
$17.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.46
|
| Rate for Payer: Managed Health Services Medicaid |
$15.29
|
| Rate for Payer: MDWise Medicaid |
$15.29
|
| Rate for Payer: PHCS All Commercial |
$23.71
|
| Rate for Payer: PHP All Commercial |
$23.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.33
|
| Rate for Payer: Sagamore Health Network All Products |
$24.41
|
| Rate for Payer: Signature Care EPO |
$26.24
|
| Rate for Payer: Signature Care PPO |
$27.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.88
|
| Rate for Payer: United Healthcare Commercial |
$24.92
|
| Rate for Payer: United Healthcare Medicare |
$10.12
|
|
|
HC EBV NUCLEAR AG IGG
|
Facility
|
OP
|
$124.54
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63001938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$115.82 |
| Rate for Payer: Aetna Commercial |
$105.11
|
| Rate for Payer: Aetna Medicare |
$39.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$57.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.84
|
| Rate for Payer: Cash Price |
$74.72
|
| Rate for Payer: Cash Price |
$74.72
|
| Rate for Payer: Centivo All Commercial |
$67.75
|
| Rate for Payer: Cigna All Commercial |
$107.48
|
| Rate for Payer: CORVEL All Commercial |
$115.82
|
| Rate for Payer: Coventry All Commercial |
$109.60
|
| Rate for Payer: Encore All Commercial |
$114.64
|
| Rate for Payer: Frontpath All Commercial |
$114.58
|
| Rate for Payer: Humana ChoiceCare |
$107.57
|
| Rate for Payer: Humana Medicare |
$39.85
|
| Rate for Payer: Lucent All Commercial |
$67.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.09
|
| Rate for Payer: Managed Health Services Medicaid |
$15.29
|
| Rate for Payer: MDWise Medicaid |
$15.29
|
| Rate for Payer: PHCS All Commercial |
$93.41
|
| Rate for Payer: PHP All Commercial |
$94.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.57
|
| Rate for Payer: Sagamore Health Network All Products |
$96.14
|
| Rate for Payer: Signature Care EPO |
$103.37
|
| Rate for Payer: Signature Care PPO |
$109.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.86
|
| Rate for Payer: United Healthcare Commercial |
$98.14
|
| Rate for Payer: United Healthcare Medicare |
$39.85
|
|
|
HC EBV NUCLEAR AG IGG
|
Facility
|
IP
|
$124.54
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
63001938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.41 |
| Max. Negotiated Rate |
$115.82 |
| Rate for Payer: Aetna Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$74.72
|
| Rate for Payer: Cigna All Commercial |
$107.48
|
| Rate for Payer: CORVEL All Commercial |
$115.82
|
| Rate for Payer: Coventry All Commercial |
$109.60
|
| Rate for Payer: Encore All Commercial |
$114.64
|
| Rate for Payer: Frontpath All Commercial |
$114.58
|
| Rate for Payer: Humana ChoiceCare |
$107.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.09
|
| Rate for Payer: PHCS All Commercial |
$93.41
|
| Rate for Payer: PHP All Commercial |
$94.45
|
| Rate for Payer: Sagamore Health Network All Products |
$96.14
|
| Rate for Payer: Signature Care EPO |
$103.37
|
| Rate for Payer: Signature Care PPO |
$109.60
|
| Rate for Payer: United Healthcare Commercial |
$98.14
|
|
|
HC EBV VIRAL CAPSID IGG
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC EBV VIRAL CAPSID IGG
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.24
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Centivo All Commercial |
$91.56
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$53.86
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$18.14
|
| Rate for Payer: MDWise Medicaid |
$18.14
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$53.86
|
|
|
HC EBV VIRAL CAPSID IGM
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.24
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Centivo All Commercial |
$91.56
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$53.86
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$18.14
|
| Rate for Payer: MDWise Medicaid |
$18.14
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$53.86
|
|
|
HC EBV VIRAL CAPSID IGM
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
63001940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC ECG UP TO 48 HRS SCAN ANALYS RPRT HOLTER
|
Facility
|
IP
|
$815.61
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
1503226
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$611.71 |
| Max. Negotiated Rate |
$758.52 |
| Rate for Payer: Aetna Commercial |
$704.69
|
| Rate for Payer: Cash Price |
$489.37
|
| Rate for Payer: Cigna All Commercial |
$703.87
|
| Rate for Payer: CORVEL All Commercial |
$758.52
|
| Rate for Payer: Coventry All Commercial |
$717.74
|
| Rate for Payer: Encore All Commercial |
$750.77
|
| Rate for Payer: Frontpath All Commercial |
$750.36
|
| Rate for Payer: Humana ChoiceCare |
$704.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.05
|
| Rate for Payer: PHCS All Commercial |
$611.71
|
| Rate for Payer: PHP All Commercial |
$618.56
|
| Rate for Payer: Sagamore Health Network All Products |
$629.65
|
| Rate for Payer: Signature Care EPO |
$676.96
|
| Rate for Payer: Signature Care PPO |
$717.74
|
| Rate for Payer: United Healthcare Commercial |
$642.70
|
|
|
HC ECG UP TO 48 HRS SCAN ANALYS RPRT HOLTER
|
Facility
|
OP
|
$815.61
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
1503226
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$758.52 |
| Rate for Payer: Aetna Commercial |
