|
HC MASK AEROSOL PEDIATRIC
|
Facility
|
OP
|
$3.18
|
|
| Hospital Charge Code |
41601075
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Centivo All Commercial |
$1.73
|
| Rate for Payer: Cigna All Commercial |
$2.74
|
| Rate for Payer: CORVEL All Commercial |
$2.96
|
| Rate for Payer: Coventry All Commercial |
$2.80
|
| Rate for Payer: Encore All Commercial |
$2.93
|
| Rate for Payer: Frontpath All Commercial |
$2.93
|
| Rate for Payer: Humana ChoiceCare |
$2.75
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Lucent All Commercial |
$1.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.86
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$2.38
|
| Rate for Payer: PHP All Commercial |
$2.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2.45
|
| Rate for Payer: Signature Care EPO |
$2.64
|
| Rate for Payer: Signature Care PPO |
$2.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.70
|
| Rate for Payer: United Healthcare Commercial |
$2.51
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
|
|
HC MASSAGE/15 MIN-OT
|
Facility
|
OP
|
$127.30
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
1738035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$107.44
|
| Rate for Payer: Aetna Medicare |
$40.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.81
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Centivo All Commercial |
$69.25
|
| Rate for Payer: Cigna All Commercial |
$109.86
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.02
|
| Rate for Payer: Encore All Commercial |
$117.18
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Humana Medicare |
$40.74
|
| Rate for Payer: Lucent All Commercial |
$69.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.57
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$95.47
|
| Rate for Payer: PHP All Commercial |
$96.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.65
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.20
|
| Rate for Payer: United Healthcare Commercial |
$100.31
|
| Rate for Payer: United Healthcare Medicare |
$40.74
|
|
|
HC MASSAGE/15 MIN-OT
|
Facility
|
IP
|
$127.30
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
1738035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$109.99
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cigna All Commercial |
$109.86
|
| Rate for Payer: CORVEL All Commercial |
$118.39
|
| Rate for Payer: Coventry All Commercial |
$112.02
|
| Rate for Payer: Encore All Commercial |
$117.18
|
| Rate for Payer: Frontpath All Commercial |
$117.12
|
| Rate for Payer: Humana ChoiceCare |
$109.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.57
|
| Rate for Payer: PHCS All Commercial |
$95.47
|
| Rate for Payer: PHP All Commercial |
$96.54
|
| Rate for Payer: Sagamore Health Network All Products |
$98.28
|
| Rate for Payer: Signature Care EPO |
$105.66
|
| Rate for Payer: Signature Care PPO |
$112.02
|
| Rate for Payer: United Healthcare Commercial |
$100.31
|
|
|
HC MASSAGE/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
1728048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC MASSAGE/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
1728048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
1704669
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$151.66 |
| Rate for Payer: Aetna Commercial |
$137.63
|
| Rate for Payer: Aetna Medicare |
$52.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$93.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.40
|
| Rate for Payer: Cash Price |
$97.84
|
| Rate for Payer: Cash Price |
$97.84
|
| Rate for Payer: Centivo All Commercial |
$88.71
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.66
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.11
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Humana Medicare |
$52.18
|
| Rate for Payer: Lucent All Commercial |
$88.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.60
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.61
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
| Rate for Payer: United Healthcare Medicare |
$52.18
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$163.07
