|
HC LEVEL 4 PATH COMPLICATED
|
Facility
|
IP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63001258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.19 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$457.56
|
| Rate for Payer: Cash Price |
$317.75
|
| Rate for Payer: Cigna All Commercial |
$457.03
|
| Rate for Payer: CORVEL All Commercial |
$492.51
|
| Rate for Payer: Coventry All Commercial |
$466.03
|
| Rate for Payer: Encore All Commercial |
$487.48
|
| Rate for Payer: Frontpath All Commercial |
$487.21
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.62
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.63
|
| Rate for Payer: Sagamore Health Network All Products |
$408.84
|
| Rate for Payer: Signature Care EPO |
$439.55
|
| Rate for Payer: Signature Care PPO |
$466.03
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
|
|
HC LEVEL 4 PATH COMPLICATED
|
Facility
|
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002171
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$314.01 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$108.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$71.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$155.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$155.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.85
|
| Rate for Payer: Cash Price |
$202.59
|
| Rate for Payer: Cash Price |
$202.59
|
| Rate for Payer: Centivo All Commercial |
$183.68
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.01
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$108.05
|
| Rate for Payer: Lucent All Commercial |
$183.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.88
|
| Rate for Payer: Managed Health Services Medicaid |
$71.12
|
| Rate for Payer: MDWise Medicaid |
$71.12
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$108.05
|
|
|
HC LEVEL 4 PATH COMPLICATED
|
Facility
|
OP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63001258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$446.97
|
| Rate for Payer: Aetna Medicare |
$169.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$71.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$243.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.41
|
| Rate for Payer: Cash Price |
$317.75
|
| Rate for Payer: Cash Price |
$317.75
|
| Rate for Payer: Centivo All Commercial |
$288.09
|
| Rate for Payer: Cigna All Commercial |
$457.03
|
| Rate for Payer: CORVEL All Commercial |
$492.51
|
| Rate for Payer: Coventry All Commercial |
$466.03
|
| Rate for Payer: Encore All Commercial |
$487.48
|
| Rate for Payer: Frontpath All Commercial |
$487.21
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Humana Medicare |
$169.47
|
| Rate for Payer: Lucent All Commercial |
$288.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.62
|
| Rate for Payer: Managed Health Services Medicaid |
$71.12
|
| Rate for Payer: MDWise Medicaid |
$71.12
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.54
|
| Rate for Payer: Sagamore Health Network All Products |
$408.84
|
| Rate for Payer: Signature Care EPO |
$439.55
|
| Rate for Payer: Signature Care PPO |
$466.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$450.14
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
| Rate for Payer: United Healthcare Medicare |
$169.47
|
|
|
HC LEVEL 5 COMPLEX PATH
|
Facility
|
IP
|
$885.26
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
63001259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$663.95 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$764.86
|
| Rate for Payer: Cash Price |
$531.16
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: PHCS All Commercial |
$663.95
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.77
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
|
|
HC LEVEL 5 COMPLEX PATH
|
Facility
|
OP
|
$885.26
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
63001259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$747.16
|
| Rate for Payer: Aetna Medicare |
$283.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$274.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$406.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$94.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$325.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$311.61
|
| Rate for Payer: Cash Price |
$531.16
|
| Rate for Payer: Cash Price |
$531.16
|
| Rate for Payer: Centivo All Commercial |
$481.58
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Humana Medicare |
