|
HC MRI-UPPER EXTREMITY W/WO CON R
|
Facility
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
11574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$875.16 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$875.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$875.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,583.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,583.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,006.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$962.68
|
| Rate for Payer: Cash Price |
$1,644.24
|
| Rate for Payer: Cash Price |
$1,644.24
|
| Rate for Payer: Centivo All Commercial |
$1,352.52
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$1,352.52
|
| Rate for Payer: Lucent All Commercial |
$1,352.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$875.16
|
|
|
HC MRI-UPPER EXTREMITY W/WO CON R
|
Facility
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
11574220
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,644.24
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC MRSA CULTURE - O/P
|
Facility
OP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$116.48
|
| Rate for Payer: Aetna Medicare |
$45.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.10
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Centivo All Commercial |
$70.38
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.03
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Humana Medicare |
$70.38
|
| Rate for Payer: Lucent All Commercial |
$70.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: Managed Health Services Medicaid |
$6.63
|
| Rate for Payer: MDWise Medicaid |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$103.50
|
| Rate for Payer: PHP All Commercial |
$104.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.82
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.54
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.31
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
|
|
HC MRSA CULTURE - O/P
|
Facility
IP
|
$138.01
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
63001060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Aetna Commercial |
$119.24
|
| Rate for Payer: Cash Price |
$85.56
|
| Rate for Payer: Cigna All Commercial |
$119.10
|
| Rate for Payer: CORVEL All Commercial |
$128.35
|
| Rate for Payer: Coventry All Commercial |
$121.45
|
| Rate for Payer: Encore All Commercial |
$127.03
|
| Rate for Payer: Frontpath All Commercial |
$126.97
|
| Rate for Payer: Humana ChoiceCare |
$119.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.21
|
| Rate for Payer: PHCS All Commercial |
$103.50
|
| Rate for Payer: PHP All Commercial |
$104.66
|
| Rate for Payer: Sagamore Health Network All Products |
$106.54
|
| Rate for Payer: Signature Care EPO |
$114.54
|
| Rate for Payer: Signature Care PPO |
$121.45
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
|
|
HC MRSA PCR
|
Facility
OP
|
$89.15
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
63001168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$82.91 |
| Rate for Payer: Aetna Commercial |
$75.24
|
| Rate for Payer: Aetna Medicare |
$29.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.36
|
| Rate for Payer: Cash Price |
$55.27
|
| Rate for Payer: Cash Price |
$55.27
|
| Rate for Payer: Centivo All Commercial |
$45.47
|
| Rate for Payer: Cigna All Commercial |
$76.93
|
| Rate for Payer: CORVEL All Commercial |
$82.91
|
| Rate for Payer: Coventry All Commercial |
$78.45
|
| Rate for Payer: Encore All Commercial |
$82.06
|
| Rate for Payer: Frontpath All Commercial |
$82.02
|
| Rate for Payer: Humana ChoiceCare |
$77.00
|
| Rate for Payer: Humana Medicare |
$45.47
|
| Rate for Payer: Lucent All Commercial |
$45.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.23
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$66.86
|
| Rate for Payer: PHP All Commercial |
$67.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.77
|
| Rate for Payer: Sagamore Health Network All Products |
$68.82
|
| Rate for Payer: Signature Care EPO |
$73.99
|
| Rate for Payer: Signature Care PPO |
$78.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.78
|
| Rate for Payer: United Healthcare Commercial |
$70.25
|
| Rate for Payer: United Healthcare Medicare |
$29.42
|
|
|
HC MRSA PCR
|
Facility
IP
|
$89.15
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
63001168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$82.91 |
| Rate for Payer: Aetna Commercial |
$77.02
|
| Rate for Payer: Cash Price |
$55.27
|
| Rate for Payer: Cigna All Commercial |
