|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
410671
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Aetna Commercial |
$37.30
|
| Rate for Payer: Aetna Medicare |
$14.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Centivo All Commercial |
$24.04
|
| Rate for Payer: Cigna All Commercial |
$38.14
|
| Rate for Payer: CORVEL All Commercial |
$41.10
|
| Rate for Payer: Coventry All Commercial |
$38.89
|
| Rate for Payer: Encore All Commercial |
$40.68
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.17
|
| Rate for Payer: Humana Medicare |
$14.14
|
| Rate for Payer: Lucent All Commercial |
$24.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.23
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.68
|
| Rate for Payer: Signature Care PPO |
$38.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.56
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
| Rate for Payer: United Healthcare Medicare |
$14.14
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
410671
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cigna All Commercial |
$38.14
|
| Rate for Payer: CORVEL All Commercial |
$41.10
|
| Rate for Payer: Coventry All Commercial |
$38.89
|
| Rate for Payer: Encore All Commercial |
$40.68
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.68
|
| Rate for Payer: Signature Care PPO |
$38.89
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
|
|
HC PROTHROMBIN TIME POCT
|
Facility
|
OP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1695610
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Aetna Commercial |
$37.30
|
| Rate for Payer: Aetna Medicare |
$14.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Centivo All Commercial |
$24.04
|
| Rate for Payer: Cigna All Commercial |
$38.14
|
| Rate for Payer: CORVEL All Commercial |
$41.10
|
| Rate for Payer: Coventry All Commercial |
$38.89
|
| Rate for Payer: Encore All Commercial |
$40.68
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.17
|
| Rate for Payer: Humana Medicare |
$14.14
|
| Rate for Payer: Lucent All Commercial |
$24.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: Managed Health Services Medicaid |
$4.29
|
| Rate for Payer: MDWise Medicaid |
$4.29
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.23
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.68
|
| Rate for Payer: Signature Care PPO |
$38.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.56
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
| Rate for Payer: United Healthcare Medicare |
$14.14
|
|
|
HC PROTHROMBIN TIME POCT
|
Facility
|
IP
|
$44.19
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1695610
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cigna All Commercial |
$38.14
|
| Rate for Payer: CORVEL All Commercial |
$41.10
|
| Rate for Payer: Coventry All Commercial |
$38.89
|
| Rate for Payer: Encore All Commercial |
$40.68
|
| Rate for Payer: Frontpath All Commercial |
$40.65
|
| Rate for Payer: Humana ChoiceCare |
$38.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.77
|
| Rate for Payer: PHCS All Commercial |
$33.14
|
| Rate for Payer: PHP All Commercial |
$33.51
|
| Rate for Payer: Sagamore Health Network All Products |
$34.11
|
| Rate for Payer: Signature Care EPO |
$36.68
|
| Rate for Payer: Signature Care PPO |
$38.89
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
|
|
HC PROX CUTTER 75MM BLUE
|
Facility
|
IP
|
$743.05
|
|
| Hospital Charge Code |
41607889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$557.29 |
| Max. Negotiated Rate |
$691.04 |
| Rate for Payer: Aetna Commercial |
$642.00
|
| Rate for Payer: Cash Price |
$445.83
|
| Rate for Payer: Cigna All Commercial |
$641.25
|
| Rate for Payer: CORVEL All Commercial |
$691.04
|
| Rate for Payer: Coventry All Commercial |
$653.88
|
| Rate for Payer: Encore All Commercial |
$683.98
|
| Rate for Payer: Frontpath All Commercial |
$683.61
|
| Rate for Payer: Humana ChoiceCare |
$641.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$668.75
|
| Rate for Payer: PHCS All Commercial |
$557.29
|
| Rate for Payer: PHP All Commercial |
$563.53
|
| Rate for Payer: Sagamore Health Network All Products |
$573.63
|
| Rate for Payer: Signature Care EPO |
$616.73
|
| Rate for Payer: Signature Care PPO |
$653.88
|
| Rate for Payer: United Healthcare Commercial |
$585.52
|
|
|
HC PROX CUTTER 75MM BLUE
|
Facility
|
OP
|
$743.05
|
|
| Hospital Charge Code |
41607889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$691.04 |
| Rate for Payer: Aetna Commercial |
$627.13
|
| Rate for Payer: Aetna Medicare |
$237.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$426.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$464.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$273.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$261.55