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
1704669
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$151.66 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Cash Price |
$97.84
|
| Rate for Payer: Cigna All Commercial |
$140.73
|
| Rate for Payer: CORVEL All Commercial |
$151.66
|
| Rate for Payer: Coventry All Commercial |
$143.50
|
| Rate for Payer: Encore All Commercial |
$150.11
|
| Rate for Payer: Frontpath All Commercial |
$150.02
|
| Rate for Payer: Humana ChoiceCare |
$140.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.76
|
| Rate for Payer: PHCS All Commercial |
$122.30
|
| Rate for Payer: PHP All Commercial |
$123.67
|
| Rate for Payer: Sagamore Health Network All Products |
$125.89
|
| Rate for Payer: Signature Care EPO |
$135.35
|
| Rate for Payer: Signature Care PPO |
$143.50
|
| Rate for Payer: United Healthcare Commercial |
$128.50
|
|
|
HC MECHANICAL VENT 1ST DAY
|
Facility
|
IP
|
$1,667.53
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
1701421
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,250.65 |
| Max. Negotiated Rate |
$1,550.80 |
| Rate for Payer: Aetna Commercial |
$1,440.75
|
| Rate for Payer: Cash Price |
$1,000.52
|
| Rate for Payer: Cigna All Commercial |
$1,439.08
|
| Rate for Payer: CORVEL All Commercial |
$1,550.80
|
| Rate for Payer: Coventry All Commercial |
$1,467.43
|
| Rate for Payer: Encore All Commercial |
$1,534.96
|
| Rate for Payer: Frontpath All Commercial |
$1,534.13
|
| Rate for Payer: Humana ChoiceCare |
$1,440.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,500.78
|
| Rate for Payer: PHCS All Commercial |
$1,250.65
|
| Rate for Payer: PHP All Commercial |
$1,264.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,287.33
|
| Rate for Payer: Signature Care EPO |
$1,384.05
|
| Rate for Payer: Signature Care PPO |
$1,467.43
|
| Rate for Payer: United Healthcare Commercial |
$1,314.01
|
|
|
HC MECHANICAL VENT 1ST DAY
|
Facility
|
OP
|
$1,667.53
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
1701421
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$1,550.80 |
| Rate for Payer: Aetna Commercial |
$1,407.40
|
| Rate for Payer: Aetna Medicare |
$533.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$957.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,042.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$613.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$586.97
|
| Rate for Payer: Cash Price |
$1,000.52
|
| Rate for Payer: Cash Price |
$1,000.52
|
| Rate for Payer: Centivo All Commercial |
$907.14
|
| Rate for Payer: Cigna All Commercial |
$1,439.08
|
| Rate for Payer: CORVEL All Commercial |
$1,550.80
|
| Rate for Payer: Coventry All Commercial |
$1,467.43
|
| Rate for Payer: Encore All Commercial |
$1,534.96
|
| Rate for Payer: Frontpath All Commercial |
$1,534.13
|
| Rate for Payer: Humana ChoiceCare |
$1,440.25
|
| Rate for Payer: Humana Medicare |
$533.61
|
| Rate for Payer: Lucent All Commercial |
$907.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,500.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$1,250.65
|
| Rate for Payer: PHP All Commercial |
$1,264.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$650.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,287.33
|
| Rate for Payer: Signature Care EPO |
$1,384.05
|
| Rate for Payer: Signature Care PPO |
$1,467.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,417.40
|
| Rate for Payer: United Healthcare Commercial |
$1,314.01
|
| Rate for Payer: United Healthcare Medicare |
$533.61
|
|
|
HC MECHANICAL VENT SUB DAYS
|
Facility
|
OP
|
$1,625.04
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
1706457
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$1,511.29 |
| Rate for Payer: Aetna Commercial |
$1,371.53
|
| Rate for Payer: Aetna Medicare |
$520.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$503.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$933.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$598.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$572.01
|
| Rate for Payer: Cash Price |
$975.02
|
| Rate for Payer: Cash Price |
$975.02
|