$76.93
|
| Rate for Payer: CORVEL All Commercial |
$82.91
|
| Rate for Payer: Coventry All Commercial |
$78.45
|
| Rate for Payer: Encore All Commercial |
$82.06
|
| Rate for Payer: Frontpath All Commercial |
$82.02
|
| Rate for Payer: Humana ChoiceCare |
$77.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.23
|
| Rate for Payer: PHCS All Commercial |
$66.86
|
| Rate for Payer: PHP All Commercial |
$67.61
|
| Rate for Payer: Sagamore Health Network All Products |
$68.82
|
| Rate for Payer: Signature Care EPO |
$73.99
|
| Rate for Payer: Signature Care PPO |
$78.45
|
| Rate for Payer: United Healthcare Commercial |
$70.25
|
|
|
HC MSLT <4 NAP RECORDING
|
Facility
OP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805 52
|
| Hospital Charge Code |
01365805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,844.90 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,718.47
|
| Rate for Payer: Aetna Medicare |
$1,844.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,844.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,210.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,494.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,121.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,029.39
|
| Rate for Payer: Cash Price |
$3,466.18
|
| Rate for Payer: Centivo All Commercial |
$2,851.21
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Humana Medicare |
$2,851.21
|
| Rate for Payer: Lucent All Commercial |
$2,851.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,180.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,752.02
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
| Rate for Payer: United Healthcare Medicare |
$1,844.90
|
|
|
HC MSLT <4 NAP RECORDING
|
Facility
IP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805 52
|
| Hospital Charge Code |
01365805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,192.96 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,830.29
|
| Rate for Payer: Cash Price |
$3,466.18
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
|
|
HC MSLT 4+ NAP RECORDINGS
|
Facility
IP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
01520012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,192.96 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,830.29
|
| Rate for Payer: Cash Price |
$3,466.18
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
|
|
HC MSLT 4+ NAP RECORDINGS
|
Facility
OP
|
$5,590.61
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
01520012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$780.39 |
| Max. Negotiated Rate |
$5,199.27 |
| Rate for Payer: Aetna Commercial |
$4,718.47
|
| Rate for Payer: Aetna Medicare |
$1,844.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,844.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,210.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,494.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$780.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,121.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,029.39
|
| Rate for Payer: Cash Price |
$3,466.18
|
| Rate for Payer: Cash Price |
$3,466.18
|
| Rate for Payer: Centivo All Commercial |
$2,851.21
|
| Rate for Payer: Cigna All Commercial |
$4,824.70
|
| Rate for Payer: CORVEL All Commercial |
$5,199.27
|
| Rate for Payer: Coventry All Commercial |
$4,919.74
|
| Rate for Payer: Encore All Commercial |
$5,146.16
|
| Rate for Payer: Frontpath All Commercial |
$5,143.36
|
| Rate for Payer: Humana ChoiceCare |
$4,828.61
|
| Rate for Payer: Humana Medicare |
$2,851.21
|
| Rate for Payer: Lucent All Commercial |
$2,851.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,031.55
|
| Rate for Payer: Managed Health Services Medicaid |
$780.39
|
| Rate for Payer: MDWise Medicaid |
$780.39
|
| Rate for Payer: PHCS All Commercial |
$4,192.96
|
| Rate for Payer: PHP All Commercial |
$4,239.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,180.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4,315.95
|
| Rate for Payer: Signature Care EPO |
$4,640.21
|
| Rate for Payer: Signature Care PPO |
$4,919.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,752.02
|
| Rate for Payer: United Healthcare Commercial |
$4,405.40
|
| Rate for Payer: United Healthcare Medicare |
$1,844.90
|
|
|
HC M TUBERCULOSIS DNA-RT-PCR
|
Facility
IP
|
$313.21
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63002044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$234.91 |
| Max. Negotiated Rate |
$291.29 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Cash Price |
$194.19
|
