|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE, NAA WITHOUT CAP-MANDATED CULTURE
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63044069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$39.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.08
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Centivo All Commercial |
$66.59
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Humana Medicare |
$39.17
|
| Rate for Payer: Lucent All Commercial |
$66.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: Managed Health Services Medicaid |
$41.68
|
| Rate for Payer: MDWise Medicaid |
$41.68
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.04
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
| Rate for Payer: United Healthcare Medicare |
$39.17
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE, NAA WITHOUT CAP-MANDATED CULTURE-B
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE, NAA WITHOUT CAP-MANDATED CULTURE-B
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$39.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.08
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Centivo All Commercial |
$66.59
|
| Rate for Payer: Cigna All Commercial |
$105.63
|
| Rate for Payer: CORVEL All Commercial |
$113.83
|
| Rate for Payer: Coventry All Commercial |
$107.71
|
| Rate for Payer: Encore All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$112.61
|
| Rate for Payer: Humana ChoiceCare |
$105.72
|
| Rate for Payer: Humana Medicare |
$39.17
|
| Rate for Payer: Lucent All Commercial |
$66.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.16
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$91.80
|
| Rate for Payer: PHP All Commercial |
$92.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.74
|
| Rate for Payer: Sagamore Health Network All Products |
$94.49
|
| Rate for Payer: Signature Care EPO |
$101.59
|
| Rate for Payer: Signature Care PPO |
$107.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.04
|
| Rate for Payer: United Healthcare Commercial |
$96.45
|
| Rate for Payer: United Healthcare Medicare |
$39.17
|
|
|
HC MYCOPLASMA IGG
|
Facility
|
OP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$369.27 |
| Rate for Payer: Aetna Commercial |
$335.12
|
| Rate for Payer: Aetna Medicare |
$127.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.77
|
| Rate for Payer: Cash Price |
$238.24
|
| Rate for Payer: Cash Price |
$238.24
|
| Rate for Payer: Centivo All Commercial |
$216.00
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.27
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.30
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Humana Medicare |
$127.06
|
| Rate for Payer: Lucent All Commercial |
$216.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$297.80
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.85
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$337.50
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
| Rate for Payer: United Healthcare Medicare |
$127.06
|
|
|
HC MYCOPLASMA IGG
|
Facility
|
IP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$369.27 |
| Rate for Payer: Aetna Commercial |
$343.06
|
| Rate for Payer: Cash Price |
$238.24
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.27
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.30
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: PHCS All Commercial |
$297.80
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
|
|
HC MYCOPLASMA IGM
|
Facility
|
OP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$369.27 |
| Rate for Payer: Aetna Commercial |
$335.12
|
| Rate for Payer: Aetna Medicare |
$127.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.77
|
| Rate for Payer: Cash Price |
$238.24
|
| Rate for Payer: Cash Price |
$238.24
|
| Rate for Payer: Centivo All Commercial |
$216.00
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.27
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.30
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Humana Medicare |
$127.06
|
| Rate for Payer: Lucent All Commercial |
$216.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$297.80
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$154.85
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$337.50
