|
HC GASTROINTESTINAL PROFILE, STOOL, PCR
|
Facility
|
IP
|
$1,081.93
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
63044048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$811.45 |
| Max. Negotiated Rate |
$1,006.19 |
| Rate for Payer: Aetna Commercial |
$934.79
|
| Rate for Payer: Cash Price |
$649.16
|
| Rate for Payer: Cigna All Commercial |
$933.71
|
| Rate for Payer: CORVEL All Commercial |
$1,006.19
|
| Rate for Payer: Coventry All Commercial |
$952.10
|
| Rate for Payer: Encore All Commercial |
$995.92
|
| Rate for Payer: Frontpath All Commercial |
$995.38
|
| Rate for Payer: Humana ChoiceCare |
$934.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$973.74
|
| Rate for Payer: PHCS All Commercial |
$811.45
|
| Rate for Payer: PHP All Commercial |
$820.54
|
| Rate for Payer: Sagamore Health Network All Products |
$835.25
|
| Rate for Payer: Signature Care EPO |
$898.00
|
| Rate for Payer: Signature Care PPO |
$952.10
|
| Rate for Payer: United Healthcare Commercial |
$852.56
|
|
|
HC GASTROINTESTINAL PROFILE, STOOL, PCR
|
Facility
|
OP
|
$1,081.93
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
63044048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$335.40 |
| Max. Negotiated Rate |
$1,006.19 |
| Rate for Payer: Aetna Commercial |
$913.15
|
| Rate for Payer: Aetna Medicare |
$346.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$416.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$335.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$497.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$497.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$416.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$380.84
|
| Rate for Payer: Cash Price |
$649.16
|
| Rate for Payer: Cash Price |
$649.16
|
| Rate for Payer: Centivo All Commercial |
$588.57
|
| Rate for Payer: Cigna All Commercial |
$933.71
|
| Rate for Payer: CORVEL All Commercial |
$1,006.19
|
| Rate for Payer: Coventry All Commercial |
$952.10
|
| Rate for Payer: Encore All Commercial |
$995.92
|
| Rate for Payer: Frontpath All Commercial |
$995.38
|
| Rate for Payer: Humana ChoiceCare |
$934.46
|
| Rate for Payer: Humana Medicare |
$346.22
|
| Rate for Payer: Lucent All Commercial |
$588.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$973.74
|
| Rate for Payer: Managed Health Services Medicaid |
$416.78
|
| Rate for Payer: MDWise Medicaid |
$416.78
|
| Rate for Payer: PHCS All Commercial |
$811.45
|
| Rate for Payer: PHP All Commercial |
$820.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$421.95
|
| Rate for Payer: Sagamore Health Network All Products |
$835.25
|
| Rate for Payer: Signature Care EPO |
$898.00
|
| Rate for Payer: Signature Care PPO |
$952.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$919.64
|
| Rate for Payer: United Healthcare Commercial |
$852.56
|
| Rate for Payer: United Healthcare Medicare |
$346.22
|
|
|
HC GATED HEART STUDY-SINGLE STUDY
|
Facility
|
OP
|
$2,285.85
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
1638452
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$128.56 |
| Max. Negotiated Rate |
$2,125.84 |
| Rate for Payer: Aetna Commercial |
$1,929.26
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$128.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$708.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,312.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,428.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$128.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$841.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$804.62
|
| Rate for Payer: Cash Price |
$1,371.51
|
| Rate for Payer: Cash Price |
$1,371.51
|
| Rate for Payer: Centivo All Commercial |
$1,243.50
|
| Rate for Payer: Cigna All Commercial |
$1,972.69
|
| Rate for Payer: CORVEL All Commercial |
$2,125.84
|
| Rate for Payer: Coventry All Commercial |
$2,011.55
|
| Rate for Payer: Encore All Commercial |
$2,104.12
|
| Rate for Payer: Frontpath All Commercial |
$2,102.98
|
| Rate for Payer: Humana ChoiceCare |
$1,974.29
|
| Rate for Payer: Humana Medicare |
$731.47
|
| Rate for Payer: Lucent All Commercial |
$1,243.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,057.26