| Rate for Payer: Centivo All Commercial |
$884.02
|
| Rate for Payer: Cigna All Commercial |
$1,402.41
|
| Rate for Payer: CORVEL All Commercial |
$1,511.29
|
| Rate for Payer: Coventry All Commercial |
$1,430.04
|
| Rate for Payer: Encore All Commercial |
$1,495.85
|
| Rate for Payer: Frontpath All Commercial |
$1,495.04
|
| Rate for Payer: Humana ChoiceCare |
$1,403.55
|
| Rate for Payer: Humana Medicare |
$520.01
|
| Rate for Payer: Lucent All Commercial |
$884.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.54
|
| Rate for Payer: Managed Health Services Medicaid |
$6.37
|
| Rate for Payer: MDWise Medicaid |
$6.37
|
| Rate for Payer: PHCS All Commercial |
$1,218.78
|
| Rate for Payer: PHP All Commercial |
$1,232.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.53
|
| Rate for Payer: Signature Care EPO |
$1,348.78
|
| Rate for Payer: Signature Care PPO |
$1,430.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.28
|
| Rate for Payer: United Healthcare Commercial |
$1,280.53
|
| Rate for Payer: United Healthcare Medicare |
$520.01
|
|
|
HC MECHANICAL VENT SUB DAYS
|
Facility
|
IP
|
$1,625.04
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
1706457
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,218.78 |
| Max. Negotiated Rate |
$1,511.29 |
| Rate for Payer: Aetna Commercial |
$1,404.03
|
| Rate for Payer: Cash Price |
$975.02
|
| Rate for Payer: Cigna All Commercial |
$1,402.41
|
| Rate for Payer: CORVEL All Commercial |
$1,511.29
|
| Rate for Payer: Coventry All Commercial |
$1,430.04
|
| Rate for Payer: Encore All Commercial |
$1,495.85
|
| Rate for Payer: Frontpath All Commercial |
$1,495.04
|
| Rate for Payer: Humana ChoiceCare |
$1,403.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.54
|
| Rate for Payer: PHCS All Commercial |
$1,218.78
|
| Rate for Payer: PHP All Commercial |
$1,232.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.53
|
| Rate for Payer: Signature Care EPO |
$1,348.78
|
| Rate for Payer: Signature Care PPO |
$1,430.04
|
| Rate for Payer: United Healthcare Commercial |
$1,280.53
|
|
|
HC MECKLES SCAN
|
Facility
|
IP
|
$1,166.83
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
1638450
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$875.12 |
| Max. Negotiated Rate |
$1,085.15 |
| Rate for Payer: Aetna Commercial |
$1,008.14
|
| Rate for Payer: Cash Price |
$700.10
|
| Rate for Payer: Cigna All Commercial |
$1,006.97
|
| Rate for Payer: CORVEL All Commercial |
$1,085.15
|
| Rate for Payer: Coventry All Commercial |
$1,026.81
|
| Rate for Payer: Encore All Commercial |
$1,074.07
|
| Rate for Payer: Frontpath All Commercial |
$1,073.48
|
| Rate for Payer: Humana ChoiceCare |
$1,007.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.15
|
| Rate for Payer: PHCS All Commercial |
$875.12
|
| Rate for Payer: PHP All Commercial |
$884.92
|
| Rate for Payer: Sagamore Health Network All Products |
$900.79
|
| Rate for Payer: Signature Care EPO |
$968.47
|
| Rate for Payer: Signature Care PPO |
$1,026.81
|
| Rate for Payer: United Healthcare Commercial |
$919.46
|
|
|
HC MECKLES SCAN
|
Facility
|
OP
|
$1,166.83
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
1638450
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$212.04 |
| Max. Negotiated Rate |
$1,085.15 |
| Rate for Payer: Aetna Commercial |
$984.80
|
| Rate for Payer: Aetna Medicare |
$373.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$212.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$670.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$729.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$212.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.72
|
| Rate for Payer: Cash Price |
$700.10
|
| Rate for Payer: Cash Price |
$700.10
|
| Rate for Payer: Centivo All Commercial |
$634.76
|
| Rate for Payer: Cigna All Commercial |
$1,006.97
|
| Rate for Payer: CORVEL All Commercial |
$1,085.15
|
| Rate for Payer: Coventry All Commercial |
$1,026.81
|
| Rate for Payer: Encore All Commercial |
$1,074.07
|
| Rate for Payer: Frontpath All Commercial |
$1,073.48
|
| Rate for Payer: Humana ChoiceCare |
$1,007.79
|
| Rate for Payer: Humana Medicare |