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
| Rate for Payer: United Healthcare Medicare |
$127.06
|
|
|
HC MYCOPLASMA IGM
|
Facility
|
IP
|
$397.06
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
63001964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$369.27 |
| Rate for Payer: Aetna Commercial |
$343.06
|
| Rate for Payer: Cash Price |
$238.24
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.27
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.30
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.35
|
| Rate for Payer: PHCS All Commercial |
$297.80
|
| Rate for Payer: PHP All Commercial |
$301.13
|
| Rate for Payer: Sagamore Health Network All Products |
$306.53
|
| Rate for Payer: Signature Care EPO |
$329.56
|
| Rate for Payer: Signature Care PPO |
$349.41
|
| Rate for Payer: United Healthcare Commercial |
$312.88
|
|
|
HC MYELOGRAPHY VIA LUMBAR INJ; LUMBOSACRAL
|
Facility
|
OP
|
$3,313.14
|
|
| Hospital Charge Code |
1612304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,027.07 |
| Max. Negotiated Rate |
$3,081.22 |
| Rate for Payer: Aetna Commercial |
$2,796.29
|
| Rate for Payer: Aetna Medicare |
$1,060.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,027.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,902.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,071.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,219.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,166.23
|
| Rate for Payer: Cash Price |
$1,987.88
|
| Rate for Payer: Centivo All Commercial |
$1,802.35
|
| Rate for Payer: Cigna All Commercial |
$2,859.24
|
| Rate for Payer: CORVEL All Commercial |
$3,081.22
|
| Rate for Payer: Coventry All Commercial |
$2,915.56
|
| Rate for Payer: Encore All Commercial |
$3,049.75
|
| Rate for Payer: Frontpath All Commercial |
$3,048.09
|
| Rate for Payer: Humana ChoiceCare |
$2,861.56
|
| Rate for Payer: Humana Medicare |
$1,060.20
|
| Rate for Payer: Lucent All Commercial |
$1,802.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,981.83
|
| Rate for Payer: PHCS All Commercial |
$2,484.86
|
| Rate for Payer: PHP All Commercial |
$2,512.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,292.12
|
| Rate for Payer: Sagamore Health Network All Products |
$2,557.74
|
| Rate for Payer: Signature Care EPO |
$2,749.91
|
| Rate for Payer: Signature Care PPO |
$2,915.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,816.17
|
| Rate for Payer: United Healthcare Commercial |
$2,610.75
|
| Rate for Payer: United Healthcare Medicare |
$1,060.20
|
|
|
HC MYELOGRAPHY VIA LUMBAR INJ; LUMBOSACRAL
|
Facility
|
IP
|
$3,313.14
|
|
| Hospital Charge Code |
1612304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,484.86 |
| Max. Negotiated Rate |
$3,081.22 |
| Rate for Payer: Aetna Commercial |
$2,862.55
|
| Rate for Payer: Cash Price |
$1,987.88
|
| Rate for Payer: Cigna All Commercial |
$2,859.24
|
| Rate for Payer: CORVEL All Commercial |
$3,081.22
|
| Rate for Payer: Coventry All Commercial |
$2,915.56
|
| Rate for Payer: Encore All Commercial |
$3,049.75
|
| Rate for Payer: Frontpath All Commercial |
$3,048.09
|
| Rate for Payer: Humana ChoiceCare |
$2,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,981.83
|
| Rate for Payer: PHCS All Commercial |
$2,484.86
|
| Rate for Payer: PHP All Commercial |
$2,512.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,557.74
|
| Rate for Payer: Signature Care EPO |
$2,749.91
|
| Rate for Payer: Signature Care PPO |
$2,915.56
|
| Rate for Payer: United Healthcare Commercial |
$2,610.75
|
|
|
HC MYOGLOBIN UR
|
Facility
|
IP
|
$80.78
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
63001639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$69.79
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Cigna All Commercial |
$69.71
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.70
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.26
|
| Rate for Payer: Sagamore Health Network All Products |
$62.36
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
|
|
HC MYOGLOBIN UR
|
Facility
|
OP
|
$80.78
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
63001639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$68.18