|
| Rate for Payer: Managed Health Services Medicaid |
$128.56
|
| Rate for Payer: MDWise Medicaid |
$128.56
|
| Rate for Payer: PHCS All Commercial |
$1,714.39
|
| Rate for Payer: PHP All Commercial |
$1,733.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$891.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,764.68
|
| Rate for Payer: Signature Care EPO |
$1,897.26
|
| Rate for Payer: Signature Care PPO |
$2,011.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,942.97
|
| Rate for Payer: United Healthcare Commercial |
$1,801.25
|
| Rate for Payer: United Healthcare Medicare |
$731.47
|
|
|
HC GATED HEART STUDY-SINGLE STUDY
|
Facility
|
IP
|
$2,285.85
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
1638452
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,714.39 |
| Max. Negotiated Rate |
$2,125.84 |
| Rate for Payer: Aetna Commercial |
$1,974.97
|
| Rate for Payer: Cash Price |
$1,371.51
|
| Rate for Payer: Cigna All Commercial |
$1,972.69
|
| Rate for Payer: CORVEL All Commercial |
$2,125.84
|
| Rate for Payer: Coventry All Commercial |
$2,011.55
|
| Rate for Payer: Encore All Commercial |
$2,104.12
|
| Rate for Payer: Frontpath All Commercial |
$2,102.98
|
| Rate for Payer: Humana ChoiceCare |
$1,974.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,057.26
|
| Rate for Payer: PHCS All Commercial |
$1,714.39
|
| Rate for Payer: PHP All Commercial |
$1,733.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,764.68
|
| Rate for Payer: Signature Care EPO |
$1,897.26
|
| Rate for Payer: Signature Care PPO |
$2,011.55
|
| Rate for Payer: United Healthcare Commercial |
$1,801.25
|
|
|
HC GC CULTURE
|
Facility
|
IP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.51 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$119.24
|
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.04
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: PHCS All Commercial |
$103.51
|
| Rate for Payer: PHP All Commercial |
$104.67
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.55
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
|
|
HC GC CULTURE
|
Facility
|
OP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$116.48
|
| Rate for Payer: Aetna Medicare |
$44.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.58
|
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Centivo All Commercial |
$75.08
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.04
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Humana Medicare |
$44.16
|
| Rate for Payer: Lucent All Commercial |
$75.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: Managed Health Services Medicaid |
$6.63
|
| Rate for Payer: MDWise Medicaid |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$103.51
|
| Rate for Payer: PHP All Commercial |
$104.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.82
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.55
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.31
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$44.16
|
|
|
HC GC DNA-URINE
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002047
|
|
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 GC DNA-URINE
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
63002047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| 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 |
$35.09
|
| 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 |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| 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 GEN CULTURE
|
Facility
|
OP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001993
|
|
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 GEN CULTURE
|
Facility
|
IP
|
$218.24
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001993
|
|
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 GENERAL ANESTH EA ADD MIN
|
Facility
|
OP
|
$23.57
|
|
| Hospital Charge Code |
1246651
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.30
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Centivo All Commercial |
$12.82
|
| Rate for Payer: Cigna All Commercial |
$20.34
|
| Rate for Payer: CORVEL All Commercial |
$21.92
|