|
| Rate for Payer: Cash Price |
$445.83
|
| Rate for Payer: Cash Price |
$445.83
|
| Rate for Payer: Centivo All Commercial |
$404.22
|
| Rate for Payer: Cigna All Commercial |
$641.25
|
| Rate for Payer: CORVEL All Commercial |
$691.04
|
| Rate for Payer: Coventry All Commercial |
$653.88
|
| Rate for Payer: Encore All Commercial |
$683.98
|
| Rate for Payer: Frontpath All Commercial |
$683.61
|
| Rate for Payer: Humana ChoiceCare |
$641.77
|
| Rate for Payer: Humana Medicare |
$237.78
|
| Rate for Payer: Lucent All Commercial |
$404.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$668.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$557.29
|
| Rate for Payer: PHP All Commercial |
$563.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.79
|
| Rate for Payer: Sagamore Health Network All Products |
$573.63
|
| Rate for Payer: Signature Care EPO |
$616.73
|
| Rate for Payer: Signature Care PPO |
$653.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$631.59
|
| Rate for Payer: United Healthcare Commercial |
$585.52
|
| Rate for Payer: United Healthcare Medicare |
$237.78
|
|
|
HC PSA FREE & TOTAL
|
Facility
|
OP
|
$188.94
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
63001123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$175.71 |
| Rate for Payer: Aetna Commercial |
$159.47
|
| Rate for Payer: Aetna Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.51
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Centivo All Commercial |
$102.78
|
| Rate for Payer: Cigna All Commercial |
$163.06
|
| Rate for Payer: CORVEL All Commercial |
$175.71
|
| Rate for Payer: Coventry All Commercial |
$166.27
|
| Rate for Payer: Encore All Commercial |
$173.92
|
| Rate for Payer: Frontpath All Commercial |
$173.82
|
| Rate for Payer: Humana ChoiceCare |
$163.19
|
| Rate for Payer: Humana Medicare |
$60.46
|
| Rate for Payer: Lucent All Commercial |
$102.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.05
|
| Rate for Payer: Managed Health Services Medicaid |
$18.39
|
| Rate for Payer: MDWise Medicaid |
$18.39
|
| Rate for Payer: PHCS All Commercial |
$141.71
|
| Rate for Payer: PHP All Commercial |
$143.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.69
|
| Rate for Payer: Sagamore Health Network All Products |
$145.86
|
| Rate for Payer: Signature Care EPO |
$156.82
|
| Rate for Payer: Signature Care PPO |
$166.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.60
|
| Rate for Payer: United Healthcare Commercial |
$148.88
|
| Rate for Payer: United Healthcare Medicare |
$60.46
|
|
|
HC PSA FREE & TOTAL
|
Facility
|
IP
|
$188.94
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
63001123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.71 |
| Max. Negotiated Rate |
$175.71 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Cigna All Commercial |
$163.06
|
| Rate for Payer: CORVEL All Commercial |
$175.71
|
| Rate for Payer: Coventry All Commercial |
$166.27
|
| Rate for Payer: Encore All Commercial |
$173.92
|
| Rate for Payer: Frontpath All Commercial |
$173.82
|
| Rate for Payer: Humana ChoiceCare |
$163.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.05
|
| Rate for Payer: PHCS All Commercial |
$141.71
|
| Rate for Payer: PHP All Commercial |
$143.29
|
| Rate for Payer: Sagamore Health Network All Products |
$145.86
|
| Rate for Payer: Signature Care EPO |
$156.82
|
| Rate for Payer: Signature Care PPO |
$166.27
|
| Rate for Payer: United Healthcare Commercial |
$148.88
|
|
|
HC PSA SCREEN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
|
|
HC PSA SCREEN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$51.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.32
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Centivo All Commercial |
$87.04
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Humana Medicare |
$51.20
|
| Rate for Payer: Lucent All Commercial |
$87.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$18.39
|
| Rate for Payer: MDWise Medicaid |
$18.39
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.40
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.00
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
| Rate for Payer: United Healthcare Medicare |
$51.20
|
|
|
HC PSA SCREEN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
63001124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
|
|
HC PSA SCREEN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
63001124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$51.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.32
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Centivo All Commercial |
$87.04
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Humana Medicare |
$51.20
|
| Rate for Payer: Lucent All Commercial |