$283.28
|
| Rate for Payer: Lucent All Commercial |
$481.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: Managed Health Services Medicaid |
$94.45
|
| Rate for Payer: MDWise Medicaid |
$94.45
|
| Rate for Payer: PHCS All Commercial |
$663.95
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.25
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.77
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.47
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
| Rate for Payer: United Healthcare Medicare |
$283.28
|
|
|
HC LEVEL 5 PATH COMPLEX
|
Facility
|
OP
|
$885.26
|
|
|
Service Code
|
CPT 88307 59
|
| Hospital Charge Code |
63002178
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$747.16
|
| Rate for Payer: Aetna Medicare |
$283.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$274.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$406.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$94.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$325.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$311.61
|
| Rate for Payer: Cash Price |
$531.16
|
| Rate for Payer: Cash Price |
$531.16
|
| Rate for Payer: Centivo All Commercial |
$481.58
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Humana Medicare |
$283.28
|
| Rate for Payer: Lucent All Commercial |
$481.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: Managed Health Services Medicaid |
$94.45
|
| Rate for Payer: MDWise Medicaid |
$94.45
|
| Rate for Payer: PHCS All Commercial |
$663.95
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.25
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.77
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.47
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
| Rate for Payer: United Healthcare Medicare |
$283.28
|
|
|
HC LEVEL 5 PATH COMPLEX
|
Facility
|
IP
|
$885.26
|
|
|
Service Code
|
CPT 88307 59
|
| Hospital Charge Code |
63002178
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$663.95 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$764.86
|
| Rate for Payer: Cash Price |
$531.16
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: PHCS All Commercial |
$663.95
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.77
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
|
|
HC LEVEL 6 COMPREHENSIVE
|
Facility
|
IP
|
$1,169.58
|
|
|
Service Code
|
CPT 88309 59
|
| Hospital Charge Code |
63002182
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$877.18 |
| Max. Negotiated Rate |
$1,087.71 |
| Rate for Payer: Aetna Commercial |
$1,010.52
|
| Rate for Payer: Cash Price |
$701.75
|
| Rate for Payer: Cigna All Commercial |
$1,009.35
|
| Rate for Payer: CORVEL All Commercial |
$1,087.71
|
| Rate for Payer: Coventry All Commercial |
$1,029.23
|
| Rate for Payer: Encore All Commercial |
$1,076.60
|
| Rate for Payer: Frontpath All Commercial |
$1,076.01
|
| Rate for Payer: Humana ChoiceCare |
$1,010.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,052.62
|
| Rate for Payer: PHCS All Commercial |
$877.18
|
| Rate for Payer: PHP All Commercial |
$887.01
|
| Rate for Payer: Sagamore Health Network All Products |
$902.92
|
| Rate for Payer: Signature Care EPO |
$970.75
|
| Rate for Payer: Signature Care PPO |
$1,029.23
|
| Rate for Payer: United Healthcare Commercial |
$921.63
|
|
|
HC LEVEL 6 COMPREHENSIVE
|
Facility
|
OP
|
$1,169.58
|
|
|
Service Code
|
CPT 88309 59
|
| Hospital Charge Code |
63002182
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.92 |
| Max. Negotiated Rate |
$1,087.71 |
| Rate for Payer: Aetna Commercial |
$987.13
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$116.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$362.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$537.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.69
|
| Rate for Payer: Cash Price |
$701.75
|
| Rate for Payer: Cash Price |
$701.75
|
| Rate for Payer: Centivo All Commercial |
$636.25
|
| Rate for Payer: Cigna All Commercial |
$1,009.35
|
| Rate for Payer: CORVEL All Commercial |
$1,087.71
|
| Rate for Payer: Coventry All Commercial |
$1,029.23
|
| Rate for Payer: Encore All Commercial |
$1,076.60
|
| Rate for Payer: Frontpath All Commercial |
$1,076.01
|
| Rate for Payer: Humana ChoiceCare |
$1,010.17
|
| Rate for Payer: Humana Medicare |
$374.27
|
| Rate for Payer: Lucent All Commercial |
$636.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,052.62
|
