|
HC IV PUSH INSULIN EA ADDITIONAL DRUG
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 96375 GZ
|
| Hospital Charge Code |
21689109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna All Commercial |
$132.04
|
| Rate for Payer: CORVEL All Commercial |
$142.29
|
| Rate for Payer: Coventry All Commercial |
$134.64
|
| Rate for Payer: Encore All Commercial |
$140.84
|
| Rate for Payer: Frontpath All Commercial |
$140.76
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: PHCS All Commercial |
$114.75
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$126.99
|
| Rate for Payer: Signature Care PPO |
$134.64
|
| Rate for Payer: United Healthcare Commercial |
$120.56
|
|
|
HC IV PUSH INSULIN EA ADDITIONAL DRUG
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 96375 GZ
|
| Hospital Charge Code |
21689109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$129.13
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.86
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Centivo All Commercial |
$83.23
|
| Rate for Payer: Cigna All Commercial |
$132.04
|
| Rate for Payer: CORVEL All Commercial |
$142.29
|
| Rate for Payer: Coventry All Commercial |
$134.64
|
| Rate for Payer: Encore All Commercial |
$140.84
|
| Rate for Payer: Frontpath All Commercial |
$140.76
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: Lucent All Commercial |
$83.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: Managed Health Services Medicaid |
$18.90
|
| Rate for Payer: MDWise Medicaid |
$18.90
|
| Rate for Payer: PHCS All Commercial |
$114.75
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.67
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$126.99
|
| Rate for Payer: Signature Care PPO |
$134.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$120.56
|
| Rate for Payer: United Healthcare Medicare |
$48.96
|
|
|
HC IV SEDATION EA ADD MIN
|
Facility
|
IP
|
$11.64
|
|
| Hospital Charge Code |
1246657
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$10.83 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna All Commercial |
$10.05
|
| Rate for Payer: CORVEL All Commercial |
$10.83
|
| Rate for Payer: Coventry All Commercial |
$10.24
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.71
|
| Rate for Payer: Humana ChoiceCare |
$10.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.48
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$8.83
|
| Rate for Payer: Sagamore Health Network All Products |
$8.99
|
| Rate for Payer: Signature Care EPO |
$9.66
|
| Rate for Payer: Signature Care PPO |
$10.24
|
| Rate for Payer: United Healthcare Commercial |
$9.17
|
|
|
HC IV SEDATION EA ADD MIN
|
Facility
|
OP
|
$11.64
|
|
| Hospital Charge Code |
1246657
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.10
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Centivo All Commercial |
$6.33
|
| Rate for Payer: Cigna All Commercial |
$10.05
|
| Rate for Payer: CORVEL All Commercial |
$10.83
|
| Rate for Payer: Coventry All Commercial |
$10.24
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.71
|
| Rate for Payer: Humana ChoiceCare |
$10.05
|
| Rate for Payer: Humana Medicare |
$3.72
|
| Rate for Payer: Lucent All Commercial |
$6.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.48
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$8.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.54
|
| Rate for Payer: Sagamore Health Network All Products |
$8.99
|
| Rate for Payer: Signature Care EPO |
$9.66
|
| Rate for Payer: Signature Care PPO |
$10.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$9.17
|
| Rate for Payer: United Healthcare Medicare |
$3.72
|
|
|
HC IV SEDATION INITIAL 15 MIN
|
Facility
|
OP
|
$162.92
|
|
| Hospital Charge Code |
1246656
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$50.51 |
| Max. Negotiated Rate |
$151.52 |
| Rate for Payer: Aetna Commercial |
$137.50
|
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.35
|
| Rate for Payer: Cash Price |
$97.75
|
| Rate for Payer: Cash Price |
$97.75
|
| Rate for Payer: Centivo All Commercial |
$88.63
|
| Rate for Payer: Cigna All Commercial |
$140.60
|
| Rate for Payer: CORVEL All Commercial |
$151.52
|
| Rate for Payer: Coventry All Commercial |
$143.37
|
| Rate for Payer: Encore All Commercial |
$149.97
|
| Rate for Payer: Frontpath All Commercial |
$149.89
|
| Rate for Payer: Humana ChoiceCare |
$140.71
|
| Rate for Payer: Humana Medicare |
$52.13
|
| Rate for Payer: Lucent All Commercial |
$88.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.63
|
| Rate for Payer: Managed Health Services Medicaid |
