|
HC ENDO TUBE PORT CUFF 6.5
|
Facility
|
OP
|
$17.01
|
|
| Hospital Charge Code |
41601046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Centivo All Commercial |
$9.25
|
| Rate for Payer: Cigna All Commercial |
$14.68
|
| Rate for Payer: CORVEL All Commercial |
$15.82
|
| Rate for Payer: Coventry All Commercial |
$14.97
|
| Rate for Payer: Encore All Commercial |
$15.66
|
| Rate for Payer: Frontpath All Commercial |
$15.65
|
| Rate for Payer: Humana ChoiceCare |
$14.69
|
| Rate for Payer: Humana Medicare |
$5.44
|
| Rate for Payer: Lucent All Commercial |
$9.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.31
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.76
|
| Rate for Payer: PHP All Commercial |
$12.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.63
|
| Rate for Payer: Sagamore Health Network All Products |
$13.13
|
| Rate for Payer: Signature Care EPO |
$14.12
|
| Rate for Payer: Signature Care PPO |
$14.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.46
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
| Rate for Payer: United Healthcare Medicare |
$5.44
|
|
|
HC ENDO TUBE PORT CUFF 7.0
|
Facility
|
OP
|
$17.64
|
|
| Hospital Charge Code |
41601047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Medicare |
$5.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.21
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Centivo All Commercial |
$9.60
|
| Rate for Payer: Cigna All Commercial |
$15.22
|
| Rate for Payer: CORVEL All Commercial |
$16.41
|
| Rate for Payer: Coventry All Commercial |
$15.52
|
| Rate for Payer: Encore All Commercial |
$16.24
|
| Rate for Payer: Frontpath All Commercial |
$16.23
|
| Rate for Payer: Humana ChoiceCare |
$15.24
|
| Rate for Payer: Humana Medicare |
$5.64
|
| Rate for Payer: Lucent All Commercial |
$9.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.88
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.23
|
| Rate for Payer: PHP All Commercial |
$13.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.88
|
| Rate for Payer: Sagamore Health Network All Products |
$13.62
|
| Rate for Payer: Signature Care EPO |
$14.64
|
| Rate for Payer: Signature Care PPO |
$15.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$13.90
|
| Rate for Payer: United Healthcare Medicare |
$5.64
|
|
|
HC ENDO TUBE PORT CUFF 7.0
|
Facility
|
IP
|
$17.64
|
|
| Hospital Charge Code |
41601047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna Commercial |
$15.24
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cigna All Commercial |
$15.22
|
| Rate for Payer: CORVEL All Commercial |
$16.41
|
| Rate for Payer: Coventry All Commercial |
$15.52
|
| Rate for Payer: Encore All Commercial |
$16.24
|
| Rate for Payer: Frontpath All Commercial |
$16.23
|
| Rate for Payer: Humana ChoiceCare |
$15.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.88
|
| Rate for Payer: PHCS All Commercial |
$13.23
|
| Rate for Payer: PHP All Commercial |
$13.38
|
| Rate for Payer: Sagamore Health Network All Products |
$13.62
|
| Rate for Payer: Signature Care EPO |
$14.64
|
| Rate for Payer: Signature Care PPO |
$15.52
|
| Rate for Payer: United Healthcare Commercial |
$13.90
|
|
|
HC ENDO TUBE PORT CUFF 7.5
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
41601048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.95
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Centivo All Commercial |
$9.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Lucent All Commercial |
$9.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.91
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.05
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
| Rate for Payer: United Healthcare Medicare |
$5.67
|
|
|
HC ENDO TUBE PORT CUFF 7.5
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
41601048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cigna All Commercial |
$15.28
|
| Rate for Payer: CORVEL All Commercial |
$16.47
|
| Rate for Payer: Coventry All Commercial |
$15.58
|
| Rate for Payer: Encore All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$16.29
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.94
|