$87.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$19.31
|
| Rate for Payer: MDWise Medicaid |
$19.31
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.40
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.00
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
| Rate for Payer: United Healthcare Medicare |
$51.20
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$51.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$73.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.32
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Centivo All Commercial |
$87.04
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Humana Medicare |
$51.20
|
| Rate for Payer: Lucent All Commercial |
$87.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$18.39
|
| Rate for Payer: MDWise Medicaid |
$18.39
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.40
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.00
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
| Rate for Payer: United Healthcare Medicare |
$51.20
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
63001664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna All Commercial |
$138.08
|
| Rate for Payer: CORVEL All Commercial |
$148.80
|
| Rate for Payer: Coventry All Commercial |
$140.80
|
| Rate for Payer: Encore All Commercial |
$147.28
|
| Rate for Payer: Frontpath All Commercial |
$147.20
|
| Rate for Payer: Humana ChoiceCare |
$138.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$120.00
|
| Rate for Payer: PHP All Commercial |
$121.34
|
| Rate for Payer: Sagamore Health Network All Products |
$123.52
|
| Rate for Payer: Signature Care EPO |
$132.80
|
| Rate for Payer: Signature Care PPO |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$126.08
|
|
|
HC P SCREW 2X12 PT CANN
|
Facility
|
IP
|
$1,912.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.38 |
| Max. Negotiated Rate |
$1,778.62 |
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna All Commercial |
$1,650.49
|
| Rate for Payer: CORVEL All Commercial |
$1,778.62
|
| Rate for Payer: Coventry All Commercial |
$1,683.00
|
| Rate for Payer: Encore All Commercial |
$1,760.46
|
| Rate for Payer: Frontpath All Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$1,651.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,721.25
|
| Rate for Payer: PHCS All Commercial |
$1,434.38
|
| Rate for Payer: PHP All Commercial |
$1,450.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,476.45
|
| Rate for Payer: Signature Care EPO |
$1,587.38
|
| Rate for Payer: Signature Care PPO |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,507.05
|
|
|
HC P SCREW 2X12 PT CANN
|
Facility
|
OP
|
$1,912.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,778.62 |
| Rate for Payer: Aetna Commercial |
$1,614.15
|
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$592.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,098.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,195.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$703.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.20
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Centivo All Commercial |
$1,040.40
|
| Rate for Payer: Cigna All Commercial |
$1,650.49
|
| Rate for Payer: CORVEL All Commercial |
$1,778.62
|
| Rate for Payer: Coventry All Commercial |
$1,683.00
|
| Rate for Payer: Encore All Commercial |
$1,760.46
|
| Rate for Payer: Frontpath All Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$1,651.83
|
| Rate for Payer: Humana Medicare |
$612.00
|
| Rate for Payer: Lucent All Commercial |
$1,040.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,721.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,434.38
|
| Rate for Payer: PHP All Commercial |
$1,450.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$745.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,476.45
|
| Rate for Payer: Signature Care EPO |
$1,587.38
|
| Rate for Payer: Signature Care PPO |
$1,683.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,625.62
|
| Rate for Payer: United Healthcare Commercial |
$1,507.05
|
| Rate for Payer: United Healthcare Medicare |
$612.00
|
|
|
HC PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
IP
|
$480.42
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
1727163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$360.31 |
| Max. Negotiated Rate |
$446.79 |
| Rate for Payer: Aetna Commercial |
$415.08
|
| Rate for Payer: Cash Price |
$288.25
|
| Rate for Payer: Cigna All Commercial |
$414.60
|
| Rate for Payer: CORVEL All Commercial |
$446.79
|
| Rate for Payer: Coventry All Commercial |
$422.77
|
| Rate for Payer: Encore All Commercial |
$442.23
|
| Rate for Payer: Frontpath All Commercial |
$441.99
|