$60.48
|
| Rate for Payer: MDWise Medicaid |
$60.48
|
| Rate for Payer: PHCS All Commercial |
$122.19
|
| Rate for Payer: PHP All Commercial |
$123.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.54
|
| Rate for Payer: Sagamore Health Network All Products |
$125.77
|
| Rate for Payer: Signature Care EPO |
$135.22
|
| Rate for Payer: Signature Care PPO |
$143.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.48
|
| Rate for Payer: United Healthcare Commercial |
$128.38
|
| Rate for Payer: United Healthcare Medicare |
$52.13
|
|
|
HC IV SEDATION INITIAL 15 MIN
|
Facility
|
IP
|
$162.92
|
|
| Hospital Charge Code |
1246656
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$122.19 |
| Max. Negotiated Rate |
$151.52 |
| Rate for Payer: Aetna Commercial |
$140.76
|
| Rate for Payer: Cash Price |
$97.75
|
| Rate for Payer: Cigna All Commercial |
$140.60
|
| Rate for Payer: CORVEL All Commercial |
$151.52
|
| Rate for Payer: Coventry All Commercial |
$143.37
|
| Rate for Payer: Encore All Commercial |
$149.97
|
| Rate for Payer: Frontpath All Commercial |
$149.89
|
| Rate for Payer: Humana ChoiceCare |
$140.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.63
|
| Rate for Payer: PHCS All Commercial |
$122.19
|
| Rate for Payer: PHP All Commercial |
$123.56
|
| Rate for Payer: Sagamore Health Network All Products |
$125.77
|
| Rate for Payer: Signature Care EPO |
$135.22
|
| Rate for Payer: Signature Care PPO |
$143.37
|
| Rate for Payer: United Healthcare Commercial |
$128.38
|
|
|
HC JADA SYSTEM HEMORRHAGE
|
Facility
|
OP
|
$4,860.00
|
|
| Hospital Charge Code |
41608162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,519.80 |
| Rate for Payer: Aetna Commercial |
$4,101.84
|
| Rate for Payer: Aetna Medicare |
$1,555.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,506.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,791.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,037.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,788.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,710.72
|
| Rate for Payer: Cash Price |
$2,916.00
|
| Rate for Payer: Cash Price |
$2,916.00
|
| Rate for Payer: Centivo All Commercial |
$2,643.84
|
| Rate for Payer: Cigna All Commercial |
$4,194.18
|
| Rate for Payer: CORVEL All Commercial |
$4,519.80
|
| Rate for Payer: Coventry All Commercial |
$4,276.80
|
| Rate for Payer: Encore All Commercial |
$4,473.63
|
| Rate for Payer: Frontpath All Commercial |
$4,471.20
|
| Rate for Payer: Humana ChoiceCare |
$4,197.58
|
| Rate for Payer: Humana Medicare |
$1,555.20
|
| Rate for Payer: Lucent All Commercial |
$2,643.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,374.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,645.00
|
| Rate for Payer: PHP All Commercial |
$3,685.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,895.40
|
| Rate for Payer: Sagamore Health Network All Products |
$3,751.92
|
| Rate for Payer: Signature Care EPO |
$4,033.80
|
| Rate for Payer: Signature Care PPO |
$4,276.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,131.00
|
| Rate for Payer: United Healthcare Commercial |
$3,829.68
|
| Rate for Payer: United Healthcare Medicare |
$1,555.20
|
|
|
HC JADA SYSTEM HEMORRHAGE
|
Facility
|
IP
|
$4,860.00
|
|
| Hospital Charge Code |
41608162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,645.00 |
| Max. Negotiated Rate |
$4,519.80 |
| Rate for Payer: Aetna Commercial |
$4,199.04
|
| Rate for Payer: Cash Price |
$2,916.00
|
| Rate for Payer: Cigna All Commercial |
$4,194.18
|
| Rate for Payer: CORVEL All Commercial |
$4,519.80
|
| Rate for Payer: Coventry All Commercial |
$4,276.80
|
| Rate for Payer: Encore All Commercial |
$4,473.63
|
| Rate for Payer: Frontpath All Commercial |
$4,471.20
|
| Rate for Payer: Humana ChoiceCare |
$4,197.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,374.00
|
| Rate for Payer: PHCS All Commercial |
$3,645.00
|
| Rate for Payer: PHP All Commercial |
$3,685.82
|
| Rate for Payer: Sagamore Health Network All Products |
$3,751.92
|
| Rate for Payer: Signature Care EPO |
$4,033.80
|
| Rate for Payer: Signature Care PPO |
$4,276.80
|
| Rate for Payer: United Healthcare Commercial |
$3,829.68
|
|
|
HC JAK2V617F MUTATION ANALYSIS, QUALITATIVE, WITH REFLEX TO JAK2 EXON 12-15 MUTATION ANALYSIS
|
Facility
|
OP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63044052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$370.17
|
| Rate for Payer: Aetna Medicare |
$140.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$91.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.38