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$12.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.43
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Cash Price |
$48.47
|
| Rate for Payer: Centivo All Commercial |
$43.94
|
| Rate for Payer: Cigna All Commercial |
$69.71
|
| Rate for Payer: CORVEL All Commercial |
$75.13
|
| Rate for Payer: Coventry All Commercial |
$71.09
|
| Rate for Payer: Encore All Commercial |
$74.36
|
| Rate for Payer: Frontpath All Commercial |
$74.32
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana Medicare |
$25.85
|
| Rate for Payer: Lucent All Commercial |
$43.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.70
|
| Rate for Payer: Managed Health Services Medicaid |
$12.92
|
| Rate for Payer: MDWise Medicaid |
$12.92
|
| Rate for Payer: PHCS All Commercial |
$60.59
|
| Rate for Payer: PHP All Commercial |
$61.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.50
|
| Rate for Payer: Sagamore Health Network All Products |
$62.36
|
| Rate for Payer: Signature Care EPO |
$67.05
|
| Rate for Payer: Signature Care PPO |
$71.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.66
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare |
$25.85
|
|
|
HC NEEDLE BIOPSY 14GX10CM
|
Facility
|
IP
|
$227.71
|
|
| Hospital Charge Code |
41601335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.78 |
| Max. Negotiated Rate |
$211.77 |
| Rate for Payer: Aetna Commercial |
$196.74
|
| Rate for Payer: Cash Price |
$136.63
|
| Rate for Payer: Cigna All Commercial |
$196.51
|
| Rate for Payer: CORVEL All Commercial |
$211.77
|
| Rate for Payer: Coventry All Commercial |
$200.38
|
| Rate for Payer: Encore All Commercial |
$209.61
|
| Rate for Payer: Frontpath All Commercial |
$209.49
|
| Rate for Payer: Humana ChoiceCare |
$196.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.94
|
| Rate for Payer: PHCS All Commercial |
$170.78
|
| Rate for Payer: PHP All Commercial |
$172.70
|
| Rate for Payer: Sagamore Health Network All Products |
$175.79
|
| Rate for Payer: Signature Care EPO |
$189.00
|
| Rate for Payer: Signature Care PPO |
$200.38
|
| Rate for Payer: United Healthcare Commercial |
$179.44
|
|
|
HC NEEDLE BIOPSY 14GX10CM
|
Facility
|
OP
|
$227.71
|
|
| Hospital Charge Code |
41601335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$211.77 |
| Rate for Payer: Aetna Commercial |
$192.19
|
| Rate for Payer: Aetna Medicare |
$72.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$130.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.15
|
| Rate for Payer: Cash Price |
$136.63
|
| Rate for Payer: Cash Price |
$136.63
|
| Rate for Payer: Centivo All Commercial |
$123.87
|
| Rate for Payer: Cigna All Commercial |
$196.51
|
| Rate for Payer: CORVEL All Commercial |
$211.77
|
| Rate for Payer: Coventry All Commercial |
$200.38
|
| Rate for Payer: Encore All Commercial |
$209.61
|
| Rate for Payer: Frontpath All Commercial |
$209.49
|
| Rate for Payer: Humana ChoiceCare |
$196.67
|
| Rate for Payer: Humana Medicare |
$72.87
|
| Rate for Payer: Lucent All Commercial |
$123.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$204.94
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$170.78
|
| Rate for Payer: PHP All Commercial |
$172.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.81
|
| Rate for Payer: Sagamore Health Network All Products |
$175.79
|
| Rate for Payer: Signature Care EPO |
$189.00
|
| Rate for Payer: Signature Care PPO |
$200.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.55
|
| Rate for Payer: United Healthcare Commercial |
$179.44
|
| Rate for Payer: United Healthcare Medicare |
$72.87
|
|
|
HC NEEDLE BIOPSY CORE 14GX10CM
|
Facility
|
IP
|
$204.40
|
|
| Hospital Charge Code |
41601336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
|
|
HC NEEDLE BIOPSY CORE 14GX10CM
|
Facility
|
OP
|
$204.40
|
|
| Hospital Charge Code |
41601336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$172.51
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.95
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Centivo All Commercial |
$111.19
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Humana Medicare |
$65.41
|
| Rate for Payer: Lucent All Commercial |
$111.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.72
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.74