| Rate for Payer: Managed Health Services Medicaid |
$116.92
|
| Rate for Payer: MDWise Medicaid |
$116.92
|
| Rate for Payer: PHCS All Commercial |
$877.18
|
| Rate for Payer: PHP All Commercial |
$887.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.14
|
| Rate for Payer: Sagamore Health Network All Products |
$902.92
|
| Rate for Payer: Signature Care EPO |
$970.75
|
| Rate for Payer: Signature Care PPO |
$1,029.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$994.14
|
| Rate for Payer: United Healthcare Commercial |
$921.63
|
| Rate for Payer: United Healthcare Medicare |
$374.27
|
|
|
HC LEVEL 6 PATH COMP
|
Facility
|
IP
|
$1,169.58
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
63001260
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$877.18 |
| Max. Negotiated Rate |
$1,087.71 |
| Rate for Payer: Aetna Commercial |
$1,010.52
|
| Rate for Payer: Cash Price |
$701.75
|
| Rate for Payer: Cigna All Commercial |
$1,009.35
|
| Rate for Payer: CORVEL All Commercial |
$1,087.71
|
| Rate for Payer: Coventry All Commercial |
$1,029.23
|
| Rate for Payer: Encore All Commercial |
$1,076.60
|
| Rate for Payer: Frontpath All Commercial |
$1,076.01
|
| Rate for Payer: Humana ChoiceCare |
$1,010.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,052.62
|
| Rate for Payer: PHCS All Commercial |
$877.18
|
| Rate for Payer: PHP All Commercial |
$887.01
|
| Rate for Payer: Sagamore Health Network All Products |
$902.92
|
| Rate for Payer: Signature Care EPO |
$970.75
|
| Rate for Payer: Signature Care PPO |
$1,029.23
|
| Rate for Payer: United Healthcare Commercial |
$921.63
|
|
|
HC LEVEL 6 PATH COMP
|
Facility
|
OP
|
$1,169.58
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
63001260
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.92 |
| Max. Negotiated Rate |
$1,087.71 |
| Rate for Payer: Aetna Commercial |
$987.13
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$116.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$362.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$537.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.69
|
| Rate for Payer: Cash Price |
$701.75
|
| Rate for Payer: Cash Price |
$701.75
|
| Rate for Payer: Centivo All Commercial |
$636.25
|
| Rate for Payer: Cigna All Commercial |
$1,009.35
|
| Rate for Payer: CORVEL All Commercial |
$1,087.71
|
| Rate for Payer: Coventry All Commercial |
$1,029.23
|
| Rate for Payer: Encore All Commercial |
$1,076.60
|
| Rate for Payer: Frontpath All Commercial |
$1,076.01
|
| Rate for Payer: Humana ChoiceCare |
$1,010.17
|
| Rate for Payer: Humana Medicare |
$374.27
|
| Rate for Payer: Lucent All Commercial |
$636.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,052.62
|
| Rate for Payer: Managed Health Services Medicaid |
$116.92
|
| Rate for Payer: MDWise Medicaid |
$116.92
|
| Rate for Payer: PHCS All Commercial |
$877.18
|
| Rate for Payer: PHP All Commercial |
$887.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.14
|
| Rate for Payer: Sagamore Health Network All Products |
$902.92
|
| Rate for Payer: Signature Care EPO |
$970.75
|
| Rate for Payer: Signature Care PPO |
$1,029.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$994.14
|
| Rate for Payer: United Healthcare Commercial |
$921.63
|
| Rate for Payer: United Healthcare Medicare |
$374.27
|
|
|
HC LH
|
Facility
|
OP
|
$242.35
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
63001189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$225.39 |
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.31
|
| Rate for Payer: Cash Price |
$145.41
|
| Rate for Payer: Cash Price |
$145.41
|
| Rate for Payer: Centivo All Commercial |
$131.84
|
| Rate for Payer: Cigna All Commercial |
$209.15
|
| Rate for Payer: CORVEL All Commercial |
$225.39
|
| Rate for Payer: Coventry All Commercial |
$213.27
|
| Rate for Payer: Encore All Commercial |
$223.08
|
| Rate for Payer: Frontpath All Commercial |
$222.96
|
| Rate for Payer: Humana ChoiceCare |
$209.32
|
| Rate for Payer: Humana Medicare |
$77.55
|
| Rate for Payer: Lucent All Commercial |
$131.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.12
|
| Rate for Payer: Managed Health Services Medicaid |
$18.52
|
| Rate for Payer: MDWise Medicaid |
$18.52
|
| Rate for Payer: PHCS All Commercial |
$181.76
|
| Rate for Payer: PHP All Commercial |
$183.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.52
|
| Rate for Payer: Sagamore Health Network All Products |
$187.09
|