$373.39
|
| Rate for Payer: Lucent All Commercial |
$634.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,050.15
|
| Rate for Payer: Managed Health Services Medicaid |
$212.04
|
| Rate for Payer: MDWise Medicaid |
$212.04
|
| Rate for Payer: PHCS All Commercial |
$875.12
|
| Rate for Payer: PHP All Commercial |
$884.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$455.06
|
| Rate for Payer: Sagamore Health Network All Products |
$900.79
|
| Rate for Payer: Signature Care EPO |
$968.47
|
| Rate for Payer: Signature Care PPO |
$1,026.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.81
|
| Rate for Payer: United Healthcare Commercial |
$919.46
|
| Rate for Payer: United Healthcare Medicare |
$373.39
|
|
|
HC MEDICATION REVIEW ATU
|
Facility
|
OP
|
$35.70
|
|
| Hospital Charge Code |
418822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.57
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Centivo All Commercial |
$19.42
|
| Rate for Payer: Cigna All Commercial |
$30.81
|
| Rate for Payer: CORVEL All Commercial |
$33.20
|
| Rate for Payer: Coventry All Commercial |
$31.42
|
| Rate for Payer: Encore All Commercial |
$32.86
|
| Rate for Payer: Frontpath All Commercial |
$32.84
|
| Rate for Payer: Humana ChoiceCare |
$30.83
|
| Rate for Payer: Humana Medicare |
$11.42
|
| Rate for Payer: Lucent All Commercial |
$19.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.13
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$26.77
|
| Rate for Payer: PHP All Commercial |
$27.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.92
|
| Rate for Payer: Sagamore Health Network All Products |
$27.56
|
| Rate for Payer: Signature Care EPO |
$29.63
|
| Rate for Payer: Signature Care PPO |
$31.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.34
|
| Rate for Payer: United Healthcare Commercial |
$28.13
|
| Rate for Payer: United Healthcare Medicare |
$11.42
|
|
|
HC MEDICATION REVIEW ATU
|
Facility
|
IP
|
$35.70
|
|
| Hospital Charge Code |
418822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Cigna All Commercial |
$30.81
|
| Rate for Payer: CORVEL All Commercial |
$33.20
|
| Rate for Payer: Coventry All Commercial |
$31.42
|
| Rate for Payer: Encore All Commercial |
$32.86
|
| Rate for Payer: Frontpath All Commercial |
$32.84
|
| Rate for Payer: Humana ChoiceCare |
$30.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.13
|
| Rate for Payer: PHCS All Commercial |
$26.77
|
| Rate for Payer: PHP All Commercial |
$27.07
|
| Rate for Payer: Sagamore Health Network All Products |
$27.56
|
| Rate for Payer: Signature Care EPO |
$29.63
|
| Rate for Payer: Signature Care PPO |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$28.13
|
|
|
HC MEPERIDINE MS
|
Facility
|
IP
|
$314.66
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
63001424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$271.87
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: PHCS All Commercial |
$236.00
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
HC MEPERIDINE MS
|
Facility
|
OP
|
$314.66
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
63001424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Aetna Medicare |
$100.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.76
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Centivo All Commercial |
$171.18
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Humana Medicare |
$100.69
|
| Rate for Payer: Lucent All Commercial |
$171.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: PHCS All Commercial |
$236.00
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.72
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.46
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$100.69
|
|
|
HC MEPERIDINE MS
|
Facility
|
OP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$265.57
|
| Rate for Payer: Aetna Medicare |
$100.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.76
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Centivo All Commercial |
$171.18
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Humana Medicare |
$100.69
|
| Rate for Payer: Lucent All Commercial |
