|
HC NOSE CULTURE
|
Facility
|
OP
|
$139.98
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
63001074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$130.18 |
| Rate for Payer: Aetna Commercial |
$118.14
|
| Rate for Payer: Aetna Medicare |
$44.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.27
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Centivo All Commercial |
$76.15
|
| Rate for Payer: Cigna All Commercial |
$120.80
|
| Rate for Payer: CORVEL All Commercial |
$130.18
|
| Rate for Payer: Coventry All Commercial |
$123.18
|
| Rate for Payer: Encore All Commercial |
$128.85
|
| Rate for Payer: Frontpath All Commercial |
$128.78
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Humana Medicare |
$44.79
|
| Rate for Payer: Lucent All Commercial |
$76.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.98
|
| Rate for Payer: Managed Health Services Medicaid |
$8.62
|
| Rate for Payer: MDWise Medicaid |
$8.62
|
| Rate for Payer: PHCS All Commercial |
$104.98
|
| Rate for Payer: PHP All Commercial |
$106.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.59
|
| Rate for Payer: Sagamore Health Network All Products |
$108.06
|
| Rate for Payer: Signature Care EPO |
$116.18
|
| Rate for Payer: Signature Care PPO |
$123.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.98
|
| Rate for Payer: United Healthcare Commercial |
$110.30
|
| Rate for Payer: United Healthcare Medicare |
$44.79
|
|
|
HC N-TELOPEPTIDE UR
|
Facility
|
OP
|
$182.58
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$169.80 |
| Rate for Payer: Aetna Commercial |
$154.10
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.27
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Centivo All Commercial |
$99.32
|
| Rate for Payer: Cigna All Commercial |
$157.57
|
| Rate for Payer: CORVEL All Commercial |
$169.80
|
| Rate for Payer: Coventry All Commercial |
$160.67
|
| Rate for Payer: Encore All Commercial |
$168.06
|
| Rate for Payer: Frontpath All Commercial |
$167.97
|
| Rate for Payer: Humana ChoiceCare |
$157.69
|
| Rate for Payer: Humana Medicare |
$58.43
|
| Rate for Payer: Lucent All Commercial |
$99.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18.68
|
| Rate for Payer: MDWise Medicaid |
$18.68
|
| Rate for Payer: PHCS All Commercial |
$136.94
|
| Rate for Payer: PHP All Commercial |
$138.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.21
|
| Rate for Payer: Sagamore Health Network All Products |
$140.95
|
| Rate for Payer: Signature Care EPO |
$151.54
|
| Rate for Payer: Signature Care PPO |
$160.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155.19
|
| Rate for Payer: United Healthcare Commercial |
$143.87
|
| Rate for Payer: United Healthcare Medicare |
$58.43
|
|
|
HC N-TELOPEPTIDE UR
|
Facility
|
IP
|
$182.58
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
63001497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.94 |
| Max. Negotiated Rate |
$169.80 |
| Rate for Payer: Aetna Commercial |
$157.75
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cigna All Commercial |
$157.57
|
| Rate for Payer: CORVEL All Commercial |
$169.80
|
| Rate for Payer: Coventry All Commercial |
$160.67
|
| Rate for Payer: Encore All Commercial |
$168.06
|
| Rate for Payer: Frontpath All Commercial |
$167.97
|
| Rate for Payer: Humana ChoiceCare |
$157.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.32
|
| Rate for Payer: PHCS All Commercial |
$136.94
|
| Rate for Payer: PHP All Commercial |
$138.47
|
| Rate for Payer: Sagamore Health Network All Products |
$140.95
|
| Rate for Payer: Signature Care EPO |
$151.54
|
| Rate for Payer: Signature Care PPO |
$160.67
|
| Rate for Payer: United Healthcare Commercial |
$143.87
|
|
|
HC NUTRITION THERAPY INITL/15 MIN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
72001002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
|
|
HC NUTRITION THERAPY INITL/15 MIN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
72001002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$13.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.36
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Centivo All Commercial |
$22.20
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Humana Medicare |
$13.06
|
| Rate for Payer: Lucent All Commercial |
$22.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.68
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
| Rate for Payer: United Healthcare Medicare |
$13.06
|
|
|
HC NUTRITION THERAPY SUBSQ/15 MIN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
72001003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$13.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.36