| Rate for Payer: Signature Care EPO |
$201.15
|
| Rate for Payer: Signature Care PPO |
$213.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.00
|
| Rate for Payer: United Healthcare Commercial |
$190.97
|
| Rate for Payer: United Healthcare Medicare |
$77.55
|
|
|
HC LH
|
Facility
|
IP
|
$242.35
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
63001189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.76 |
| Max. Negotiated Rate |
$225.39 |
| Rate for Payer: Aetna Commercial |
$209.39
|
| Rate for Payer: Cash Price |
$145.41
|
| Rate for Payer: Cigna All Commercial |
$209.15
|
| Rate for Payer: CORVEL All Commercial |
$225.39
|
| Rate for Payer: Coventry All Commercial |
$213.27
|
| Rate for Payer: Encore All Commercial |
$223.08
|
| Rate for Payer: Frontpath All Commercial |
$222.96
|
| Rate for Payer: Humana ChoiceCare |
$209.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.12
|
| Rate for Payer: PHCS All Commercial |
$181.76
|
| Rate for Payer: PHP All Commercial |
$183.80
|
| Rate for Payer: Sagamore Health Network All Products |
$187.09
|
| Rate for Payer: Signature Care EPO |
$201.15
|
| Rate for Payer: Signature Care PPO |
$213.27
|
| Rate for Payer: United Healthcare Commercial |
$190.97
|
|
|
HC LIGACLIP MEDIUM LT200
|
Facility
|
OP
|
$13.79
|
|
| Hospital Charge Code |
41601932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.64
|
| Rate for Payer: Aetna Medicare |
$4.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.85
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Centivo All Commercial |
$7.50
|
| Rate for Payer: Cigna All Commercial |
$11.90
|
| Rate for Payer: CORVEL All Commercial |
$12.82
|
| Rate for Payer: Coventry All Commercial |
$12.14
|
| Rate for Payer: Encore All Commercial |
$12.69
|
| Rate for Payer: Frontpath All Commercial |
$12.69
|
| Rate for Payer: Humana ChoiceCare |
$11.91
|
| Rate for Payer: Humana Medicare |
$4.41
|
| Rate for Payer: Lucent All Commercial |
$7.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.34
|
| Rate for Payer: PHP All Commercial |
$10.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.38
|
| Rate for Payer: Sagamore Health Network All Products |
$10.65
|
| Rate for Payer: Signature Care EPO |
$11.45
|
| Rate for Payer: Signature Care PPO |
$12.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.72
|
| Rate for Payer: United Healthcare Commercial |
$10.87
|
| Rate for Payer: United Healthcare Medicare |
$4.41
|
|
|
HC LIGACLIP MEDIUM LT200
|
Facility
|
IP
|
$13.79
|
|
| Hospital Charge Code |
41601932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna All Commercial |
$11.90
|
| Rate for Payer: CORVEL All Commercial |
$12.82
|
| Rate for Payer: Coventry All Commercial |
$12.14
|
| Rate for Payer: Encore All Commercial |
$12.69
|
| Rate for Payer: Frontpath All Commercial |
$12.69
|
| Rate for Payer: Humana ChoiceCare |
$11.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.41
|
| Rate for Payer: PHCS All Commercial |
$10.34
|
| Rate for Payer: PHP All Commercial |
$10.46
|
| Rate for Payer: Sagamore Health Network All Products |
$10.65
|
| Rate for Payer: Signature Care EPO |
$11.45
|
| Rate for Payer: Signature Care PPO |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$10.87
|
|
|
HC LIGACLIP SMALL LT100
|
Facility
|
IP
|
$14.18
|
|
| Hospital Charge Code |
41602495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$13.19 |
| Rate for Payer: Aetna Commercial |
$12.25
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cigna All Commercial |
$12.24
|
| Rate for Payer: CORVEL All Commercial |
$13.19
|
| Rate for Payer: Coventry All Commercial |
$12.48
|
| Rate for Payer: Encore All Commercial |
$13.05
|
| Rate for Payer: Frontpath All Commercial |
$13.05
|
| Rate for Payer: Humana ChoiceCare |
$12.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.76
|
| Rate for Payer: PHCS All Commercial |
$10.63
|
| Rate for Payer: PHP All Commercial |
$10.75
|
| Rate for Payer: Sagamore Health Network All Products |
$10.95
|
| Rate for Payer: Signature Care EPO |
$11.77
|
| Rate for Payer: Signature Care PPO |
$12.48
|
| Rate for Payer: United Healthcare Commercial |
$11.17
|
|
|
HC LIGACLIP SMALL LT100
|
Facility
|
OP
|
$14.18
|
|
| Hospital Charge Code |
41602495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.97
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.99
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Centivo All Commercial |
$7.71
|
| Rate for Payer: Cigna All Commercial |