| Rate for Payer: Coventry All Commercial |
$20.74
|
| Rate for Payer: Encore All Commercial |
$21.70
|
| Rate for Payer: Frontpath All Commercial |
$21.68
|
| Rate for Payer: Humana ChoiceCare |
$20.36
|
| Rate for Payer: Humana Medicare |
$7.54
|
| Rate for Payer: Lucent All Commercial |
$12.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.21
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$17.68
|
| Rate for Payer: PHP All Commercial |
$17.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.20
|
| Rate for Payer: Signature Care EPO |
$19.56
|
| Rate for Payer: Signature Care PPO |
$20.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.03
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare |
$7.54
|
|
|
HC GENERAL ANESTH EA ADD MIN
|
Facility
|
IP
|
$23.57
|
|
| Hospital Charge Code |
1246651
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$21.92 |
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cigna All Commercial |
$20.34
|
| Rate for Payer: CORVEL All Commercial |
$21.92
|
| Rate for Payer: Coventry All Commercial |
$20.74
|
| Rate for Payer: Encore All Commercial |
$21.70
|
| Rate for Payer: Frontpath All Commercial |
$21.68
|
| Rate for Payer: Humana ChoiceCare |
$20.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.21
|
| Rate for Payer: PHCS All Commercial |
$17.68
|
| Rate for Payer: PHP All Commercial |
$17.88
|
| Rate for Payer: Sagamore Health Network All Products |
$18.20
|
| Rate for Payer: Signature Care EPO |
$19.56
|
| Rate for Payer: Signature Care PPO |
$20.74
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
|
|
HC GENERAL ANESTH INITIAL 15 MIN
|
Facility
|
IP
|
$350.17
|
|
| Hospital Charge Code |
1246650
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$325.66 |
| Rate for Payer: Aetna Commercial |
$302.55
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Cigna All Commercial |
$302.20
|
| Rate for Payer: CORVEL All Commercial |
$325.66
|
| Rate for Payer: Coventry All Commercial |
$308.15
|
| Rate for Payer: Encore All Commercial |
$322.33
|
| Rate for Payer: Frontpath All Commercial |
$322.16
|
| Rate for Payer: Humana ChoiceCare |
$302.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.15
|
| Rate for Payer: PHCS All Commercial |
$262.63
|
| Rate for Payer: PHP All Commercial |
$265.57
|
| Rate for Payer: Sagamore Health Network All Products |
$270.33
|
| Rate for Payer: Signature Care EPO |
$290.64
|
| Rate for Payer: Signature Care PPO |
$308.15
|
| Rate for Payer: United Healthcare Commercial |
$275.93
|
|
|
HC GENERAL ANESTH INITIAL 15 MIN
|
Facility
|
OP
|
$350.17
|
|
| Hospital Charge Code |
1246650
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$325.66 |
| Rate for Payer: Aetna Commercial |
$295.54
|
| Rate for Payer: Aetna Medicare |
$112.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.26
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Centivo All Commercial |
$190.49
|
| Rate for Payer: Cigna All Commercial |
$302.20
|
| Rate for Payer: CORVEL All Commercial |
$325.66
|
| Rate for Payer: Coventry All Commercial |
$308.15
|
| Rate for Payer: Encore All Commercial |
$322.33
|
| Rate for Payer: Frontpath All Commercial |
$322.16
|
| Rate for Payer: Humana ChoiceCare |
$302.44
|
| Rate for Payer: Humana Medicare |
$112.05
|
| Rate for Payer: Lucent All Commercial |
$190.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.15
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$262.63
|
| Rate for Payer: PHP All Commercial |
$265.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.57
|
| Rate for Payer: Sagamore Health Network All Products |
$270.33
|
| Rate for Payer: Signature Care EPO |
$290.64
|
| Rate for Payer: Signature Care PPO |
$308.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.64
|
| Rate for Payer: United Healthcare Commercial |
$275.93
|
| Rate for Payer: United Healthcare Medicare |
$112.05
|
|
|
HC GENTAMYCIN - PEAK
|
Facility
|
IP
|
$601.81
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$559.68 |
| Rate for Payer: Aetna Commercial |
$519.96
|
| Rate for Payer: Cash Price |
$361.09
|
| Rate for Payer: Cigna All Commercial |
$519.36
|
| Rate for Payer: CORVEL All Commercial |