| Rate for Payer: PHCS All Commercial |
$13.28
|
| Rate for Payer: PHP All Commercial |
$13.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.67
|
| Rate for Payer: Signature Care EPO |
$14.70
|
| Rate for Payer: Signature Care PPO |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$13.96
|
|
|
HC ENDO TUBE PORT CUFF 8.0
|
Facility
|
IP
|
$17.22
|
|
| Hospital Charge Code |
41601049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cigna All Commercial |
$14.86
|
| Rate for Payer: CORVEL All Commercial |
$16.01
|
| Rate for Payer: Coventry All Commercial |
$15.15
|
| Rate for Payer: Encore All Commercial |
$15.85
|
| Rate for Payer: Frontpath All Commercial |
$15.84
|
| Rate for Payer: Humana ChoiceCare |
$14.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.50
|
| Rate for Payer: PHCS All Commercial |
$12.91
|
| Rate for Payer: PHP All Commercial |
$13.06
|
| Rate for Payer: Sagamore Health Network All Products |
$13.29
|
| Rate for Payer: Signature Care EPO |
$14.29
|
| Rate for Payer: Signature Care PPO |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$13.57
|
|
|
HC ENDO TUBE PORT CUFF 8.0
|
Facility
|
OP
|
$17.22
|
|
| Hospital Charge Code |
41601049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.06
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Centivo All Commercial |
$9.37
|
| Rate for Payer: Cigna All Commercial |
$14.86
|
| Rate for Payer: CORVEL All Commercial |
$16.01
|
| Rate for Payer: Coventry All Commercial |
$15.15
|
| Rate for Payer: Encore All Commercial |
$15.85
|
| Rate for Payer: Frontpath All Commercial |
$15.84
|
| Rate for Payer: Humana ChoiceCare |
$14.87
|
| Rate for Payer: Humana Medicare |
$5.51
|
| Rate for Payer: Lucent All Commercial |
$9.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.91
|
| Rate for Payer: PHP All Commercial |
$13.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.72
|
| Rate for Payer: Sagamore Health Network All Products |
$13.29
|
| Rate for Payer: Signature Care EPO |
$14.29
|
| Rate for Payer: Signature Care PPO |
$15.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.64
|
| Rate for Payer: United Healthcare Commercial |
$13.57
|
| Rate for Payer: United Healthcare Medicare |
$5.51
|
|
|
HC ENSEAL 25 CURVED
|
Facility
|
IP
|
$2,188.87
|
|
| Hospital Charge Code |
41607439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.65 |
| Max. Negotiated Rate |
$2,035.65 |
| Rate for Payer: Aetna Commercial |
$1,891.18
|
| Rate for Payer: Cash Price |
$1,313.32
|
| Rate for Payer: Cigna All Commercial |
$1,888.99
|
| Rate for Payer: CORVEL All Commercial |
$2,035.65
|
| Rate for Payer: Coventry All Commercial |
$1,926.21
|
| Rate for Payer: Encore All Commercial |
$2,014.85
|
| Rate for Payer: Frontpath All Commercial |
$2,013.76
|
| Rate for Payer: Humana ChoiceCare |
$1,890.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,969.98
|
| Rate for Payer: PHCS All Commercial |
$1,641.65
|
| Rate for Payer: PHP All Commercial |
$1,660.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,689.81
|
| Rate for Payer: Signature Care EPO |
$1,816.76
|
| Rate for Payer: Signature Care PPO |
$1,926.21
|
| Rate for Payer: United Healthcare Commercial |
$1,724.83
|
|
|
HC ENSEAL 25 CURVED
|
Facility
|
OP
|
$2,188.87
|
|
| Hospital Charge Code |
41607439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,035.65 |
| Rate for Payer: Aetna Commercial |
$1,847.41
|
| Rate for Payer: Aetna Medicare |
$700.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$678.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,257.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,368.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$805.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$770.48
|
| Rate for Payer: Cash Price |
$1,313.32
|
| Rate for Payer: Cash Price |
$1,313.32
|
| Rate for Payer: Centivo All Commercial |
$1,190.75
|
| Rate for Payer: Cigna All Commercial |
$1,888.99
|
| Rate for Payer: CORVEL All Commercial |
$2,035.65
|
| Rate for Payer: Coventry All Commercial |
$1,926.21
|
| Rate for Payer: Encore All Commercial |
$2,014.85
|
| Rate for Payer: Frontpath All Commercial |
$2,013.76
|