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Centivo All Commercial |
$22.20
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Humana Medicare |
$13.06
|
| Rate for Payer: Lucent All Commercial |
$22.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: Managed Health Services Medicaid |
$6.12
|
| Rate for Payer: MDWise Medicaid |
$6.12
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.91
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.68
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
| Rate for Payer: United Healthcare Medicare |
$13.06
|
|
|
HC NUTRITION THERAPY SUBSQ/15 MIN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
72001003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cigna All Commercial |
$35.21
|
| Rate for Payer: CORVEL All Commercial |
$37.94
|
| Rate for Payer: Coventry All Commercial |
$35.90
|
| Rate for Payer: Encore All Commercial |
$37.56
|
| Rate for Payer: Frontpath All Commercial |
$37.54
|
| Rate for Payer: Humana ChoiceCare |
$35.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.72
|
| Rate for Payer: PHCS All Commercial |
$30.60
|
| Rate for Payer: PHP All Commercial |
$30.94
|
| Rate for Payer: Sagamore Health Network All Products |
$31.50
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$35.90
|
| Rate for Payer: United Healthcare Commercial |
$32.15
|
|
|
HC OBSERVATION EA ADDTNL HR DA
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1688101
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$194.29 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
HC OBSERVATION EA ADDTNL HR DA
|
Facility
|
IP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1688101
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC OBSERVATION INITIAL HOUR DA
|
Facility
|
OP
|
$1,154.97
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
1688100
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$194.29 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$974.79
|
| Rate for Payer: Aetna Medicare |
$369.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$663.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$425.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$406.55
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Centivo All Commercial |
$628.30
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.55
|
| Rate for Payer: Humana Medicare |
$369.59
|
| Rate for Payer: Lucent All Commercial |
$628.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$866.23
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$891.64
|
| Rate for Payer: Signature Care EPO |
$958.63
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.72
|
| Rate for Payer: United Healthcare Commercial |
$910.12
|
| Rate for Payer: United Healthcare Medicare |
$369.59
|
|
|
HC OBSERVATION INITIAL HOUR DA
|
Facility
|
IP
|
$1,154.97
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
1688100
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$866.23 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$997.89
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: PHCS All Commercial |
$866.23
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Sagamore Health Network All Products |
$891.64
|
| Rate for Payer: Signature Care EPO |
$958.63
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: United Healthcare Commercial |
$910.12
|
|
|
HC OBSERVATION MED SURG
|
Facility
|
IP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$866.23 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$997.89
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: PHCS All Commercial |
$866.23
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Sagamore Health Network All Products |
$891.64
|
| Rate for Payer: Signature Care EPO |
$958.63
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: United Healthcare Commercial |
$910.12
|
|
|
HC OBSERVATION MED SURG
|
Facility
|
OP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$194.29 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$974.79
|
| Rate for Payer: Aetna Medicare |
$369.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$663.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$425.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$406.55
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Centivo All Commercial |
$628.30
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.55
|
| Rate for Payer: Humana Medicare |
$369.59
|
| Rate for Payer: Lucent All Commercial |
$628.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$866.23
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$891.64
|