$171.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$236.00
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.72
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$267.46
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$100.69
|
|
|
HC MEPERIDINE MS
|
Facility
|
IP
|
$314.66
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Aetna Commercial |
$271.87
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cigna All Commercial |
$271.55
|
| Rate for Payer: CORVEL All Commercial |
$292.63
|
| Rate for Payer: Coventry All Commercial |
$276.90
|
| Rate for Payer: Encore All Commercial |
$289.64
|
| Rate for Payer: Frontpath All Commercial |
$289.49
|
| Rate for Payer: Humana ChoiceCare |
$271.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$283.19
|
| Rate for Payer: PHCS All Commercial |
$236.00
|
| Rate for Payer: PHP All Commercial |
$238.64
|
| Rate for Payer: Sagamore Health Network All Products |
$242.92
|
| Rate for Payer: Signature Care EPO |
$261.17
|
| Rate for Payer: Signature Care PPO |
$276.90
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
HC MERCURY
|
Facility
|
IP
|
$145.33
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Aetna Commercial |
$125.57
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cigna All Commercial |
$125.42
|
| Rate for Payer: CORVEL All Commercial |
$135.16
|
| Rate for Payer: Coventry All Commercial |
$127.89
|
| Rate for Payer: Encore All Commercial |
$133.78
|
| Rate for Payer: Frontpath All Commercial |
$133.70
|
| Rate for Payer: Humana ChoiceCare |
$125.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.80
|
| Rate for Payer: PHCS All Commercial |
$109.00
|
| Rate for Payer: PHP All Commercial |
$110.22
|
| Rate for Payer: Sagamore Health Network All Products |
$112.19
|
| Rate for Payer: Signature Care EPO |
$120.62
|
| Rate for Payer: Signature Care PPO |
$127.89
|
| Rate for Payer: United Healthcare Commercial |
$114.52
|
|
|
HC MERCURY
|
Facility
|
OP
|
$145.33
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Aetna Commercial |
$122.66
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.16
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Centivo All Commercial |
$79.06
|
| Rate for Payer: Cigna All Commercial |
$125.42
|
| Rate for Payer: CORVEL All Commercial |
$135.16
|
| Rate for Payer: Coventry All Commercial |
$127.89
|
| Rate for Payer: Encore All Commercial |
$133.78
|
| Rate for Payer: Frontpath All Commercial |
$133.70
|
| Rate for Payer: Humana ChoiceCare |
$125.52
|
| Rate for Payer: Humana Medicare |
$46.51
|
| Rate for Payer: Lucent All Commercial |
$79.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.80
|
| Rate for Payer: Managed Health Services Medicaid |
$16.26
|
| Rate for Payer: MDWise Medicaid |
$16.26
|
| Rate for Payer: PHCS All Commercial |
$109.00
|
| Rate for Payer: PHP All Commercial |
$110.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.68
|
| Rate for Payer: Sagamore Health Network All Products |
$112.19
|
| Rate for Payer: Signature Care EPO |
$120.62
|
| Rate for Payer: Signature Care PPO |
$127.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.53
|
| Rate for Payer: United Healthcare Commercial |
$114.52
|
| Rate for Payer: United Healthcare Medicare |
$46.51
|
|
|
HC MERCURY UR RANDOM
|
Facility
|
IP
|
$135.02
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.27 |
| Max. Negotiated Rate |
$125.57 |
| Rate for Payer: Aetna Commercial |
$116.66
|
| Rate for Payer: Cash Price |
$81.01
|
| Rate for Payer: Cigna All Commercial |
$116.52
|
| Rate for Payer: CORVEL All Commercial |
$125.57
|
| Rate for Payer: Coventry All Commercial |
$118.82
|
| Rate for Payer: Encore All Commercial |
$124.29
|
| Rate for Payer: Frontpath All Commercial |
$124.22
|
| Rate for Payer: Humana ChoiceCare |
$116.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.52
|
| Rate for Payer: PHCS All Commercial |
$101.27
|
| Rate for Payer: PHP All Commercial |
$102.40
|
| Rate for Payer: Sagamore Health Network All Products |
$104.24
|
| Rate for Payer: Signature Care EPO |
$112.07
|
| Rate for Payer: Signature Care PPO |
$118.82
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