| Rate for Payer: Humana ChoiceCare |
$1,890.53
|
| Rate for Payer: Humana Medicare |
$700.44
|
| Rate for Payer: Lucent All Commercial |
$1,190.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,969.98
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,641.65
|
| Rate for Payer: PHP All Commercial |
$1,660.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$853.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,689.81
|
| Rate for Payer: Signature Care EPO |
$1,816.76
|
| Rate for Payer: Signature Care PPO |
$1,926.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,860.54
|
| Rate for Payer: United Healthcare Commercial |
$1,724.83
|
| Rate for Payer: United Healthcare Medicare |
$700.44
|
|
|
HC ENSEAL 37 CURVED
|
Facility
|
OP
|
$2,392.53
|
|
| Hospital Charge Code |
41607440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,225.05 |
| Rate for Payer: Aetna Commercial |
$2,019.30
|
| Rate for Payer: Aetna Medicare |
$765.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$741.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,374.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,495.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$880.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$842.17
|
| Rate for Payer: Cash Price |
$1,435.52
|
| Rate for Payer: Cash Price |
$1,435.52
|
| Rate for Payer: Centivo All Commercial |
$1,301.54
|
| Rate for Payer: Cigna All Commercial |
$2,064.75
|
| Rate for Payer: CORVEL All Commercial |
$2,225.05
|
| Rate for Payer: Coventry All Commercial |
$2,105.43
|
| Rate for Payer: Encore All Commercial |
$2,202.32
|
| Rate for Payer: Frontpath All Commercial |
$2,201.13
|
| Rate for Payer: Humana ChoiceCare |
$2,066.43
|
| Rate for Payer: Humana Medicare |
$765.61
|
| Rate for Payer: Lucent All Commercial |
$1,301.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,153.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,794.40
|
| Rate for Payer: PHP All Commercial |
$1,814.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$933.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,847.03
|
| Rate for Payer: Signature Care EPO |
$1,985.80
|
| Rate for Payer: Signature Care PPO |
$2,105.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,033.65
|
| Rate for Payer: United Healthcare Commercial |
$1,885.31
|
| Rate for Payer: United Healthcare Medicare |
$765.61
|
|
|
HC ENSEAL 37 CURVED
|
Facility
|
IP
|
$2,392.53
|
|
| Hospital Charge Code |
41607440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,794.40 |
| Max. Negotiated Rate |
$2,225.05 |
| Rate for Payer: Aetna Commercial |
$2,067.15
|
| Rate for Payer: Cash Price |
$1,435.52
|
| Rate for Payer: Cigna All Commercial |
$2,064.75
|
| Rate for Payer: CORVEL All Commercial |
$2,225.05
|
| Rate for Payer: Coventry All Commercial |
$2,105.43
|
| Rate for Payer: Encore All Commercial |
$2,202.32
|
| Rate for Payer: Frontpath All Commercial |
$2,201.13
|
| Rate for Payer: Humana ChoiceCare |
$2,066.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,153.28
|
| Rate for Payer: PHCS All Commercial |
$1,794.40
|
| Rate for Payer: PHP All Commercial |
$1,814.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,847.03
|
| Rate for Payer: Signature Care EPO |
$1,985.80
|
| Rate for Payer: Signature Care PPO |
$2,105.43
|
| Rate for Payer: United Healthcare Commercial |
$1,885.31
|
|
|
HC EPIDURAL N RX KIT
|
Facility
|
IP
|
$251.30
|
|
| Hospital Charge Code |
41601066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.47 |
| Max. Negotiated Rate |
$233.71 |
| Rate for Payer: Aetna Commercial |
$217.12
|
| Rate for Payer: Cash Price |
$150.78
|
| Rate for Payer: Cigna All Commercial |
$216.87
|
| Rate for Payer: CORVEL All Commercial |
$233.71
|
| Rate for Payer: Coventry All Commercial |
$221.14
|
| Rate for Payer: Encore All Commercial |
$231.32
|
| Rate for Payer: Frontpath All Commercial |
$231.20
|
| Rate for Payer: Humana ChoiceCare |
$217.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.17
|
| Rate for Payer: PHCS All Commercial |
$188.47
|
| Rate for Payer: PHP All Commercial |
$190.59
|
| Rate for Payer: Sagamore Health Network All Products |
$194.00
|
