|
HC HISTOPLASMA GALACTOMANNAN ANTIGEN EIA, SERUM
|
Facility
|
OP
|
$137.70
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
63044049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$128.06 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: Aetna Medicare |
$44.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.47
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Cash Price |
$82.62
|
| Rate for Payer: Centivo All Commercial |
$74.91
|
| Rate for Payer: Cigna All Commercial |
$118.84
|
| Rate for Payer: CORVEL All Commercial |
$128.06
|
| Rate for Payer: Coventry All Commercial |
$121.18
|
| Rate for Payer: Encore All Commercial |
$126.75
|
| Rate for Payer: Frontpath All Commercial |
$126.68
|
| Rate for Payer: Humana ChoiceCare |
$118.93
|
| Rate for Payer: Humana Medicare |
$44.06
|
| Rate for Payer: Lucent All Commercial |
$74.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.93
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$103.28
|
| Rate for Payer: PHP All Commercial |
$104.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.70
|
| Rate for Payer: Sagamore Health Network All Products |
$106.30
|
| Rate for Payer: Signature Care EPO |
$114.29
|
| Rate for Payer: Signature Care PPO |
$121.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.05
|
| Rate for Payer: United Healthcare Commercial |
$108.51
|
| Rate for Payer: United Healthcare Medicare |
$44.06
|
|
|
HC HISTOPLASMA MYCELIA AB-CF/ID
|
Facility
|
OP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: Aetna Medicare |
$35.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.30
|
| Rate for Payer: Cash Price |
$66.98
|
| Rate for Payer: Cash Price |
$66.98
|
| Rate for Payer: Centivo All Commercial |
$60.73
|
| Rate for Payer: Cigna All Commercial |
$96.35
|
| Rate for Payer: CORVEL All Commercial |
$103.83
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Humana Medicare |
$35.72
|
| Rate for Payer: Lucent All Commercial |
$60.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.54
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.89
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
| Rate for Payer: United Healthcare Medicare |
$35.72
|
|
|
HC HISTOPLASMA MYCELIA AB-CF/ID
|
Facility
|
IP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna Commercial |
$96.46
|
| Rate for Payer: Cash Price |
$66.98
|
| Rate for Payer: Cigna All Commercial |
$96.35
|
| Rate for Payer: CORVEL All Commercial |
$103.83
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
|
|
HC HISTOPLASMA YEAST AB - CF
|
Facility
|
IP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna Commercial |
$96.46
|
| Rate for Payer: Cash Price |
$66.98
|
| Rate for Payer: Cigna All Commercial |
$96.35
|
| Rate for Payer: CORVEL All Commercial |
$103.83
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
|
|
HC HISTOPLASMA YEAST AB - CF
|
Facility
|
OP
|
$111.64
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
63001951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: Aetna Medicare |
$35.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.30
|
| Rate for Payer: Cash Price |
$66.98
|
| Rate for Payer: Cash Price |
$66.98
|
| Rate for Payer: Centivo All Commercial |
$60.73
|
| Rate for Payer: Cigna All Commercial |
$96.35
|
| Rate for Payer: CORVEL All Commercial |
$103.83
|
| Rate for Payer: Coventry All Commercial |
$98.24
|
| Rate for Payer: Encore All Commercial |
$102.76
|
| Rate for Payer: Frontpath All Commercial |
$102.71
|
| Rate for Payer: Humana ChoiceCare |
$96.42
|
| Rate for Payer: Humana Medicare |
$35.72
|
| Rate for Payer: Lucent All Commercial |
$60.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.48
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$83.73
|
| Rate for Payer: PHP All Commercial |
$84.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.54
|
| Rate for Payer: Sagamore Health Network All Products |
$86.19
|
| Rate for Payer: Signature Care EPO |
$92.66
|
| Rate for Payer: Signature Care PPO |
$98.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.89
|
| Rate for Payer: United Healthcare Commercial |
$87.97
|
| Rate for Payer: United Healthcare Medicare |
$35.72
|
|
|
HC HIV-1 GENOTYPE - DNA OR RNA
|
Facility
|
OP
|
$986.04
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
63001038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$917.02 |
| Rate for Payer: Aetna Commercial |
$832.22
|
| Rate for Payer: Aetna Medicare |