| Rate for Payer: Humana ChoiceCare |
$414.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.38
|
| Rate for Payer: PHCS All Commercial |
$360.31
|
| Rate for Payer: PHP All Commercial |
$364.35
|
| Rate for Payer: Sagamore Health Network All Products |
$370.88
|
| Rate for Payer: Signature Care EPO |
$398.75
|
| Rate for Payer: Signature Care PPO |
$422.77
|
| Rate for Payer: United Healthcare Commercial |
$378.57
|
|
|
HC PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
OP
|
$480.42
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
1727163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$446.79 |
| Rate for Payer: Aetna Commercial |
$405.47
|
| Rate for Payer: Aetna Medicare |
$153.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$300.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.11
|
| Rate for Payer: Cash Price |
$288.25
|
| Rate for Payer: Cash Price |
$288.25
|
| Rate for Payer: Centivo All Commercial |
$261.35
|
| Rate for Payer: Cigna All Commercial |
$414.60
|
| Rate for Payer: CORVEL All Commercial |
$446.79
|
| Rate for Payer: Coventry All Commercial |
$422.77
|
| Rate for Payer: Encore All Commercial |
$442.23
|
| Rate for Payer: Frontpath All Commercial |
$441.99
|
| Rate for Payer: Humana ChoiceCare |
$414.94
|
| Rate for Payer: Humana Medicare |
$153.73
|
| Rate for Payer: Lucent All Commercial |
$261.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.38
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$360.31
|
| Rate for Payer: PHP All Commercial |
$364.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.36
|
| Rate for Payer: Sagamore Health Network All Products |
$370.88
|
| Rate for Payer: Signature Care EPO |
$398.75
|
| Rate for Payer: Signature Care PPO |
$422.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$408.36
|
| Rate for Payer: United Healthcare Commercial |
$378.57
|
| Rate for Payer: United Healthcare Medicare |
$153.73
|
|
|
HC PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
OP
|
$269.28
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
1727161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$250.43 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Medicare |
$86.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$154.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.79
|
| Rate for Payer: Cash Price |
$161.57
|
| Rate for Payer: Cash Price |
$161.57
|
| Rate for Payer: Centivo All Commercial |
$146.49
|
| Rate for Payer: Cigna All Commercial |
$232.39
|
| Rate for Payer: CORVEL All Commercial |
$250.43
|
| Rate for Payer: Coventry All Commercial |
$236.97
|
| Rate for Payer: Encore All Commercial |
$247.87
|
| Rate for Payer: Frontpath All Commercial |
$247.74
|
| Rate for Payer: Humana ChoiceCare |
$232.58
|
| Rate for Payer: Humana Medicare |
$86.17
|
| Rate for Payer: Lucent All Commercial |
$146.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.35
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$201.96
|
| Rate for Payer: PHP All Commercial |
$204.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.02
|
| Rate for Payer: Sagamore Health Network All Products |
$207.88
|
| Rate for Payer: Signature Care EPO |
$223.50
|
| Rate for Payer: Signature Care PPO |
$236.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$228.89
|
| Rate for Payer: United Healthcare Commercial |
$212.19
|
| Rate for Payer: United Healthcare Medicare |
$86.17
|
|
|
HC PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
IP
|
$269.28
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
1727161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$250.43 |
| Rate for Payer: Aetna Commercial |
$232.66
|
| Rate for Payer: Cash Price |
$161.57
|
| Rate for Payer: Cigna All Commercial |
$232.39
|
| Rate for Payer: CORVEL All Commercial |
$250.43
|
| Rate for Payer: Coventry All Commercial |
$236.97
|
| Rate for Payer: Encore All Commercial |
$247.87
|
| Rate for Payer: Frontpath All Commercial |
$247.74
|
| Rate for Payer: Humana ChoiceCare |
$232.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.35
|
| Rate for Payer: PHCS All Commercial |
$201.96
|
| Rate for Payer: PHP All Commercial |
$204.22
|
| Rate for Payer: Sagamore Health Network All Products |
$207.88
|
| Rate for Payer: Signature Care EPO |
$223.50
|
| Rate for Payer: Signature Care PPO |
$236.97
|
| Rate for Payer: United Healthcare Commercial |
$212.19
|
|
|
HC PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
IP
|
$408.82
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
1727162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$306.62 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Aetna Commercial |
$353.22
|
| Rate for Payer: Cash Price |
$245.29
|
| Rate for Payer: Cigna All Commercial |
$352.81
|
| Rate for Payer: CORVEL All Commercial |