| Rate for Payer: Signature Care EPO |
$208.58
|
| Rate for Payer: Signature Care PPO |
$221.14
|
| Rate for Payer: United Healthcare Commercial |
$198.02
|
|
|
HC EPIDURAL N RX KIT
|
Facility
|
OP
|
$251.30
|
|
| Hospital Charge Code |
41601066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$233.71 |
| Rate for Payer: Aetna Commercial |
$212.10
|
| Rate for Payer: Aetna Medicare |
$80.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$77.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.46
|
| Rate for Payer: Cash Price |
$150.78
|
| Rate for Payer: Cash Price |
$150.78
|
| Rate for Payer: Centivo All Commercial |
$136.71
|
| Rate for Payer: Cigna All Commercial |
$216.87
|
| Rate for Payer: CORVEL All Commercial |
$233.71
|
| Rate for Payer: Coventry All Commercial |
$221.14
|
| Rate for Payer: Encore All Commercial |
$231.32
|
| Rate for Payer: Frontpath All Commercial |
$231.20
|
| Rate for Payer: Humana ChoiceCare |
$217.05
|
| Rate for Payer: Humana Medicare |
$80.42
|
| Rate for Payer: Lucent All Commercial |
$136.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.17
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$188.47
|
| Rate for Payer: PHP All Commercial |
$190.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.01
|
| Rate for Payer: Sagamore Health Network All Products |
$194.00
|
| Rate for Payer: Signature Care EPO |
$208.58
|
| Rate for Payer: Signature Care PPO |
$221.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.60
|
| Rate for Payer: United Healthcare Commercial |
$198.02
|
| Rate for Payer: United Healthcare Medicare |
$80.42
|
|
|
HC EPIDURAL PLACEMENT
|
Facility
|
IP
|
$795.60
|
|
| Hospital Charge Code |
1028001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$596.70 |
| Max. Negotiated Rate |
$739.91 |
| Rate for Payer: Aetna Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$477.36
|
| Rate for Payer: Cigna All Commercial |
$686.60
|
| Rate for Payer: CORVEL All Commercial |
$739.91
|
| Rate for Payer: Coventry All Commercial |
$700.13
|
| Rate for Payer: Encore All Commercial |
$732.35
|
| Rate for Payer: Frontpath All Commercial |
$731.95
|
| Rate for Payer: Humana ChoiceCare |
$687.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.04
|
| Rate for Payer: PHCS All Commercial |
$596.70
|
| Rate for Payer: PHP All Commercial |
$603.38
|
| Rate for Payer: Sagamore Health Network All Products |
$614.20
|
| Rate for Payer: Signature Care EPO |
$660.35
|
| Rate for Payer: Signature Care PPO |
$700.13
|
| Rate for Payer: United Healthcare Commercial |
$626.93
|
|
|
HC EPIDURAL PLACEMENT
|
Facility
|
OP
|
$795.60
|
|
| Hospital Charge Code |
1028001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$739.91 |
| Rate for Payer: Aetna Commercial |
$671.49
|
| Rate for Payer: Aetna Medicare |
$254.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$126.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$246.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$456.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$497.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$126.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.05
|
| Rate for Payer: Cash Price |
$477.36
|
| Rate for Payer: Cash Price |
$477.36
|
| Rate for Payer: Centivo All Commercial |
$432.81
|
| Rate for Payer: Cigna All Commercial |
$686.60
|
| Rate for Payer: CORVEL All Commercial |
$739.91
|
| Rate for Payer: Coventry All Commercial |
$700.13
|
| Rate for Payer: Encore All Commercial |
$732.35
|
| Rate for Payer: Frontpath All Commercial |
$731.95
|
| Rate for Payer: Humana ChoiceCare |
$687.16
|
| Rate for Payer: Humana Medicare |
$254.59
|
| Rate for Payer: Lucent All Commercial |
$432.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.04
|
| Rate for Payer: Managed Health Services Medicaid |
$126.33
|
| Rate for Payer: MDWise Medicaid |
$126.33
|
| Rate for Payer: PHCS All Commercial |
$596.70
|
| Rate for Payer: PHP All Commercial |
$603.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$310.28
|
| Rate for Payer: Sagamore Health Network All Products |
$614.20
|
| Rate for Payer: Signature Care EPO |
$660.35
|
| Rate for Payer: Signature Care PPO |