$315.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$257.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$453.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$453.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$257.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$362.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$347.09
|
| Rate for Payer: Cash Price |
$591.62
|
| Rate for Payer: Cash Price |
$591.62
|
| Rate for Payer: Centivo All Commercial |
$536.41
|
| Rate for Payer: Cigna All Commercial |
$850.95
|
| Rate for Payer: CORVEL All Commercial |
$917.02
|
| Rate for Payer: Coventry All Commercial |
$867.72
|
| Rate for Payer: Encore All Commercial |
$907.65
|
| Rate for Payer: Frontpath All Commercial |
$907.16
|
| Rate for Payer: Humana ChoiceCare |
$851.64
|
| Rate for Payer: Humana Medicare |
$315.53
|
| Rate for Payer: Lucent All Commercial |
$536.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$887.44
|
| Rate for Payer: Managed Health Services Medicaid |
$257.45
|
| Rate for Payer: MDWise Medicaid |
$257.45
|
| Rate for Payer: PHCS All Commercial |
$739.53
|
| Rate for Payer: PHP All Commercial |
$747.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$384.56
|
| Rate for Payer: Sagamore Health Network All Products |
$761.22
|
| Rate for Payer: Signature Care EPO |
$818.41
|
| Rate for Payer: Signature Care PPO |
$867.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$838.13
|
| Rate for Payer: United Healthcare Commercial |
$777.00
|
| Rate for Payer: United Healthcare Medicare |
$315.53
|
|
|
HC HIV-1 GENOTYPE - DNA OR RNA
|
Facility
|
IP
|
$986.04
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
63001038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$739.53 |
| Max. Negotiated Rate |
$917.02 |
| Rate for Payer: Aetna Commercial |
$851.94
|
| Rate for Payer: Cash Price |
$591.62
|
| Rate for Payer: Cigna All Commercial |
$850.95
|
| Rate for Payer: CORVEL All Commercial |
$917.02
|
| Rate for Payer: Coventry All Commercial |
$867.72
|
| Rate for Payer: Encore All Commercial |
$907.65
|
| Rate for Payer: Frontpath All Commercial |
$907.16
|
| Rate for Payer: Humana ChoiceCare |
$851.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$887.44
|
| Rate for Payer: PHCS All Commercial |
$739.53
|
| Rate for Payer: PHP All Commercial |
$747.81
|
| Rate for Payer: Sagamore Health Network All Products |
$761.22
|
| Rate for Payer: Signature Care EPO |
$818.41
|
| Rate for Payer: Signature Care PPO |
$867.72
|
| Rate for Payer: United Healthcare Commercial |
$777.00
|
|
|
HC HIV-1 & HIV-2 AB SCREEN
|
Facility
|
IP
|
$131.24
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
63001289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$122.05 |
| Rate for Payer: Aetna Commercial |
$113.39
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cigna All Commercial |
$113.26
|
| Rate for Payer: CORVEL All Commercial |
$122.05
|
| Rate for Payer: Coventry All Commercial |
$115.49
|
| Rate for Payer: Encore All Commercial |
$120.81
|
| Rate for Payer: Frontpath All Commercial |
$120.74
|
| Rate for Payer: Humana ChoiceCare |
$113.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: PHCS All Commercial |
$98.43
|
| Rate for Payer: PHP All Commercial |
$99.53
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.93
|
| Rate for Payer: Signature Care PPO |
$115.49
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
|
|
HC HIV-1 & HIV-2 AB SCREEN
|
Facility
|
OP
|
$131.24
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
63001289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$122.05 |
| Rate for Payer: Aetna Commercial |
$110.77
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.20
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Centivo All Commercial |
$71.39
|
| Rate for Payer: Cigna All Commercial |
$113.26
|
| Rate for Payer: CORVEL All Commercial |
$122.05
|
| Rate for Payer: Coventry All Commercial |
$115.49
|
| Rate for Payer: Encore All Commercial |
$120.81
|
| Rate for Payer: Frontpath All Commercial |
$120.74
|
| Rate for Payer: Humana ChoiceCare |
$113.35
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Lucent All Commercial |
$71.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.12
|
| Rate for Payer: Managed Health Services Medicaid |
$24.08
|
| Rate for Payer: MDWise Medicaid |
$24.08
|
| Rate for Payer: PHCS All Commercial |
$98.43
|
| Rate for Payer: PHP All Commercial |
$99.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.18
|
| Rate for Payer: Sagamore Health Network All Products |
$101.32
|
| Rate for Payer: Signature Care EPO |
$108.93
|
| Rate for Payer: Signature Care PPO |
$115.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.55
|
| Rate for Payer: United Healthcare Commercial |
$103.42
|