|
| Rate for Payer: Cash Price |
$263.15
|
| Rate for Payer: Cash Price |
$263.15
|
| Rate for Payer: Centivo All Commercial |
$238.59
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Humana Medicare |
$140.35
|
| Rate for Payer: Lucent All Commercial |
$238.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: Managed Health Services Medicaid |
$91.66
|
| Rate for Payer: MDWise Medicaid |
$91.66
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.05
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.80
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
| Rate for Payer: United Healthcare Medicare |
$140.35
|
|
|
HC JAK2V617F MUTATION ANALYSIS, QUALITATIVE, WITH REFLEX TO JAK2 EXON 12-15 MUTATION ANALYSIS
|
Facility
|
IP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63044052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.94 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: Cash Price |
$263.15
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
|
|
HC JAK2 V617F MUTATION-PCR
|
Facility
|
IP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63001439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.94 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: Cash Price |
$263.15
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
|
|
HC JAK2 V617F MUTATION-PCR
|
Facility
|
OP
|
$438.59
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
63001439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$407.89 |
| Rate for Payer: Aetna Commercial |
$370.17
|
| Rate for Payer: Aetna Medicare |
$140.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$91.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$201.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.38
|
| Rate for Payer: Cash Price |
$263.15
|
| Rate for Payer: Cash Price |
$263.15
|
| Rate for Payer: Centivo All Commercial |
$238.59
|
| Rate for Payer: Cigna All Commercial |
$378.50
|
| Rate for Payer: CORVEL All Commercial |
$407.89
|
| Rate for Payer: Coventry All Commercial |
$385.96
|
| Rate for Payer: Encore All Commercial |
$403.72
|
| Rate for Payer: Frontpath All Commercial |
$403.50
|
| Rate for Payer: Humana ChoiceCare |
$378.81
|
| Rate for Payer: Humana Medicare |
$140.35
|
| Rate for Payer: Lucent All Commercial |
$238.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.73
|
| Rate for Payer: Managed Health Services Medicaid |
$91.66
|
| Rate for Payer: MDWise Medicaid |
$91.66
|
| Rate for Payer: PHCS All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$332.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.05
|
| Rate for Payer: Sagamore Health Network All Products |
$338.59
|
| Rate for Payer: Signature Care EPO |
$364.03
|
| Rate for Payer: Signature Care PPO |
$385.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.80
|
| Rate for Payer: United Healthcare Commercial |
$345.61
|
| Rate for Payer: United Healthcare Medicare |
$140.35
|
|
|
HC JEVITY 1.5CAL 1500ML
|
Facility
|
IP
|
$15.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cigna All Commercial |
$13.46
|
| Rate for Payer: CORVEL All Commercial |
$14.51
|
| Rate for Payer: Coventry All Commercial |
$13.73
|
| Rate for Payer: Encore All Commercial |
$14.36
|
| Rate for Payer: Frontpath All Commercial |
$14.35
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.04
|
| Rate for Payer: PHCS All Commercial |
$11.70
|
| Rate for Payer: PHP All Commercial |
$11.83
|
| Rate for Payer: Sagamore Health Network All Products |
$12.04
|
| Rate for Payer: Signature Care EPO |
$12.95
|
| Rate for Payer: Signature Care PPO |
$13.73
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
|
|
HC JEVITY 1.5CAL 1500ML
|
Facility
|
OP
|
$15.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.49
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Centivo All Commercial |
$8.49
|
| Rate for Payer: Cigna All Commercial |
$13.46
|
| Rate for Payer: CORVEL All Commercial |
$14.51
|
| Rate for Payer: Coventry All Commercial |
$13.73
|
| Rate for Payer: Encore All Commercial |
$14.36
|
| Rate for Payer: Frontpath All Commercial |
$14.35
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Humana Medicare |
$4.99
|
| Rate for Payer: Lucent All Commercial |
$8.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.04
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$11.70
|
| Rate for Payer: PHP All Commercial |
$11.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.08
|
| Rate for Payer: Sagamore Health Network All Products |
$12.04
|
| Rate for Payer: Signature Care EPO |
$12.95
|