$700.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$676.26
|
| Rate for Payer: United Healthcare Commercial |
$626.93
|
| Rate for Payer: United Healthcare Medicare |
$254.59
|
|
|
HC EPISTAXIS RR ANTERIOR ADULT 5.5CM
|
Facility
|
OP
|
$327.74
|
|
| Hospital Charge Code |
41601871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Aetna Commercial |
$276.61
|
| Rate for Payer: Aetna Medicare |
$104.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$188.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.36
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Centivo All Commercial |
$178.29
|
| Rate for Payer: Cigna All Commercial |
$282.84
|
| Rate for Payer: CORVEL All Commercial |
$304.80
|
| Rate for Payer: Coventry All Commercial |
$288.41
|
| Rate for Payer: Encore All Commercial |
$301.68
|
| Rate for Payer: Frontpath All Commercial |
$301.52
|
| Rate for Payer: Humana ChoiceCare |
$283.07
|
| Rate for Payer: Humana Medicare |
$104.88
|
| Rate for Payer: Lucent All Commercial |
$178.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.97
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$245.81
|
| Rate for Payer: PHP All Commercial |
$248.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.82
|
| Rate for Payer: Sagamore Health Network All Products |
$253.02
|
| Rate for Payer: Signature Care EPO |
$272.02
|
| Rate for Payer: Signature Care PPO |
$288.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.58
|
| Rate for Payer: United Healthcare Commercial |
$258.26
|
| Rate for Payer: United Healthcare Medicare |
$104.88
|
|
|
HC EPISTAXIS RR ANTERIOR ADULT 5.5CM
|
Facility
|
IP
|
$327.74
|
|
| Hospital Charge Code |
41601871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.81 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Aetna Commercial |
$283.17
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Cigna All Commercial |
$282.84
|
| Rate for Payer: CORVEL All Commercial |
$304.80
|
| Rate for Payer: Coventry All Commercial |
$288.41
|
| Rate for Payer: Encore All Commercial |
$301.68
|
| Rate for Payer: Frontpath All Commercial |
$301.52
|
| Rate for Payer: Humana ChoiceCare |
$283.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.97
|
| Rate for Payer: PHCS All Commercial |
$245.81
|
| Rate for Payer: PHP All Commercial |
$248.56
|
| Rate for Payer: Sagamore Health Network All Products |
$253.02
|
| Rate for Payer: Signature Care EPO |
$272.02
|
| Rate for Payer: Signature Care PPO |
$288.41
|
| Rate for Payer: United Healthcare Commercial |
$258.26
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM
|
Facility
|
OP
|
$268.10
|
|
| Hospital Charge Code |
41601872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$249.33 |
| Rate for Payer: Aetna Commercial |
$226.28
|
| Rate for Payer: Aetna Medicare |
$85.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$153.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$167.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.37
|
| Rate for Payer: Cash Price |
$160.86
|
| Rate for Payer: Cash Price |
$160.86
|
| Rate for Payer: Centivo All Commercial |
$145.85
|
| Rate for Payer: Cigna All Commercial |
$231.37
|
| Rate for Payer: CORVEL All Commercial |
$249.33
|
| Rate for Payer: Coventry All Commercial |
$235.93
|
| Rate for Payer: Encore All Commercial |
$246.79
|
| Rate for Payer: Frontpath All Commercial |
$246.65
|
| Rate for Payer: Humana ChoiceCare |
$231.56
|
| Rate for Payer: Humana Medicare |
$85.79
|
| Rate for Payer: Lucent All Commercial |
$145.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.29
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$201.07
|
| Rate for Payer: PHP All Commercial |
$203.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.56
|
| Rate for Payer: Sagamore Health Network All Products |
$206.97
|
| Rate for Payer: Signature Care EPO |
$222.52
|
| Rate for Payer: Signature Care PPO |
$235.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$227.88
|
| Rate for Payer: United Healthcare Commercial |
$211.26
|
| Rate for Payer: United Healthcare Medicare |
$85.79
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM
|
Facility
|
IP