$559.68
|
| Rate for Payer: Coventry All Commercial |
$529.59
|
| Rate for Payer: Encore All Commercial |
$553.97
|
| Rate for Payer: Frontpath All Commercial |
$553.67
|
| Rate for Payer: Humana ChoiceCare |
$519.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.63
|
| Rate for Payer: PHCS All Commercial |
$451.36
|
| Rate for Payer: PHP All Commercial |
$456.41
|
| Rate for Payer: Sagamore Health Network All Products |
$464.60
|
| Rate for Payer: Signature Care EPO |
$499.50
|
| Rate for Payer: Signature Care PPO |
$529.59
|
| Rate for Payer: United Healthcare Commercial |
$474.23
|
|
|
HC GENTAMYCIN - PEAK
|
Facility
|
OP
|
$601.81
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$559.68 |
| Rate for Payer: Aetna Commercial |
$507.93
|
| Rate for Payer: Aetna Medicare |
$192.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$186.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$276.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.84
|
| Rate for Payer: Cash Price |
$361.09
|
| Rate for Payer: Cash Price |
$361.09
|
| Rate for Payer: Centivo All Commercial |
$327.38
|
| Rate for Payer: Cigna All Commercial |
$519.36
|
| Rate for Payer: CORVEL All Commercial |
$559.68
|
| Rate for Payer: Coventry All Commercial |
$529.59
|
| Rate for Payer: Encore All Commercial |
$553.97
|
| Rate for Payer: Frontpath All Commercial |
$553.67
|
| Rate for Payer: Humana ChoiceCare |
$519.78
|
| Rate for Payer: Humana Medicare |
$192.58
|
| Rate for Payer: Lucent All Commercial |
$327.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$541.63
|
| Rate for Payer: Managed Health Services Medicaid |
$16.38
|
| Rate for Payer: MDWise Medicaid |
$16.38
|
| Rate for Payer: PHCS All Commercial |
$451.36
|
| Rate for Payer: PHP All Commercial |
$456.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.71
|
| Rate for Payer: Sagamore Health Network All Products |
$464.60
|
| Rate for Payer: Signature Care EPO |
$499.50
|
| Rate for Payer: Signature Care PPO |
$529.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.54
|
| Rate for Payer: United Healthcare Commercial |
$474.23
|
| Rate for Payer: United Healthcare Medicare |
$192.58
|
|
|
HC GENTAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$213.90 |
| Rate for Payer: Aetna Commercial |
$194.12
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.96
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Centivo All Commercial |
$125.12
|
| Rate for Payer: Cigna All Commercial |
$198.49
|
| Rate for Payer: CORVEL All Commercial |
$213.90
|
| Rate for Payer: Coventry All Commercial |
$202.40
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.60
|
| Rate for Payer: Humana ChoiceCare |
$198.65
|
| Rate for Payer: Humana Medicare |
$73.60
|
| Rate for Payer: Lucent All Commercial |
$125.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.00
|
| Rate for Payer: Managed Health Services Medicaid |
$16.38
|
| Rate for Payer: MDWise Medicaid |
$16.38
|
| Rate for Payer: PHCS All Commercial |
$172.50
|
| Rate for Payer: PHP All Commercial |
$174.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.70
|
| Rate for Payer: Sagamore Health Network All Products |
$177.56
|
| Rate for Payer: Signature Care EPO |
$190.90
|
| Rate for Payer: Signature Care PPO |
$202.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.50
|
| Rate for Payer: United Healthcare Commercial |
$181.24
|
| Rate for Payer: United Healthcare Medicare |
$73.60
|
|
|
HC GENTAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
63001326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$213.90 |
| Rate for Payer: Aetna Commercial |
$198.72
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna All Commercial |
$198.49
|
| Rate for Payer: CORVEL All Commercial |
$213.90
|
| Rate for Payer: Coventry All Commercial |
$202.40
|
| Rate for Payer: Encore All Commercial |
$211.72
|
| Rate for Payer: Frontpath All Commercial |
$211.60
|
| Rate for Payer: Humana ChoiceCare |
$198.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.00
|
| Rate for Payer: PHCS All Commercial |
$172.50
|
| Rate for Payer: PHP All Commercial |
$174.43
|
| Rate for Payer: Sagamore Health Network All Products |
$177.56