| Rate for Payer: Signature Care PPO |
$13.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.26
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
| Rate for Payer: United Healthcare Medicare |
$4.99
|
|
|
HC JEVITY 1.5CAL 8OZ
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Centivo All Commercial |
$1.24
|
| Rate for Payer: Cigna All Commercial |
$1.97
|
| Rate for Payer: CORVEL All Commercial |
$2.12
|
| Rate for Payer: Coventry All Commercial |
$2.01
|
| Rate for Payer: Encore All Commercial |
$2.10
|
| Rate for Payer: Frontpath All Commercial |
$2.10
|
| Rate for Payer: Humana ChoiceCare |
$1.97
|
| Rate for Payer: Humana Medicare |
$0.73
|
| Rate for Payer: Lucent All Commercial |
$1.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.05
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$1.71
|
| Rate for Payer: PHP All Commercial |
$1.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1.76
|
| Rate for Payer: Signature Care EPO |
$1.89
|
| Rate for Payer: Signature Care PPO |
$2.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.94
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
|
|
HC JEVITY 1.5CAL 8OZ
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
41602457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna All Commercial |
$1.97
|
| Rate for Payer: CORVEL All Commercial |
$2.12
|
| Rate for Payer: Coventry All Commercial |
$2.01
|
| Rate for Payer: Encore All Commercial |
$2.10
|
| Rate for Payer: Frontpath All Commercial |
$2.10
|
| Rate for Payer: Humana ChoiceCare |
$1.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.05
|
| Rate for Payer: PHCS All Commercial |
$1.71
|
| Rate for Payer: PHP All Commercial |
$1.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1.76
|
| Rate for Payer: Signature Care EPO |
$1.89
|
| Rate for Payer: Signature Care PPO |
$2.01
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
|
HC JO-1 IGG ANTIBODY
|
Facility
|
IP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$134.43
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: United Healthcare Commercial |
$122.60
|
|
|
HC JO-1 IGG ANTIBODY
|
Facility
|
OP
|
$155.59
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.70 |
| Rate for Payer: Aetna Commercial |
$131.32
|
| Rate for Payer: Aetna Medicare |
$49.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Centivo All Commercial |
$84.64
|
| Rate for Payer: Cigna All Commercial |
$134.27
|
| Rate for Payer: CORVEL All Commercial |
$144.70
|
| Rate for Payer: Coventry All Commercial |
$136.92
|
| Rate for Payer: Encore All Commercial |
$143.22
|
| Rate for Payer: Frontpath All Commercial |
$143.14
|
| Rate for Payer: Humana ChoiceCare |
$134.38
|
| Rate for Payer: Humana Medicare |
$49.79
|
| Rate for Payer: Lucent All Commercial |
$84.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$116.69
|
| Rate for Payer: PHP All Commercial |
$118.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.68
|
| Rate for Payer: Sagamore Health Network All Products |
$120.12
|
| Rate for Payer: Signature Care EPO |
$129.14
|
| Rate for Payer: Signature Care PPO |
$136.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.25
|
| Rate for Payer: United Healthcare Commercial |
$122.60
|
| Rate for Payer: United Healthcare Medicare |
$49.79
|
|
|
HC KCI ATS VAC MACHINE - PER DAY
|
Facility
|
OP
|
$306.41
|
|
| Hospital Charge Code |
1891229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Aetna Medicare |
$98.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.86
|
| Rate for Payer: Cash Price |
$183.85
|
| Rate for Payer: Cash Price |
$183.85
|
| Rate for Payer: Centivo All Commercial |
$166.69
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.65
|
| Rate for Payer: Humana Medicare |
$98.05
|
| Rate for Payer: Lucent All Commercial |
$166.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.50
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.45
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
| Rate for Payer: United Healthcare Medicare |
$98.05
|
|
|
HC KCI ATS VAC MACHINE - PER DAY
|
Facility
|
IP
|
$306.41
|
|
| Hospital Charge Code |
1891229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$284.96 |
| Rate for Payer: Aetna Commercial |
$264.74
|
| Rate for Payer: Cash Price |
$183.85
|
| Rate for Payer: Cigna All Commercial |
$264.43
|
| Rate for Payer: CORVEL All Commercial |
$284.96
|
| Rate for Payer: Coventry All Commercial |
$269.64
|
| Rate for Payer: Encore All Commercial |
$282.05
|
| Rate for Payer: Frontpath All Commercial |
$281.90
|
| Rate for Payer: Humana ChoiceCare |