|
$268.10
|
|
| Hospital Charge Code |
41601872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.07 |
| Max. Negotiated Rate |
$249.33 |
| Rate for Payer: Aetna Commercial |
$231.64
|
| Rate for Payer: Cash Price |
$160.86
|
| Rate for Payer: Cigna All Commercial |
$231.37
|
| Rate for Payer: CORVEL All Commercial |
$249.33
|
| Rate for Payer: Coventry All Commercial |
$235.93
|
| Rate for Payer: Encore All Commercial |
$246.79
|
| Rate for Payer: Frontpath All Commercial |
$246.65
|
| Rate for Payer: Humana ChoiceCare |
$231.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.29
|
| Rate for Payer: PHCS All Commercial |
$201.07
|
| Rate for Payer: PHP All Commercial |
$203.33
|
| Rate for Payer: Sagamore Health Network All Products |
$206.97
|
| Rate for Payer: Signature Care EPO |
$222.52
|
| Rate for Payer: Signature Care PPO |
$235.93
|
| Rate for Payer: United Healthcare Commercial |
$211.26
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM INCLD COPD
|
Facility
|
OP
|
$346.36
|
|
| Hospital Charge Code |
41601873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$322.11 |
| Rate for Payer: Aetna Commercial |
$292.33
|
| Rate for Payer: Aetna Medicare |
$110.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$198.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.92
|
| Rate for Payer: Cash Price |
$207.82
|
| Rate for Payer: Cash Price |
$207.82
|
| Rate for Payer: Centivo All Commercial |
$188.42
|
| Rate for Payer: Cigna All Commercial |
$298.91
|
| Rate for Payer: CORVEL All Commercial |
$322.11
|
| Rate for Payer: Coventry All Commercial |
$304.80
|
| Rate for Payer: Encore All Commercial |
$318.82
|
| Rate for Payer: Frontpath All Commercial |
$318.65
|
| Rate for Payer: Humana ChoiceCare |
$299.15
|
| Rate for Payer: Humana Medicare |
$110.84
|
| Rate for Payer: Lucent All Commercial |
$188.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$259.77
|
| Rate for Payer: PHP All Commercial |
$262.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.08
|
| Rate for Payer: Sagamore Health Network All Products |
$267.39
|
| Rate for Payer: Signature Care EPO |
$287.48
|
| Rate for Payer: Signature Care PPO |
$304.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$294.41
|
| Rate for Payer: United Healthcare Commercial |
$272.93
|
| Rate for Payer: United Healthcare Medicare |
$110.84
|
|
|
HC EPISTAXIS RR POST/ANTR 7.5CM INCLD COPD
|
Facility
|
IP
|
$346.36
|
|
| Hospital Charge Code |
41601873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.77 |
| Max. Negotiated Rate |
$322.11 |
| Rate for Payer: Aetna Commercial |
$299.26
|
| Rate for Payer: Cash Price |
$207.82
|
| Rate for Payer: Cigna All Commercial |
$298.91
|
| Rate for Payer: CORVEL All Commercial |
$322.11
|
| Rate for Payer: Coventry All Commercial |
$304.80
|
| Rate for Payer: Encore All Commercial |
$318.82
|
| Rate for Payer: Frontpath All Commercial |
$318.65
|
| Rate for Payer: Humana ChoiceCare |
$299.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.72
|
| Rate for Payer: PHCS All Commercial |
$259.77
|
| Rate for Payer: PHP All Commercial |
$262.68
|
| Rate for Payer: Sagamore Health Network All Products |
$267.39
|
| Rate for Payer: Signature Care EPO |
$287.48
|
| Rate for Payer: Signature Care PPO |
$304.80
|
| Rate for Payer: United Healthcare Commercial |
$272.93
|
|
|
HC EPSTEIN-BARR VIRUS, QUANTITATIVE PCR
|
Facility
|
OP
|
$398.82
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$370.90 |
| Rate for Payer: Aetna Commercial |
$336.60
|
| Rate for Payer: Aetna Medicare |
$127.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$183.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.38
|
| Rate for Payer: Cash Price |
$239.29
|
| Rate for Payer: Cash Price |
$239.29
|
| Rate for Payer: Centivo All Commercial |
$216.96
|
| Rate for Payer: Cigna All Commercial |
$344.18
|
| Rate for Payer: CORVEL All Commercial |
$370.90
|
| Rate for Payer: Coventry All Commercial |
$350.96
|
| Rate for Payer: Encore All Commercial |
$367.11
|
| Rate for Payer: Frontpath All Commercial |
$366.91
|
| Rate for Payer: Humana ChoiceCare |
$344.46
|
| Rate for Payer: Humana Medicare |