|
|
HC MERCURY UR RANDOM
|
Facility
|
OP
|
$135.02
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
63001635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$125.57 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Aetna Medicare |
$43.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.53
|
| Rate for Payer: Cash Price |
$81.01
|
| Rate for Payer: Cash Price |
$81.01
|
| Rate for Payer: Centivo All Commercial |
$73.45
|
| Rate for Payer: Cigna All Commercial |
$116.52
|
| Rate for Payer: CORVEL All Commercial |
$125.57
|
| Rate for Payer: Coventry All Commercial |
$118.82
|
| Rate for Payer: Encore All Commercial |
$124.29
|
| Rate for Payer: Frontpath All Commercial |
$124.22
|
| Rate for Payer: Humana ChoiceCare |
$116.62
|
| Rate for Payer: Humana Medicare |
$43.21
|
| Rate for Payer: Lucent All Commercial |
$73.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.52
|
| Rate for Payer: Managed Health Services Medicaid |
$16.26
|
| Rate for Payer: MDWise Medicaid |
$16.26
|
| Rate for Payer: PHCS All Commercial |
$101.27
|
| Rate for Payer: PHP All Commercial |
$102.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.66
|
| Rate for Payer: Sagamore Health Network All Products |
$104.24
|
| Rate for Payer: Signature Care EPO |
$112.07
|
| Rate for Payer: Signature Care PPO |
$118.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.77
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
| Rate for Payer: United Healthcare Medicare |
$43.21
|
|
|
HC MESH 3D MAX LIGHT LG LT
|
Facility
|
OP
|
$1,194.50
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,110.88 |
| Rate for Payer: Aetna Commercial |
$1,008.16
|
| Rate for Payer: Aetna Medicare |
$382.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$370.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$686.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$746.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$439.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$420.46
|
| Rate for Payer: Cash Price |
$716.70
|
| Rate for Payer: Cash Price |
$716.70
|
| Rate for Payer: Centivo All Commercial |
$649.81
|
| Rate for Payer: Cigna All Commercial |
$1,030.85
|
| Rate for Payer: CORVEL All Commercial |
$1,110.88
|
| Rate for Payer: Coventry All Commercial |
$1,051.16
|
| Rate for Payer: Encore All Commercial |
$1,099.54
|
| Rate for Payer: Frontpath All Commercial |
$1,098.94
|
| Rate for Payer: Humana ChoiceCare |
$1,031.69
|
| Rate for Payer: Humana Medicare |
$382.24
|
| Rate for Payer: Lucent All Commercial |
$649.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,075.05
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$895.88
|
| Rate for Payer: PHP All Commercial |
$905.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.86
|
| Rate for Payer: Sagamore Health Network All Products |
$922.15
|
| Rate for Payer: Signature Care EPO |
$991.43
|
| Rate for Payer: Signature Care PPO |
$1,051.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,015.33
|
| Rate for Payer: United Healthcare Commercial |
$941.27
|
| Rate for Payer: United Healthcare Medicare |
$382.24
|
|
|
HC MESH 3D MAX LIGHT LG LT
|
Facility
|
IP
|
$1,194.50
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
41602107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.88 |
| Max. Negotiated Rate |
$1,110.88 |
| Rate for Payer: Aetna Commercial |
$1,032.05
|
| Rate for Payer: Cash Price |
$716.70
|
| Rate for Payer: Cigna All Commercial |
$1,030.85
|
| Rate for Payer: CORVEL All Commercial |
$1,110.88
|
| Rate for Payer: Coventry All Commercial |
$1,051.16
|
| Rate for Payer: Encore All Commercial |
$1,099.54
|
| Rate for Payer: Frontpath All Commercial |
$1,098.94
|
| Rate for Payer: Humana ChoiceCare |
$1,031.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,075.05
|
| Rate for Payer: PHCS All Commercial |
$895.88
|
| Rate for Payer: PHP All Commercial |
$905.91
|
| Rate for Payer: Sagamore Health Network All Products |
$922.15
|
| Rate for Payer: Signature Care EPO |
$991.43
|
| Rate for Payer: Signature Care PPO |
$1,051.16
|
| Rate for Payer: United Healthcare Commercial |
$941.27
|
|