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
| Rate for Payer: United Healthcare Medicare |
$65.41
|
|
|
HC NEEDLE BIOP TRUE-G 17G 13.8CM
|
Facility
|
OP
|
$73.99
|
|
| Hospital Charge Code |
41608072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: Aetna Medicare |
$23.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.04
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Centivo All Commercial |
$40.25
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Lucent All Commercial |
$40.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.86
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.89
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
|
|
HC NEEDLE BIOP TRUE-G 17G 13.8CM
|
Facility
|
IP
|
$73.99
|
|
| Hospital Charge Code |
41608072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
|
|
HC NEEDLE BIOP TRUE-G 17G 17.8CM
|
Facility
|
OP
|
$73.99
|
|
| Hospital Charge Code |
41608074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: Aetna Medicare |
$23.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.04
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Centivo All Commercial |
$40.25
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Lucent All Commercial |
$40.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.86
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.89
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
|
|
HC NEEDLE BIOP TRUE-G 17G 17.8CM
|
Facility
|
IP
|
$73.99
|
|
| Hospital Charge Code |
41608074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
|
|
HC NEEDLE ECHOGENIC PNB 20G
|
Facility
|
IP
|
$105.51
|
|
| Hospital Charge Code |
41601404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.13 |
| Max. Negotiated Rate |
$98.12 |
| Rate for Payer: Aetna Commercial |
$91.16
|
| Rate for Payer: Cash Price |
$63.31
|
| Rate for Payer: Cigna All Commercial |
$91.06
|
| Rate for Payer: CORVEL All Commercial |
$98.12
|
| Rate for Payer: Coventry All Commercial |
$92.85
|
| Rate for Payer: Encore All Commercial |
$97.12
|
| Rate for Payer: Frontpath All Commercial |
$97.07
|
| Rate for Payer: Humana ChoiceCare |
$91.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.96
|
| Rate for Payer: PHCS All Commercial |
$79.13
|
| Rate for Payer: PHP All Commercial |
$80.02
|
| Rate for Payer: Sagamore Health Network All Products |
$81.45
|
| Rate for Payer: Signature Care EPO |
$87.57
|
| Rate for Payer: Signature Care PPO |
$92.85
|
| Rate for Payer: United Healthcare Commercial |
$83.14
|
|
|
HC NEEDLE ECHOGENIC PNB 20G
|
Facility
|
OP
|
$105.51
|
|
| Hospital Charge Code |
41601404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$98.12 |
| Rate for Payer: Aetna Commercial |
$89.05
|
| Rate for Payer: Aetna Medicare |
$33.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.14
|
| Rate for Payer: Cash Price |
$63.31
|
| Rate for Payer: Cash Price |
$63.31
|
| Rate for Payer: Centivo All Commercial |
$57.40
|
| Rate for Payer: Cigna All Commercial |
$91.06
|
| Rate for Payer: CORVEL All Commercial |
$98.12
|
| Rate for Payer: Coventry All Commercial |
$92.85
|
| Rate for Payer: Encore All Commercial |
$97.12
|
| Rate for Payer: Frontpath All Commercial |
$97.07
|
| Rate for Payer: Humana ChoiceCare |
$91.13
|
| Rate for Payer: Humana Medicare |
$33.76
|
| Rate for Payer: Lucent All Commercial |
$57.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$79.13
|
| Rate for Payer: PHP All Commercial |
$80.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.15
|
| Rate for Payer: Sagamore Health Network All Products |
$81.45
|
| Rate for Payer: Signature Care EPO |
$87.57
|
| Rate for Payer: Signature Care PPO |
$92.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.68
|
| Rate for Payer: United Healthcare Commercial |
$83.14
|
| Rate for Payer: United Healthcare Medicare |
$33.76
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 15MM
|
Facility
|
OP
|
$998.20
|
|
| Hospital Charge Code |
41601265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$842.48
|
| Rate for Payer: Aetna Medicare |
$319.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$309.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$573.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.37