$127.62
|
| Rate for Payer: Lucent All Commercial |
$216.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.94
|
| Rate for Payer: Managed Health Services Medicaid |
$42.84
|
| Rate for Payer: MDWise Medicaid |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$299.12
|
| Rate for Payer: PHP All Commercial |
$302.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.54
|
| Rate for Payer: Sagamore Health Network All Products |
$307.89
|
| Rate for Payer: Signature Care EPO |
$331.02
|
| Rate for Payer: Signature Care PPO |
$350.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$339.00
|
| Rate for Payer: United Healthcare Commercial |
$314.27
|
| Rate for Payer: United Healthcare Medicare |
$127.62
|
|
|
HC EPSTEIN-BARR VIRUS, QUANTITATIVE PCR
|
Facility
|
IP
|
$398.82
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
63002054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$299.12 |
| Max. Negotiated Rate |
$370.90 |
| Rate for Payer: Aetna Commercial |
$344.58
|
| Rate for Payer: Cash Price |
$239.29
|
| Rate for Payer: Cigna All Commercial |
$344.18
|
| Rate for Payer: CORVEL All Commercial |
$370.90
|
| Rate for Payer: Coventry All Commercial |
$350.96
|
| Rate for Payer: Encore All Commercial |
$367.11
|
| Rate for Payer: Frontpath All Commercial |
$366.91
|
| Rate for Payer: Humana ChoiceCare |
$344.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.94
|
| Rate for Payer: PHCS All Commercial |
$299.12
|
| Rate for Payer: PHP All Commercial |
$302.47
|
| Rate for Payer: Sagamore Health Network All Products |
$307.89
|
| Rate for Payer: Signature Care EPO |
$331.02
|
| Rate for Payer: Signature Care PPO |
$350.96
|
| Rate for Payer: United Healthcare Commercial |
$314.27
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$243.47
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
63001532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$226.43 |
| Rate for Payer: Aetna Commercial |
$205.49
|
| Rate for Payer: Aetna Medicare |
$77.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.70
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Centivo All Commercial |
$132.45
|
| Rate for Payer: Cigna All Commercial |
$210.11
|
| Rate for Payer: CORVEL All Commercial |
$226.43
|
| Rate for Payer: Coventry All Commercial |
$214.25
|
| Rate for Payer: Encore All Commercial |
$224.11
|
| Rate for Payer: Frontpath All Commercial |
$223.99
|
| Rate for Payer: Humana ChoiceCare |
$210.29
|
| Rate for Payer: Humana Medicare |
$77.91
|
| Rate for Payer: Lucent All Commercial |
$132.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.12
|
| Rate for Payer: Managed Health Services Medicaid |
$18.79
|
| Rate for Payer: MDWise Medicaid |
$18.79
|
| Rate for Payer: PHCS All Commercial |
$182.60
|
| Rate for Payer: PHP All Commercial |
$184.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.95
|
| Rate for Payer: Sagamore Health Network All Products |
$187.96
|
| Rate for Payer: Signature Care EPO |
$202.08
|
| Rate for Payer: Signature Care PPO |
$214.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.95
|
| Rate for Payer: United Healthcare Commercial |
$191.85
|
| Rate for Payer: United Healthcare Medicare |
$77.91
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$243.47
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
63001532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$226.43 |
| Rate for Payer: Aetna Commercial |
$210.36
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Cigna All Commercial |
$210.11
|
| Rate for Payer: CORVEL All Commercial |
$226.43
|
| Rate for Payer: Coventry All Commercial |
$214.25
|
| Rate for Payer: Encore All Commercial |
$224.11
|
| Rate for Payer: Frontpath All Commercial |
$223.99
|
| Rate for Payer: Humana ChoiceCare |
$210.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$219.12
|
| Rate for Payer: PHCS All Commercial |
$182.60
|
| Rate for Payer: PHP All Commercial |
$184.65
|
| Rate for Payer: Sagamore Health Network All Products |
$187.96
|
| Rate for Payer: Signature Care EPO |
$202.08
|
| Rate for Payer: Signature Care PPO |
$214.25
|
| Rate for Payer: United Healthcare Commercial |
$191.85
|
|