| Rate for Payer: United Healthcare Medicare |
$42.00
|
|
|
HC HIV-1/HIV-2 SINGLE RESULT
|
Facility
|
OP
|
$136.32
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
63001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna Commercial |
$115.05
|
| Rate for Payer: Aetna Medicare |
$43.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.98
|
| Rate for Payer: Cash Price |
$81.79
|
| Rate for Payer: Cash Price |
$81.79
|
| Rate for Payer: Centivo All Commercial |
$74.16
|
| Rate for Payer: Cigna All Commercial |
$117.64
|
| Rate for Payer: CORVEL All Commercial |
$126.78
|
| Rate for Payer: Coventry All Commercial |
$119.96
|
| Rate for Payer: Encore All Commercial |
$125.48
|
| Rate for Payer: Frontpath All Commercial |
$125.41
|
| Rate for Payer: Humana ChoiceCare |
$117.74
|
| Rate for Payer: Humana Medicare |
$43.62
|
| Rate for Payer: Lucent All Commercial |
$74.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.69
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$102.24
|
| Rate for Payer: PHP All Commercial |
$103.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.16
|
| Rate for Payer: Sagamore Health Network All Products |
$105.24
|
| Rate for Payer: Signature Care EPO |
$113.15
|
| Rate for Payer: Signature Care PPO |
$119.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.87
|
| Rate for Payer: United Healthcare Commercial |
$107.42
|
| Rate for Payer: United Healthcare Medicare |
$43.62
|
|
|
HC HIV-1/HIV-2 SINGLE RESULT
|
Facility
|
IP
|
$136.32
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
63001953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna Commercial |
$117.78
|
| Rate for Payer: Cash Price |
$81.79
|
| Rate for Payer: Cigna All Commercial |
$117.64
|
| Rate for Payer: CORVEL All Commercial |
$126.78
|
| Rate for Payer: Coventry All Commercial |
$119.96
|
| Rate for Payer: Encore All Commercial |
$125.48
|
| Rate for Payer: Frontpath All Commercial |
$125.41
|
| Rate for Payer: Humana ChoiceCare |
$117.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.69
|
| Rate for Payer: PHCS All Commercial |
$102.24
|
| Rate for Payer: PHP All Commercial |
$103.39
|
| Rate for Payer: Sagamore Health Network All Products |
$105.24
|
| Rate for Payer: Signature Care EPO |
$113.15
|
| Rate for Payer: Signature Care PPO |
$119.96
|
| Rate for Payer: United Healthcare Commercial |
$107.42
|
|
|
HC HIV-1 RNA QT
|
Facility
|
OP
|
$682.66
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
63002043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$634.87 |
| Rate for Payer: Aetna Commercial |
$576.17
|
| Rate for Payer: Aetna Medicare |
$218.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$313.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$313.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$251.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$240.30
|
| Rate for Payer: Cash Price |
$409.60
|
| Rate for Payer: Cash Price |
$409.60
|
| Rate for Payer: Centivo All Commercial |
$371.37
|
| Rate for Payer: Cigna All Commercial |
$589.14
|
| Rate for Payer: CORVEL All Commercial |
$634.87
|
| Rate for Payer: Coventry All Commercial |
$600.74
|
| Rate for Payer: Encore All Commercial |
$628.39
|
| Rate for Payer: Frontpath All Commercial |
$628.05
|
| Rate for Payer: Humana ChoiceCare |
$589.61
|
| Rate for Payer: Humana Medicare |
$218.45
|
| Rate for Payer: Lucent All Commercial |
$371.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$614.39
|
| Rate for Payer: Managed Health Services Medicaid |
$85.10
|
| Rate for Payer: MDWise Medicaid |
$85.10
|
| Rate for Payer: PHCS All Commercial |
$512.00
|
| Rate for Payer: PHP All Commercial |
$517.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$266.24
|
| Rate for Payer: Sagamore Health Network All Products |
$527.01
|
| Rate for Payer: Signature Care EPO |
$566.61
|
| Rate for Payer: Signature Care PPO |
$600.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$580.26
|
| Rate for Payer: United Healthcare Commercial |
$537.94
|
| Rate for Payer: United Healthcare Medicare |
$218.45
|
|
|
HC HIV-1 RNA QT
|
Facility
|
IP
|
$682.66
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
63002043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$512.00 |
| Max. Negotiated Rate |
$634.87 |
| Rate for Payer: Aetna Commercial |
$589.82
|
| Rate for Payer: Cash Price |
$409.60
|
| Rate for Payer: Cigna All Commercial |
$589.14
|
| Rate for Payer: CORVEL All Commercial |
$634.87
|
| Rate for Payer: Coventry All Commercial |
$600.74
|
| Rate for Payer: Encore All Commercial |
$628.39
|
| Rate for Payer: Frontpath All Commercial |