$380.20
|
| Rate for Payer: Coventry All Commercial |
$359.76
|
| Rate for Payer: Encore All Commercial |
$376.32
|
| Rate for Payer: Frontpath All Commercial |
$376.11
|
| Rate for Payer: Humana ChoiceCare |
$353.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.94
|
| Rate for Payer: PHCS All Commercial |
$306.62
|
| Rate for Payer: PHP All Commercial |
$310.05
|
| Rate for Payer: Sagamore Health Network All Products |
$315.61
|
| Rate for Payer: Signature Care EPO |
$339.32
|
| Rate for Payer: Signature Care PPO |
$359.76
|
| Rate for Payer: United Healthcare Commercial |
$322.15
|
|
|
HC PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
OP
|
$408.82
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
1727162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Aetna Commercial |
$345.04
|
| Rate for Payer: Aetna Medicare |
$130.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$234.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.90
|
| Rate for Payer: Cash Price |
$245.29
|
| Rate for Payer: Cash Price |
$245.29
|
| Rate for Payer: Centivo All Commercial |
$222.40
|
| Rate for Payer: Cigna All Commercial |
$352.81
|
| Rate for Payer: CORVEL All Commercial |
$380.20
|
| Rate for Payer: Coventry All Commercial |
$359.76
|
| Rate for Payer: Encore All Commercial |
$376.32
|
| Rate for Payer: Frontpath All Commercial |
$376.11
|
| Rate for Payer: Humana ChoiceCare |
$353.10
|
| Rate for Payer: Humana Medicare |
$130.82
|
| Rate for Payer: Lucent All Commercial |
$222.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.94
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$306.62
|
| Rate for Payer: PHP All Commercial |
$310.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.44
|
| Rate for Payer: Sagamore Health Network All Products |
$315.61
|
| Rate for Payer: Signature Care EPO |
$339.32
|
| Rate for Payer: Signature Care PPO |
$359.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$347.50
|
| Rate for Payer: United Healthcare Commercial |
$322.15
|
| Rate for Payer: United Healthcare Medicare |
$130.82
|
|
|
HC PTH INTACT
|
Facility
|
IP
|
$391.04
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
63001133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$363.67 |
| Rate for Payer: Aetna Commercial |
$337.86
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Cigna All Commercial |
$337.47
|
| Rate for Payer: CORVEL All Commercial |
$363.67
|
| Rate for Payer: Coventry All Commercial |
$344.12
|
| Rate for Payer: Encore All Commercial |
$359.95
|
| Rate for Payer: Frontpath All Commercial |
$359.76
|
| Rate for Payer: Humana ChoiceCare |
$337.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.94
|
| Rate for Payer: PHCS All Commercial |
$293.28
|
| Rate for Payer: PHP All Commercial |
$296.56
|
| Rate for Payer: Sagamore Health Network All Products |
$301.88
|
| Rate for Payer: Signature Care EPO |
$324.56
|
| Rate for Payer: Signature Care PPO |
$344.12
|
| Rate for Payer: United Healthcare Commercial |
$308.14
|
|
|
HC PTH INTACT
|
Facility
|
OP
|
$391.04
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
63001133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$363.67 |
| Rate for Payer: Aetna Commercial |
$330.04
|
| Rate for Payer: Aetna Medicare |
$125.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$179.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$179.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.65
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Centivo All Commercial |
$212.73
|
| Rate for Payer: Cigna All Commercial |
$337.47
|
| Rate for Payer: CORVEL All Commercial |
$363.67
|
| Rate for Payer: Coventry All Commercial |
$344.12
|
| Rate for Payer: Encore All Commercial |
$359.95
|
| Rate for Payer: Frontpath All Commercial |
$359.76
|
| Rate for Payer: Humana ChoiceCare |
$337.74
|
| Rate for Payer: Humana Medicare |
$125.13
|
| Rate for Payer: Lucent All Commercial |
$212.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.94
|
| Rate for Payer: Managed Health Services Medicaid |
$41.28
|
| Rate for Payer: MDWise Medicaid |
$41.28
|
| Rate for Payer: PHCS All Commercial |
$293.28
|
| Rate for Payer: PHP All Commercial |
$296.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.51
|
| Rate for Payer: Sagamore Health Network All Products |
$301.88
|
| Rate for Payer: Signature Care EPO |
$324.56
|
| Rate for Payer: Signature Care PPO |
$344.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.38
|
| Rate for Payer: United Healthcare Commercial |
$308.14
|
| Rate for Payer: United Healthcare Medicare |
$125.13
|
|
|
HC PT ORTHOTIC MGMT&TRAINJ 1ST ENC /15 MIN
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
1728060
|
|
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
|
|