|
| Rate for Payer: Signature Care EPO |
$190.90
|
| Rate for Payer: Signature Care PPO |
$202.40
|
| Rate for Payer: United Healthcare Commercial |
$181.24
|
|
|
HC GGTP
|
Facility
|
OP
|
$97.03
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
63001150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$81.89
|
| Rate for Payer: Aetna Medicare |
$31.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$7.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$44.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.15
|
| Rate for Payer: Cash Price |
$58.22
|
| Rate for Payer: Cash Price |
$58.22
|
| Rate for Payer: Centivo All Commercial |
$52.78
|
| Rate for Payer: Cigna All Commercial |
$83.74
|
| Rate for Payer: CORVEL All Commercial |
$90.24
|
| Rate for Payer: Coventry All Commercial |
$85.39
|
| Rate for Payer: Encore All Commercial |
$89.32
|
| Rate for Payer: Frontpath All Commercial |
$89.27
|
| Rate for Payer: Humana ChoiceCare |
$83.80
|
| Rate for Payer: Humana Medicare |
$31.05
|
| Rate for Payer: Lucent All Commercial |
$52.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.33
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: MDWise Medicaid |
$7.20
|
| Rate for Payer: PHCS All Commercial |
$72.77
|
| Rate for Payer: PHP All Commercial |
$73.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.84
|
| Rate for Payer: Sagamore Health Network All Products |
$74.91
|
| Rate for Payer: Signature Care EPO |
$80.53
|
| Rate for Payer: Signature Care PPO |
$85.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.48
|
| Rate for Payer: United Healthcare Commercial |
$76.46
|
| Rate for Payer: United Healthcare Medicare |
$31.05
|
|
|
HC GGTP
|
Facility
|
IP
|
$97.03
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
63001150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.77 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$83.83
|
| Rate for Payer: Cash Price |
$58.22
|
| Rate for Payer: Cigna All Commercial |
$83.74
|
| Rate for Payer: CORVEL All Commercial |
$90.24
|
| Rate for Payer: Coventry All Commercial |
$85.39
|
| Rate for Payer: Encore All Commercial |
$89.32
|
| Rate for Payer: Frontpath All Commercial |
$89.27
|
| Rate for Payer: Humana ChoiceCare |
$83.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.33
|
| Rate for Payer: PHCS All Commercial |
$72.77
|
| Rate for Payer: PHP All Commercial |
$73.59
|
| Rate for Payer: Sagamore Health Network All Products |
$74.91
|
| Rate for Payer: Signature Care EPO |
$80.53
|
| Rate for Payer: Signature Care PPO |
$85.39
|
| Rate for Payer: United Healthcare Commercial |
$76.46
|
|
|
HC GIARDIA AG
|
Facility
|
OP
|
$151.32
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
63001084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$140.73 |
| Rate for Payer: Aetna Commercial |
$127.71
|
| Rate for Payer: Aetna Medicare |
$48.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$69.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.26
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Centivo All Commercial |
$82.32
|
| Rate for Payer: Cigna All Commercial |
$130.59
|
| Rate for Payer: CORVEL All Commercial |
$140.73
|
| Rate for Payer: Coventry All Commercial |
$133.16
|
| Rate for Payer: Encore All Commercial |
$139.29
|
| Rate for Payer: Frontpath All Commercial |
$139.21
|
| Rate for Payer: Humana ChoiceCare |
$130.70
|
| Rate for Payer: Humana Medicare |
$48.42
|
| Rate for Payer: Lucent All Commercial |
$82.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.19
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$113.49
|
| Rate for Payer: PHP All Commercial |
$114.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.01
|
| Rate for Payer: Sagamore Health Network All Products |
$116.82
|
| Rate for Payer: Signature Care EPO |
$125.60
|
| Rate for Payer: Signature Care PPO |
$133.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.62
|
| Rate for Payer: United Healthcare Commercial |
$119.24
|
| Rate for Payer: United Healthcare Medicare |
$48.42
|
|
|
HC GIARDIA AG
|
Facility
|
IP
|
$151.32
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
63001084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$140.73 |