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Centivo All Commercial |
$543.02
|
| Rate for Payer: Cigna All Commercial |
$861.45
|
| Rate for Payer: CORVEL All Commercial |
$928.33
|
| Rate for Payer: Coventry All Commercial |
$878.42
|
| Rate for Payer: Encore All Commercial |
$918.84
|
| Rate for Payer: Frontpath All Commercial |
$918.34
|
| Rate for Payer: Humana ChoiceCare |
$862.15
|
| Rate for Payer: Humana Medicare |
$319.42
|
| Rate for Payer: Lucent All Commercial |
$543.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$748.65
|
| Rate for Payer: PHP All Commercial |
$757.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.30
|
| Rate for Payer: Sagamore Health Network All Products |
$770.61
|
| Rate for Payer: Signature Care EPO |
$828.51
|
| Rate for Payer: Signature Care PPO |
$878.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$848.47
|
| Rate for Payer: United Healthcare Commercial |
$786.58
|
| Rate for Payer: United Healthcare Medicare |
$319.42
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 15MM
|
Facility
|
IP
|
$998.20
|
|
| Hospital Charge Code |
41601265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$748.65 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$862.44
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cigna All Commercial |
$861.45
|
| Rate for Payer: CORVEL All Commercial |
$928.33
|
| Rate for Payer: Coventry All Commercial |
$878.42
|
| Rate for Payer: Encore All Commercial |
$918.84
|
| Rate for Payer: Frontpath All Commercial |
$918.34
|
| Rate for Payer: Humana ChoiceCare |
$862.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: PHCS All Commercial |
$748.65
|
| Rate for Payer: PHP All Commercial |
$757.03
|
| Rate for Payer: Sagamore Health Network All Products |
$770.61
|
| Rate for Payer: Signature Care EPO |
$828.51
|
| Rate for Payer: Signature Care PPO |
$878.42
|
| Rate for Payer: United Healthcare Commercial |
$786.58
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 25MM
|
Facility
|
IP
|
$998.20
|
|
| Hospital Charge Code |
41601266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$748.65 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$862.44
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cigna All Commercial |
$861.45
|
| Rate for Payer: CORVEL All Commercial |
$928.33
|
| Rate for Payer: Coventry All Commercial |
$878.42
|
| Rate for Payer: Encore All Commercial |
$918.84
|
| Rate for Payer: Frontpath All Commercial |
$918.34
|
| Rate for Payer: Humana ChoiceCare |
$862.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: PHCS All Commercial |
$748.65
|
| Rate for Payer: PHP All Commercial |
$757.03
|
| Rate for Payer: Sagamore Health Network All Products |
$770.61
|
| Rate for Payer: Signature Care EPO |
$828.51
|
| Rate for Payer: Signature Care PPO |
$878.42
|
| Rate for Payer: United Healthcare Commercial |
$786.58
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 25MM
|
Facility
|
OP
|
$998.20
|
|
| Hospital Charge Code |
41601266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$842.48
|
| Rate for Payer: Aetna Medicare |
$319.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$309.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$573.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.37
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Centivo All Commercial |
$543.02
|
| Rate for Payer: Cigna All Commercial |
$861.45
|
| Rate for Payer: CORVEL All Commercial |
$928.33
|
| Rate for Payer: Coventry All Commercial |
$878.42
|
| Rate for Payer: Encore All Commercial |
$918.84
|
| Rate for Payer: Frontpath All Commercial |
$918.34
|
| Rate for Payer: Humana ChoiceCare |
$862.15
|
| Rate for Payer: Humana Medicare |
$319.42
|
| Rate for Payer: Lucent All Commercial |
$543.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$748.65
|
| Rate for Payer: PHP All Commercial |
$757.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.30
|
| Rate for Payer: Sagamore Health Network All Products |
$770.61
|
| Rate for Payer: Signature Care EPO |
$828.51
|
| Rate for Payer: Signature Care PPO |
$878.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$848.47
|
| Rate for Payer: United Healthcare Commercial |
$786.58
|
| Rate for Payer: United Healthcare Medicare |
$319.42
|
|