$628.05
|
| Rate for Payer: Humana ChoiceCare |
$589.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$614.39
|
| Rate for Payer: PHCS All Commercial |
$512.00
|
| Rate for Payer: PHP All Commercial |
$517.73
|
| Rate for Payer: Sagamore Health Network All Products |
$527.01
|
| Rate for Payer: Signature Care EPO |
$566.61
|
| Rate for Payer: Signature Care PPO |
$600.74
|
| Rate for Payer: United Healthcare Commercial |
$537.94
|
|
|
HC HLA B27
|
Facility
|
IP
|
$325.38
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
63001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$244.03 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: Aetna Commercial |
$281.13
|
| Rate for Payer: Cash Price |
$195.23
|
| Rate for Payer: Cigna All Commercial |
$280.80
|
| Rate for Payer: CORVEL All Commercial |
$302.60
|
| Rate for Payer: Coventry All Commercial |
$286.33
|
| Rate for Payer: Encore All Commercial |
$299.51
|
| Rate for Payer: Frontpath All Commercial |
$299.35
|
| Rate for Payer: Humana ChoiceCare |
$281.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.84
|
| Rate for Payer: PHCS All Commercial |
$244.03
|
| Rate for Payer: PHP All Commercial |
$246.77
|
| Rate for Payer: Sagamore Health Network All Products |
$251.19
|
| Rate for Payer: Signature Care EPO |
$270.07
|
| Rate for Payer: Signature Care PPO |
$286.33
|
| Rate for Payer: United Healthcare Commercial |
$256.40
|
|
|
HC HLA B27
|
Facility
|
OP
|
$325.38
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
63001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: Aetna Commercial |
$274.62
|
| Rate for Payer: Aetna Medicare |
$104.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$149.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.53
|
| Rate for Payer: Cash Price |
$195.23
|
| Rate for Payer: Cash Price |
$195.23
|
| Rate for Payer: Centivo All Commercial |
$177.01
|
| Rate for Payer: Cigna All Commercial |
$280.80
|
| Rate for Payer: CORVEL All Commercial |
$302.60
|
| Rate for Payer: Coventry All Commercial |
$286.33
|
| Rate for Payer: Encore All Commercial |
$299.51
|
| Rate for Payer: Frontpath All Commercial |
$299.35
|
| Rate for Payer: Humana ChoiceCare |
$281.03
|
| Rate for Payer: Humana Medicare |
$104.12
|
| Rate for Payer: Lucent All Commercial |
$177.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.84
|
| Rate for Payer: Managed Health Services Medicaid |
$25.81
|
| Rate for Payer: MDWise Medicaid |
$25.81
|
| Rate for Payer: PHCS All Commercial |
$244.03
|
| Rate for Payer: PHP All Commercial |
$246.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.90
|
| Rate for Payer: Sagamore Health Network All Products |
$251.19
|
| Rate for Payer: Signature Care EPO |
$270.07
|
| Rate for Payer: Signature Care PPO |
$286.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.57
|
| Rate for Payer: United Healthcare Commercial |
$256.40
|
| Rate for Payer: United Healthcare Medicare |
$104.12
|
|
|
HC HLA-B27 CONFIRMATION-PCR
|
Facility
|
OP
|
$576.97
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
63001443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.33 |
| Max. Negotiated Rate |
$536.58 |
| Rate for Payer: Aetna Commercial |
$486.96
|
| Rate for Payer: Aetna Medicare |
$184.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$74.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$178.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$265.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.09
|
| Rate for Payer: Cash Price |
$346.18
|
| Rate for Payer: Cash Price |
$346.18
|
| Rate for Payer: Centivo All Commercial |
$313.87
|
| Rate for Payer: Cigna All Commercial |
$497.93
|
| Rate for Payer: CORVEL All Commercial |
$536.58
|
| Rate for Payer: Coventry All Commercial |
$507.73
|
| Rate for Payer: Encore All Commercial |
$531.10
|
| Rate for Payer: Frontpath All Commercial |
$530.81
|
| Rate for Payer: Humana ChoiceCare |
$498.33
|
| Rate for Payer: Humana Medicare |
$184.63
|
| Rate for Payer: Lucent All Commercial |
$313.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.27
|
| Rate for Payer: Managed Health Services Medicaid |
$74.33
|
| Rate for Payer: MDWise Medicaid |
$74.33
|
| Rate for Payer: PHCS All Commercial |
$432.73
|
| Rate for Payer: PHP All Commercial |
$437.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.02
|
| Rate for Payer: Sagamore Health Network All Products |
$445.42
|
| Rate for Payer: Signature Care EPO |
$478.89
|
| Rate for Payer: Signature Care PPO |
$507.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$490.42
|
| Rate for Payer: United Healthcare Commercial |