| Rate for Payer: Aetna Commercial |
$130.74
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cigna All Commercial |
$130.59
|
| Rate for Payer: CORVEL All Commercial |
$140.73
|
| Rate for Payer: Coventry All Commercial |
$133.16
|
| Rate for Payer: Encore All Commercial |
$139.29
|
| Rate for Payer: Frontpath All Commercial |
$139.21
|
| Rate for Payer: Humana ChoiceCare |
$130.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.19
|
| Rate for Payer: PHCS All Commercial |
$113.49
|
| Rate for Payer: PHP All Commercial |
$114.76
|
| Rate for Payer: Sagamore Health Network All Products |
$116.82
|
| Rate for Payer: Signature Care EPO |
$125.60
|
| Rate for Payer: Signature Care PPO |
$133.16
|
| Rate for Payer: United Healthcare Commercial |
$119.24
|
|
|
HC GI BLEEDING
|
Facility
|
OP
|
$1,497.93
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
1638460
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$212.04 |
| Max. Negotiated Rate |
$1,393.07 |
| Rate for Payer: Aetna Commercial |
$1,264.25
|
| Rate for Payer: Aetna Medicare |
$479.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$212.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$464.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$860.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$936.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$212.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$551.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$527.27
|
| Rate for Payer: Cash Price |
$898.76
|
| Rate for Payer: Cash Price |
$898.76
|
| Rate for Payer: Centivo All Commercial |
$814.87
|
| Rate for Payer: Cigna All Commercial |
$1,292.71
|
| Rate for Payer: CORVEL All Commercial |
$1,393.07
|
| Rate for Payer: Coventry All Commercial |
$1,318.18
|
| Rate for Payer: Encore All Commercial |
$1,378.84
|
| Rate for Payer: Frontpath All Commercial |
$1,378.10
|
| Rate for Payer: Humana ChoiceCare |
$1,293.76
|
| Rate for Payer: Humana Medicare |
$479.34
|
| Rate for Payer: Lucent All Commercial |
$814.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.14
|
| Rate for Payer: Managed Health Services Medicaid |
$212.04
|
| Rate for Payer: MDWise Medicaid |
$212.04
|
| Rate for Payer: PHCS All Commercial |
$1,123.45
|
| Rate for Payer: PHP All Commercial |
$1,136.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$584.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.40
|
| Rate for Payer: Signature Care EPO |
$1,243.28
|
| Rate for Payer: Signature Care PPO |
$1,318.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,273.24
|
| Rate for Payer: United Healthcare Commercial |
$1,180.37
|
| Rate for Payer: United Healthcare Medicare |
$479.34
|
|
|
HC GI BLEEDING
|
Facility
|
IP
|
$1,497.93
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
1638460
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,123.45 |
| Max. Negotiated Rate |
$1,393.07 |
| Rate for Payer: Aetna Commercial |
$1,294.21
|
| Rate for Payer: Cash Price |
$898.76
|
| Rate for Payer: Cigna All Commercial |
$1,292.71
|
| Rate for Payer: CORVEL All Commercial |
$1,393.07
|
| Rate for Payer: Coventry All Commercial |
$1,318.18
|
| Rate for Payer: Encore All Commercial |
$1,378.84
|
| Rate for Payer: Frontpath All Commercial |
$1,378.10
|
| Rate for Payer: Humana ChoiceCare |
$1,293.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.14
|
| Rate for Payer: PHCS All Commercial |
$1,123.45
|
| Rate for Payer: PHP All Commercial |
$1,136.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1,156.40
|
| Rate for Payer: Signature Care EPO |
$1,243.28
|
| Rate for Payer: Signature Care PPO |
$1,318.18
|
| Rate for Payer: United Healthcare Commercial |
$1,180.37
|
|
|
HC GLIADIN IGA
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
63001581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$41.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$41.88
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.05
|
| Rate for Payer: MDWise Medicaid |
$12.05
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.04
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
| Rate for Payer: United Healthcare Medicare |
$41.88
|
|