$12.24
|
| Rate for Payer: CORVEL All Commercial |
$13.19
|
| Rate for Payer: Coventry All Commercial |
$12.48
|
| Rate for Payer: Encore All Commercial |
$13.05
|
| Rate for Payer: Frontpath All Commercial |
$13.05
|
| Rate for Payer: Humana ChoiceCare |
$12.25
|
| Rate for Payer: Humana Medicare |
$4.54
|
| Rate for Payer: Lucent All Commercial |
$7.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.63
|
| Rate for Payer: PHP All Commercial |
$10.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.53
|
| Rate for Payer: Sagamore Health Network All Products |
$10.95
|
| Rate for Payer: Signature Care EPO |
$11.77
|
| Rate for Payer: Signature Care PPO |
$12.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$11.17
|
| Rate for Payer: United Healthcare Medicare |
$4.54
|
|
|
HC LIPASE
|
Facility
|
IP
|
$171.67
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$148.32
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.94
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.49
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: United Healthcare Commercial |
$135.28
|
|
|
HC LIPASE
|
Facility
|
IP
|
$120.87
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$112.41 |
| Rate for Payer: Aetna Commercial |
$104.43
|
| Rate for Payer: Cash Price |
$72.52
|
| Rate for Payer: Cigna All Commercial |
$104.31
|
| Rate for Payer: CORVEL All Commercial |
$112.41
|
| Rate for Payer: Coventry All Commercial |
$106.37
|
| Rate for Payer: Encore All Commercial |
$111.26
|
| Rate for Payer: Frontpath All Commercial |
$111.20
|
| Rate for Payer: Humana ChoiceCare |
$104.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.78
|
| Rate for Payer: PHCS All Commercial |
$90.65
|
| Rate for Payer: PHP All Commercial |
$91.67
|
| Rate for Payer: Sagamore Health Network All Products |
$93.31
|
| Rate for Payer: Signature Care EPO |
$100.32
|
| Rate for Payer: Signature Care PPO |
$106.37
|
| Rate for Payer: United Healthcare Commercial |
$95.25
|
|
|
HC LIPASE
|
Facility
|
OP
|
$171.67
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Aetna Commercial |
$144.89
|
| Rate for Payer: Aetna Medicare |
$54.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.43
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Centivo All Commercial |
$93.39
|
| Rate for Payer: Cigna All Commercial |
$148.15
|
| Rate for Payer: CORVEL All Commercial |
$159.65
|
| Rate for Payer: Coventry All Commercial |
$151.07
|
| Rate for Payer: Encore All Commercial |
$158.02
|
| Rate for Payer: Frontpath All Commercial |
$157.94
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Humana Medicare |
$54.93
|
| Rate for Payer: Lucent All Commercial |
$93.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.50
|
| Rate for Payer: Managed Health Services Medicaid |
$6.89
|
| Rate for Payer: MDWise Medicaid |
$6.89
|
| Rate for Payer: PHCS All Commercial |
$128.75
|
| Rate for Payer: PHP All Commercial |
$130.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.95
|
| Rate for Payer: Sagamore Health Network All Products |
$132.53
|
| Rate for Payer: Signature Care EPO |
$142.49
|
| Rate for Payer: Signature Care PPO |
$151.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.92
|
| Rate for Payer: United Healthcare Commercial |
$135.28
|
| Rate for Payer: United Healthcare Medicare |
$54.93
|
|
|
HC LIPASE
|
Facility
|
OP
|
$120.87
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
63001097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$112.41 |
| Rate for Payer: Aetna Commercial |
$102.01
|
| Rate for Payer: Aetna Medicare |
$38.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$55.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.55
|
| Rate for Payer: Cash Price |
$72.52
|
| Rate for Payer: Cash Price |
$72.52
|
| Rate for Payer: Centivo All Commercial |
$65.75
|
| Rate for Payer: Cigna All Commercial |
$104.31
|
| Rate for Payer: CORVEL All Commercial |
$112.41
|
| Rate for Payer: Coventry All Commercial |
$106.37
|
| Rate for Payer: Encore All Commercial |
$111.26
|
| Rate for Payer: Frontpath All Commercial |
$111.20
|
| Rate for Payer: Humana ChoiceCare |
$104.40
|
| Rate for Payer: Humana Medicare |
$38.68
|
| Rate for Payer: Lucent All Commercial |
$65.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$108.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.89
|
| Rate for Payer: MDWise Medicaid |
$6.89
|
| Rate for Payer: PHCS All Commercial |
$90.65
|
| Rate for Payer: PHP All Commercial |