$454.65
|
| Rate for Payer: United Healthcare Medicare |
$184.63
|
|
|
HC HLA-B27 CONFIRMATION-PCR
|
Facility
|
IP
|
$576.97
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
63001443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$432.73 |
| Max. Negotiated Rate |
$536.58 |
| Rate for Payer: Aetna Commercial |
$498.50
|
| Rate for Payer: Cash Price |
$346.18
|
| Rate for Payer: Cigna All Commercial |
$497.93
|
| Rate for Payer: CORVEL All Commercial |
$536.58
|
| Rate for Payer: Coventry All Commercial |
$507.73
|
| Rate for Payer: Encore All Commercial |
$531.10
|
| Rate for Payer: Frontpath All Commercial |
$530.81
|
| Rate for Payer: Humana ChoiceCare |
$498.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.27
|
| Rate for Payer: PHCS All Commercial |
$432.73
|
| Rate for Payer: PHP All Commercial |
$437.57
|
| Rate for Payer: Sagamore Health Network All Products |
$445.42
|
| Rate for Payer: Signature Care EPO |
$478.89
|
| Rate for Payer: Signature Care PPO |
$507.73
|
| Rate for Payer: United Healthcare Commercial |
$454.65
|
|
|
HC HLA-DQ TYPING CHARGE
|
Facility
|
OP
|
$159.06
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
63001444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.31 |
| Max. Negotiated Rate |
$147.93 |
| Rate for Payer: Aetna Commercial |
$134.25
|
| Rate for Payer: Aetna Medicare |
$50.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.99
|
| Rate for Payer: Cash Price |
$95.44
|
| Rate for Payer: Cash Price |
$95.44
|
| Rate for Payer: Centivo All Commercial |
$86.53
|
| Rate for Payer: Cigna All Commercial |
$137.27
|
| Rate for Payer: CORVEL All Commercial |
$147.93
|
| Rate for Payer: Coventry All Commercial |
$139.97
|
| Rate for Payer: Encore All Commercial |
$146.41
|
| Rate for Payer: Frontpath All Commercial |
$146.34
|
| Rate for Payer: Humana ChoiceCare |
$137.38
|
| Rate for Payer: Humana Medicare |
$50.90
|
| Rate for Payer: Lucent All Commercial |
$86.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.15
|
| Rate for Payer: Managed Health Services Medicaid |
$122.22
|
| Rate for Payer: MDWise Medicaid |
$122.22
|
| Rate for Payer: PHCS All Commercial |
$119.30
|
| Rate for Payer: PHP All Commercial |
$120.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.03
|
| Rate for Payer: Sagamore Health Network All Products |
$122.79
|
| Rate for Payer: Signature Care EPO |
$132.02
|
| Rate for Payer: Signature Care PPO |
$139.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.20
|
| Rate for Payer: United Healthcare Commercial |
$125.34
|
| Rate for Payer: United Healthcare Medicare |
$50.90
|
|
|
HC HLA-DQ TYPING CHARGE
|
Facility
|
IP
|
$159.06
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
63001444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$147.93 |
| Rate for Payer: Aetna Commercial |
$137.43
|
| Rate for Payer: Cash Price |
$95.44
|
| Rate for Payer: Cigna All Commercial |
$137.27
|
| Rate for Payer: CORVEL All Commercial |
$147.93
|
| Rate for Payer: Coventry All Commercial |
$139.97
|
| Rate for Payer: Encore All Commercial |
$146.41
|
| Rate for Payer: Frontpath All Commercial |
$146.34
|
| Rate for Payer: Humana ChoiceCare |
$137.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.15
|
| Rate for Payer: PHCS All Commercial |
$119.30
|
| Rate for Payer: PHP All Commercial |
$120.63
|
| Rate for Payer: Sagamore Health Network All Products |
$122.79
|
| Rate for Payer: Signature Care EPO |
$132.02
|
| Rate for Payer: Signature Care PPO |
$139.97
|
| Rate for Payer: United Healthcare Commercial |
$125.34
|
|
|
HC HOME SLEEP STUDY
|
Facility
|
IP
|
$1,103.53
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
1369580
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$827.65 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$953.45
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Cigna All Commercial |
$952.35
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.11
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Sagamore Health Network All Products |
$851.93
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.11
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
|
|
HC HOME SLEEP STUDY
|
Facility
|
OP
|
$1,103.53
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
1365806
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$931.38
|
| Rate for Payer: Aetna Medicare |
$353.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$127.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$342.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$633.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$127.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Centivo All Commercial |