$264.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.77
|
| Rate for Payer: PHCS All Commercial |
$229.81
|
| Rate for Payer: PHP All Commercial |
$232.38
|
| Rate for Payer: Sagamore Health Network All Products |
$236.55
|
| Rate for Payer: Signature Care EPO |
$254.32
|
| Rate for Payer: Signature Care PPO |
$269.64
|
| Rate for Payer: United Healthcare Commercial |
$241.45
|
|
|
HC KEPPRA
|
Facility
|
OP
|
$243.47
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
63001375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| 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 |
$13.25
|
| 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 |
$13.25
|
| 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 |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| 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 KEPPRA
|
Facility
|
IP
|
$243.47
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
63001375
|
|
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
|
|
|
HC KIT CHOLANGIOGRAM 4 F ARROW
|
Facility
|
IP
|
$996.44
|
|
| Hospital Charge Code |
41602619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.33 |
| Max. Negotiated Rate |
$926.69 |
| Rate for Payer: Aetna Commercial |
$860.92
|
| Rate for Payer: Cash Price |
$597.86
|
| Rate for Payer: Cigna All Commercial |
$859.93
|
| Rate for Payer: CORVEL All Commercial |
$926.69
|
| Rate for Payer: Coventry All Commercial |
$876.87
|
| Rate for Payer: Encore All Commercial |
$917.22
|
| Rate for Payer: Frontpath All Commercial |
$916.72
|
| Rate for Payer: Humana ChoiceCare |
$860.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$896.80
|
| Rate for Payer: PHCS All Commercial |
$747.33
|
| Rate for Payer: PHP All Commercial |
$755.70
|
| Rate for Payer: Sagamore Health Network All Products |
$769.25
|
| Rate for Payer: Signature Care EPO |
$827.05
|
| Rate for Payer: Signature Care PPO |
$876.87
|
| Rate for Payer: United Healthcare Commercial |
$785.19
|
|
|
HC KIT CHOLANGIOGRAM 4 F ARROW
|
Facility
|
OP
|
$996.44
|
|
| Hospital Charge Code |
41602619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$926.69 |
| Rate for Payer: Aetna Commercial |
$841.00
|
| Rate for Payer: Aetna Medicare |
$318.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$308.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$572.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$622.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.75
|
| Rate for Payer: Cash Price |
$597.86
|
| Rate for Payer: Cash Price |
$597.86
|
| Rate for Payer: Centivo All Commercial |
$542.06
|
| Rate for Payer: Cigna All Commercial |
$859.93
|
| Rate for Payer: CORVEL All Commercial |
$926.69
|
| Rate for Payer: Coventry All Commercial |
$876.87
|
| Rate for Payer: Encore All Commercial |
$917.22
|
| Rate for Payer: Frontpath All Commercial |
$916.72
|
| Rate for Payer: Humana ChoiceCare |
$860.63
|
| Rate for Payer: Humana Medicare |
$318.86
|
| Rate for Payer: Lucent All Commercial |
$542.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$896.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$747.33
|
| Rate for Payer: PHP All Commercial |
$755.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.61
|
| Rate for Payer: Sagamore Health Network All Products |
$769.25
|
| Rate for Payer: Signature Care EPO |
$827.05
|
| Rate for Payer: Signature Care PPO |
$876.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$846.97
|
| Rate for Payer: United Healthcare Commercial |
$785.19
|
| Rate for Payer: United Healthcare Medicare |
$318.86
|
|
|
HC KIT COLLECTION FEE
|
Facility
|
OP
|
$27.29
|
|
| Hospital Charge Code |
63002224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.61
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Centivo All Commercial |
$14.85
|
| Rate for Payer: Cigna All Commercial |
$23.55
|
| Rate for Payer: CORVEL All Commercial |
$25.38
|
| Rate for Payer: Coventry All Commercial |
$24.02
|
| Rate for Payer: Encore All Commercial |
$25.12
|
| Rate for Payer: Frontpath All Commercial |
$25.11
|
| Rate for Payer: Humana ChoiceCare |
$23.57
|
| Rate for Payer: Humana Medicare |
$8.73
|
| Rate for Payer: Lucent All Commercial |
$14.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.56
|
| Rate for Payer: PHCS All Commercial |
$20.47
|
| Rate for Payer: PHP All Commercial |
$20.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$21.07
|
| Rate for Payer: Signature Care EPO |
$22.65
|
| Rate for Payer: Signature Care PPO |
$24.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
| Rate for Payer: United Healthcare Medicare |
$8.73
|
|