| Rate for Payer: Signature Care EPO |
$958.63
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.72
|
| Rate for Payer: United Healthcare Commercial |
$910.12
|
| Rate for Payer: United Healthcare Medicare |
$369.59
|
|
|
HC OBSERVATION M/S <24 HR
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$194.29 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
HC OBSERVATION M/S <24 HR
|
Facility
|
IP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC OBSERVATION M/S >24 HR
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Aetna Commercial |
$59.18
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.70
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.05
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.85
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
|
|
HC OBSERVATION M/S >24 HR
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$194.29 |
| Rate for Payer: Aetna Commercial |
$57.81
|
| Rate for Payer: Aetna Medicare |
$21.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.11
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Centivo All Commercial |
$37.26
|
| Rate for Payer: Cigna All Commercial |
$59.12
|
| Rate for Payer: CORVEL All Commercial |
$63.70
|
| Rate for Payer: Coventry All Commercial |
$60.28
|
| Rate for Payer: Encore All Commercial |
$63.05
|
| Rate for Payer: Frontpath All Commercial |
$63.02
|
| Rate for Payer: Humana ChoiceCare |
$59.16
|
| Rate for Payer: Humana Medicare |
$21.92
|
| Rate for Payer: Lucent All Commercial |
$37.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$61.65
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$51.38
|
| Rate for Payer: PHP All Commercial |
$51.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.71
|
| Rate for Payer: Sagamore Health Network All Products |
$52.88
|
| Rate for Payer: Signature Care EPO |
$56.85
|
| Rate for Payer: Signature Care PPO |
$60.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.23
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare |
$21.92
|
|
|
HC OBSERVATION NUR < 24 HR
|
Facility
|
OP
|
$10.75
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$194.29 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Aetna Medicare |
$3.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.78
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Centivo All Commercial |
$5.85
|
| Rate for Payer: Cigna All Commercial |
$9.28
|
| Rate for Payer: CORVEL All Commercial |
$10.00
|
| Rate for Payer: Coventry All Commercial |
$9.46
|
| Rate for Payer: Encore All Commercial |
$9.90
|
| Rate for Payer: Frontpath All Commercial |
$9.89
|
| Rate for Payer: Humana ChoiceCare |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.44
|
| Rate for Payer: Lucent All Commercial |
$5.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.68
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$8.06
|
| Rate for Payer: PHP All Commercial |
$8.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8.30
|
| Rate for Payer: Signature Care EPO |
$8.92
|
| Rate for Payer: Signature Care PPO |
$9.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.14
|
| Rate for Payer: United Healthcare Commercial |
$8.47
|
| Rate for Payer: United Healthcare Medicare |
$3.44
|
|
|
HC OBSERVATION NUR < 24 HR
|
Facility
|
IP
|
$10.75
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.29
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cigna All Commercial |
$9.28
|
| Rate for Payer: CORVEL All Commercial |
$10.00
|
| Rate for Payer: Coventry All Commercial |
$9.46
|
| Rate for Payer: Encore All Commercial |
$9.90
|
| Rate for Payer: Frontpath All Commercial |
$9.89
|
| Rate for Payer: Humana ChoiceCare |
$9.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.68
|
| Rate for Payer: PHCS All Commercial |
$8.06
|
| Rate for Payer: PHP All Commercial |
$8.15
|
| Rate for Payer: Sagamore Health Network All Products |
$8.30
|
| Rate for Payer: Signature Care EPO |
$8.92
|
| Rate for Payer: Signature Care PPO |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$8.47
|
|
|
HC OBSERVATION OB <24 HR
|
Facility
|
OP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$194.29 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.17
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
HC OBSERVATION OB <24 HR
|
Facility
|
IP
|
$19.27
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$16.63
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.96
|
| Rate for Payer: Encore All Commercial |
$17.74
|
| Rate for Payer: Frontpath All Commercial |
$17.73
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.88
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
HC OBSERVATION OB INITIAL