$600.32
|
| Rate for Payer: Cigna All Commercial |
$952.35
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.11
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Humana Medicare |
$353.13
|
| Rate for Payer: Lucent All Commercial |
$600.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: Managed Health Services Medicaid |
$127.78
|
| Rate for Payer: MDWise Medicaid |
$127.78
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.38
|
| Rate for Payer: Sagamore Health Network All Products |
$851.93
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
| Rate for Payer: United Healthcare Medicare |
$353.13
|
|
|
HC HOME SLEEP STUDY
|
Facility
|
IP
|
$1,103.53
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
1369580
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$827.65 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$953.45
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Cigna All Commercial |
$952.35
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.11
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Sagamore Health Network All Products |
$851.93
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.11
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
|
|
HC HOME SLEEP STUDY
|
Facility
|
IP
|
$1,103.53
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
1365806
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$827.65 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$953.45
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Cigna All Commercial |
$952.35
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.11
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Sagamore Health Network All Products |
$851.93
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.11
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
|
|
HC HOME SLEEP STUDY
|
Facility
|
OP
|
$1,103.53
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
1369580
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$931.38
|
| Rate for Payer: Aetna Medicare |
$353.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$127.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$342.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$633.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$127.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Centivo All Commercial |
$600.32
|
| Rate for Payer: Cigna All Commercial |
$952.35
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.11
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Humana Medicare |
$353.13
|
| Rate for Payer: Lucent All Commercial |
$600.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: Managed Health Services Medicaid |
$127.78
|
| Rate for Payer: MDWise Medicaid |
$127.78
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.38
|
| Rate for Payer: Sagamore Health Network All Products |
$851.93
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
| Rate for Payer: United Healthcare Medicare |
$353.13
|
|
|
HC HOME SLEEP STUDY
|
Facility
|
OP
|
$1,103.53
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
1369580
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$1,026.28 |
| Rate for Payer: Aetna Commercial |
$931.38
|
| Rate for Payer: Aetna Medicare |
$353.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$342.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$633.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$689.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Cash Price |
$662.12
|
| Rate for Payer: Centivo All Commercial |
$600.32
|
| Rate for Payer: Cigna All Commercial |
$952.35
|
| Rate for Payer: CORVEL All Commercial |
$1,026.28
|
| Rate for Payer: Coventry All Commercial |
$971.11
|
| Rate for Payer: Encore All Commercial |
$1,015.80
|
| Rate for Payer: Frontpath All Commercial |
$1,015.25
|
| Rate for Payer: Humana ChoiceCare |
$953.12
|
| Rate for Payer: Humana Medicare |
$353.13
|
| Rate for Payer: Lucent All Commercial |
$600.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.18
|
| Rate for Payer: Managed Health Services Medicaid |
$200.10
|
| Rate for Payer: MDWise Medicaid |
$200.10
|
| Rate for Payer: PHCS All Commercial |
$827.65
|
| Rate for Payer: PHP All Commercial |
$836.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$430.38
|
| Rate for Payer: Sagamore Health Network All Products |
$851.93
|
| Rate for Payer: Signature Care EPO |
$915.93
|
| Rate for Payer: Signature Care PPO |
$971.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$869.58
|
| Rate for Payer: United Healthcare Medicare |
$353.13
|
|