$688.37
|
| Rate for Payer: Aetna Medicare |
$261.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$468.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$509.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$144.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$300.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$287.09
|
| Rate for Payer: Cash Price |
$489.37
|
| Rate for Payer: Cash Price |
$489.37
|
| Rate for Payer: Centivo All Commercial |
$443.69
|
| Rate for Payer: Cigna All Commercial |
$703.87
|
| Rate for Payer: CORVEL All Commercial |
$758.52
|
| Rate for Payer: Coventry All Commercial |
$717.74
|
| Rate for Payer: Encore All Commercial |
$750.77
|
| Rate for Payer: Frontpath All Commercial |
$750.36
|
| Rate for Payer: Humana ChoiceCare |
$704.44
|
| Rate for Payer: Humana Medicare |
$261.00
|
| Rate for Payer: Lucent All Commercial |
$443.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.05
|
| Rate for Payer: Managed Health Services Medicaid |
$144.59
|
| Rate for Payer: MDWise Medicaid |
$144.59
|
| Rate for Payer: PHCS All Commercial |
$611.71
|
| Rate for Payer: PHP All Commercial |
$618.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.09
|
| Rate for Payer: Sagamore Health Network All Products |
$629.65
|
| Rate for Payer: Signature Care EPO |
$676.96
|
| Rate for Payer: Signature Care PPO |
$717.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.27
|
| Rate for Payer: United Healthcare Commercial |
$642.70
|
| Rate for Payer: United Healthcare Medicare |
$261.00
|
|
|
HC ECHO - 2-D & M-MODE - LIMITED
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
863308
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$881.28
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna All Commercial |
$880.26
|
| Rate for Payer: CORVEL All Commercial |
$948.60
|
| Rate for Payer: Coventry All Commercial |
$897.60
|
| Rate for Payer: Encore All Commercial |
$938.91
|
| Rate for Payer: Frontpath All Commercial |
$938.40
|
| Rate for Payer: Humana ChoiceCare |
$880.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: PHCS All Commercial |
$765.00
|
| Rate for Payer: PHP All Commercial |
$773.57
|
| Rate for Payer: Sagamore Health Network All Products |
$787.44
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$897.60
|
| Rate for Payer: United Healthcare Commercial |
$803.76
|
|
|
HC ECHO - 2-D & M-MODE - LIMITED
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
863308
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$202.23 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$860.88
|
| Rate for Payer: Aetna Medicare |
$326.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$316.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$585.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.04
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Centivo All Commercial |
$554.88
|
| Rate for Payer: Cigna All Commercial |
$880.26
|
| Rate for Payer: CORVEL All Commercial |
$948.60
|
| Rate for Payer: Coventry All Commercial |
$897.60
|
| Rate for Payer: Encore All Commercial |
$938.91
|
| Rate for Payer: Frontpath All Commercial |
$938.40
|
| Rate for Payer: Humana ChoiceCare |
$880.97
|
| Rate for Payer: Humana Medicare |
$326.40
|
| Rate for Payer: Lucent All Commercial |
$554.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$765.00
|
| Rate for Payer: PHP All Commercial |
$773.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.80
|
| Rate for Payer: Sagamore Health Network All Products |
$787.44
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$897.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$867.00
|
| Rate for Payer: United Healthcare Commercial |
$803.76
|
| Rate for Payer: United Healthcare Medicare |
$326.40
|
|
|
HC ECHO MYOCARDIAL STRAIN IMAGING
|
Facility
|
OP
|
$564.52
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
860399
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$476.45
|
| Rate for Payer: Aetna Medicare |
$180.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$324.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$352.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$202.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.71
|
| Rate for Payer: Cash Price |
$338.71
|
| Rate for Payer: Cash Price |
$338.71
|
| Rate for Payer: Centivo All Commercial |
$307.10
|
| Rate for Payer: Cigna All Commercial |
$487.18
|
| Rate for Payer: CORVEL All Commercial |
$525.00
|
| Rate for Payer: Coventry All Commercial |
$496.78
|
| Rate for Payer: Encore All Commercial |
$519.64
|
| Rate for Payer: Frontpath All Commercial |
$519.36
|
| Rate for Payer: Humana ChoiceCare |
$487.58
|
| Rate for Payer: Humana Medicare |
$180.65
|
| Rate for Payer: Lucent All Commercial |
$307.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$508.07
|
| Rate for Payer: Managed Health Services Medicaid |
$202.23
|
| Rate for Payer: MDWise Medicaid |
$202.23
|
| Rate for Payer: PHCS All Commercial |
$423.39
|
| Rate for Payer: PHP All Commercial |
$428.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$220.16
|
| Rate for Payer: Sagamore Health Network All Products |
$435.81
|
| Rate for Payer: Signature Care EPO |
$468.55
|
| Rate for Payer: Signature Care PPO |
$496.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$479.84
|
| Rate for Payer: United Healthcare Commercial |
$444.84
|
| Rate for Payer: United Healthcare Medicare |
$180.65
|
|