|
Facility
|
OP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$194.29 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$974.79
|
| Rate for Payer: Aetna Medicare |
$369.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$663.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$721.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$194.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$425.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$406.55
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Centivo All Commercial |
$628.30
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.55
|
| Rate for Payer: Humana Medicare |
$369.59
|
| Rate for Payer: Lucent All Commercial |
$628.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: Managed Health Services Medicaid |
$194.29
|
| Rate for Payer: MDWise Medicaid |
$194.29
|
| Rate for Payer: PHCS All Commercial |
$866.23
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$891.64
|
| Rate for Payer: Signature Care EPO |
$958.63
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$981.72
|
| Rate for Payer: United Healthcare Commercial |
$910.12
|
| Rate for Payer: United Healthcare Medicare |
$369.59
|
|
|
HC OBSERVATION OB INITIAL
|
Facility
|
IP
|
$1,154.97
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1684012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$866.23 |
| Max. Negotiated Rate |
$1,074.12 |
| Rate for Payer: Aetna Commercial |
$997.89
|
| Rate for Payer: Cash Price |
$692.98
|
| Rate for Payer: Cigna All Commercial |
$996.74
|
| Rate for Payer: CORVEL All Commercial |
$1,074.12
|
| Rate for Payer: Coventry All Commercial |
$1,016.37
|
| Rate for Payer: Encore All Commercial |
$1,063.15
|
| Rate for Payer: Frontpath All Commercial |
$1,062.57
|
| Rate for Payer: Humana ChoiceCare |
$997.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.47
|
| Rate for Payer: PHCS All Commercial |
$866.23
|
| Rate for Payer: PHP All Commercial |
$875.93
|
| Rate for Payer: Sagamore Health Network All Products |
$891.64
|
| Rate for Payer: Signature Care EPO |
$958.63
|
| Rate for Payer: Signature Care PPO |
$1,016.37
|
| Rate for Payer: United Healthcare Commercial |
$910.12
|
|
|
HC OCCULT BLOOD IMMUNOASSAY
|
Facility
|
IP
|
$117.29
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
63001167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$101.34
|
| Rate for Payer: Cash Price |
$70.37
|
| Rate for Payer: Cigna All Commercial |
$101.22
|
| Rate for Payer: CORVEL All Commercial |
$109.08
|
| Rate for Payer: Coventry All Commercial |
$103.22
|
| Rate for Payer: Encore All Commercial |
$107.97
|
| Rate for Payer: Frontpath All Commercial |
$107.91
|
| Rate for Payer: Humana ChoiceCare |
$101.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.56
|
| Rate for Payer: PHCS All Commercial |
$87.97
|
| Rate for Payer: PHP All Commercial |
$88.95
|
| Rate for Payer: Sagamore Health Network All Products |
$90.55
|
| Rate for Payer: Signature Care EPO |
$97.35
|
| Rate for Payer: Signature Care PPO |
$103.22
|
| Rate for Payer: United Healthcare Commercial |
$92.42
|
|
|
HC OCCULT BLOOD IMMUNOASSAY
|
Facility
|
OP
|
$117.29
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
63001167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$98.99
|
| Rate for Payer: Aetna Medicare |
$37.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$53.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.29
|
| Rate for Payer: Cash Price |
$70.37
|
| Rate for Payer: Cash Price |
$70.37
|
| Rate for Payer: Centivo All Commercial |
$63.81
|
| Rate for Payer: Cigna All Commercial |
$101.22
|
| Rate for Payer: CORVEL All Commercial |
$109.08
|
| Rate for Payer: Coventry All Commercial |
$103.22
|
| Rate for Payer: Encore All Commercial |
$107.97
|
| Rate for Payer: Frontpath All Commercial |
$107.91
|
| Rate for Payer: Humana ChoiceCare |
$101.30
|
| Rate for Payer: Humana Medicare |
$37.53
|
| Rate for Payer: Lucent All Commercial |
$63.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.56
|
| Rate for Payer: Managed Health Services Medicaid |
$15.92
|
| Rate for Payer: MDWise Medicaid |
$15.92
|
| Rate for Payer: PHCS All Commercial |
$87.97
|
| Rate for Payer: PHP All Commercial |
$88.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.74
|
| Rate for Payer: Sagamore Health Network All Products |
$90.55
|
| Rate for Payer: Signature Care EPO |
$97.35
|
| Rate for Payer: Signature Care PPO |
$103.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.70
|
| Rate for Payer: United Healthcare Commercial |
$92.42
|
| Rate for Payer: United Healthcare Medicare |
$37.53
|
|