$91.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.14
|
| Rate for Payer: Sagamore Health Network All Products |
$93.31
|
| Rate for Payer: Signature Care EPO |
$100.32
|
| Rate for Payer: Signature Care PPO |
$106.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.74
|
| Rate for Payer: United Healthcare Commercial |
$95.25
|
| Rate for Payer: United Healthcare Medicare |
$38.68
|
|
|
HC LIPID FOR LIPOPROFILE
|
Facility
|
OP
|
$56.31
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$52.37 |
| Rate for Payer: Aetna Commercial |
$47.53
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.82
|
| Rate for Payer: Cash Price |
$33.79
|
| Rate for Payer: Cash Price |
$33.79
|
| Rate for Payer: Centivo All Commercial |
$30.63
|
| Rate for Payer: Cigna All Commercial |
$48.60
|
| Rate for Payer: CORVEL All Commercial |
$52.37
|
| Rate for Payer: Coventry All Commercial |
$49.55
|
| Rate for Payer: Encore All Commercial |
$51.83
|
| Rate for Payer: Frontpath All Commercial |
$51.81
|
| Rate for Payer: Humana ChoiceCare |
$48.63
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Lucent All Commercial |
$30.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.68
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$42.23
|
| Rate for Payer: PHP All Commercial |
$42.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.96
|
| Rate for Payer: Sagamore Health Network All Products |
$43.47
|
| Rate for Payer: Signature Care EPO |
$46.74
|
| Rate for Payer: Signature Care PPO |
$49.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.86
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$18.02
|
|
|
HC LIPID FOR LIPOPROFILE
|
Facility
|
IP
|
$56.31
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.23 |
| Max. Negotiated Rate |
$52.37 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Cash Price |
$33.79
|
| Rate for Payer: Cigna All Commercial |
$48.60
|
| Rate for Payer: CORVEL All Commercial |
$52.37
|
| Rate for Payer: Coventry All Commercial |
$49.55
|
| Rate for Payer: Encore All Commercial |
$51.83
|
| Rate for Payer: Frontpath All Commercial |
$51.81
|
| Rate for Payer: Humana ChoiceCare |
$48.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.68
|
| Rate for Payer: PHCS All Commercial |
$42.23
|
| Rate for Payer: PHP All Commercial |
$42.71
|
| Rate for Payer: Sagamore Health Network All Products |
$43.47
|
| Rate for Payer: Signature Care EPO |
$46.74
|
| Rate for Payer: Signature Care PPO |
$49.55
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
|
|
HC LIPID PANEL
|
Facility
|
IP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.93 |
| Max. Negotiated Rate |
$118.96 |
| Rate for Payer: Aetna Commercial |
$110.51
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Cigna All Commercial |
$110.39
|
| Rate for Payer: CORVEL All Commercial |
$118.96
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Sagamore Health Network All Products |
$98.75
|
| Rate for Payer: Signature Care EPO |
$106.17
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
|
|
HC LIPID PANEL
|
Facility
|
OP
|
$127.91
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
63001303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$118.96 |
| Rate for Payer: Aetna Commercial |
$107.96
|
| Rate for Payer: Aetna Medicare |
$40.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.02
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Centivo All Commercial |
$69.58
|
| Rate for Payer: Cigna All Commercial |
$110.39
|
| Rate for Payer: CORVEL All Commercial |
$118.96
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Encore All Commercial |
$117.74
|
| Rate for Payer: Frontpath All Commercial |
$117.68
|
| Rate for Payer: Humana ChoiceCare |
$110.48
|
| Rate for Payer: Humana Medicare |
$40.93
|
| Rate for Payer: Lucent All Commercial |
$69.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.12
|
| Rate for Payer: Managed Health Services Medicaid |
$13.39
|
| Rate for Payer: MDWise Medicaid |
$13.39
|
| Rate for Payer: PHCS All Commercial |
$95.93
|
| Rate for Payer: PHP All Commercial |
$97.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.88
|
| Rate for Payer: Sagamore Health Network All Products |
$98.75
|
| Rate for Payer: Signature Care EPO |
$106.17
|
| Rate for Payer: Signature Care PPO |
$112.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.72
|
| Rate for Payer: United Healthcare Commercial |
$100.79
|
| Rate for Payer: United Healthcare Medicare |
$40.93
|
|