| Rate for Payer: Cigna All Commercial |
$270.30
|
| Rate for Payer: CORVEL All Commercial |
$291.29
|
| Rate for Payer: Coventry All Commercial |
$275.63
|
| Rate for Payer: Encore All Commercial |
$288.31
|
| Rate for Payer: Frontpath All Commercial |
$288.15
|
| Rate for Payer: Humana ChoiceCare |
$270.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.89
|
| Rate for Payer: PHCS All Commercial |
$234.91
|
| Rate for Payer: PHP All Commercial |
$237.54
|
| Rate for Payer: Sagamore Health Network All Products |
$241.80
|
| Rate for Payer: Signature Care EPO |
$259.97
|
| Rate for Payer: Signature Care PPO |
$275.63
|
| Rate for Payer: United Healthcare Commercial |
$246.81
|
|
|
HC M TUBERCULOSIS DNA-RT-PCR
|
Facility
OP
|
$313.21
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63002044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$291.29 |
| Rate for Payer: Aetna Commercial |
$264.35
|
| Rate for Payer: Aetna Medicare |
$103.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$179.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$41.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.70
|
| Rate for Payer: Cash Price |
$194.19
|
| Rate for Payer: Cash Price |
$194.19
|
| Rate for Payer: Centivo All Commercial |
$159.74
|
| Rate for Payer: Cigna All Commercial |
$270.30
|
| Rate for Payer: CORVEL All Commercial |
$291.29
|
| Rate for Payer: Coventry All Commercial |
$275.63
|
| Rate for Payer: Encore All Commercial |
$288.31
|
| Rate for Payer: Frontpath All Commercial |
$288.15
|
| Rate for Payer: Humana ChoiceCare |
$270.52
|
| Rate for Payer: Humana Medicare |
$159.74
|
| Rate for Payer: Lucent All Commercial |
$159.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.89
|
| Rate for Payer: Managed Health Services Medicaid |
$41.68
|
| Rate for Payer: MDWise Medicaid |
$41.68
|
| Rate for Payer: PHCS All Commercial |
$234.91
|
| Rate for Payer: PHP All Commercial |
$237.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.15
|
| Rate for Payer: Sagamore Health Network All Products |
$241.80
|
| Rate for Payer: Signature Care EPO |
$259.97
|
| Rate for Payer: Signature Care PPO |
$275.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$266.23
|
| Rate for Payer: United Healthcare Commercial |
$246.81
|
| Rate for Payer: United Healthcare Medicare |
$103.36
|
|
|
HC MUMPS IGG AB
|
Facility
IP
|
$134.64
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
63001960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.98 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Aetna Commercial |
$116.33
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Cigna All Commercial |
$116.19
|
| Rate for Payer: CORVEL All Commercial |
$125.22
|
| Rate for Payer: Coventry All Commercial |
$118.48
|
| Rate for Payer: Encore All Commercial |
$123.94
|
| Rate for Payer: Frontpath All Commercial |
$123.87
|
| Rate for Payer: Humana ChoiceCare |
$116.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.18
|
| Rate for Payer: PHCS All Commercial |
$100.98
|
| Rate for Payer: PHP All Commercial |
$102.11
|
| Rate for Payer: Sagamore Health Network All Products |
$103.94
|
| Rate for Payer: Signature Care EPO |
$111.75
|
| Rate for Payer: Signature Care PPO |
$118.48
|
| Rate for Payer: United Healthcare Commercial |
$106.10
|
|
|
HC MUMPS IGG AB
|
Facility
OP
|
$134.64
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
63001960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Aetna Commercial |
$113.64
|
| Rate for Payer: Aetna Medicare |
$44.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.87
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Cash Price |
$83.48
|
| Rate for Payer: Centivo All Commercial |
$68.67
|
| Rate for Payer: Cigna All Commercial |
$116.19
|
| Rate for Payer: CORVEL All Commercial |
$125.22
|
| Rate for Payer: Coventry All Commercial |
$118.48
|
| Rate for Payer: Encore All Commercial |
$123.94
|
| Rate for Payer: Frontpath All Commercial |
$123.87
|
| Rate for Payer: Humana ChoiceCare |
$116.29
|
| Rate for Payer: Humana Medicare |
$68.67
|
| Rate for Payer: Lucent All Commercial |
$68.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.18
|
| Rate for Payer: Managed Health Services Medicaid |
$13.05
|
| Rate for Payer: MDWise Medicaid |
$13.05
|
| Rate for Payer: PHCS All Commercial |
$100.98
|
| Rate for Payer: PHP All Commercial |
$102.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.51
|
| Rate for Payer: Sagamore Health Network All Products |
$103.94
|
| Rate for Payer: Signature Care EPO |
$111.75
|
| Rate for Payer: Signature Care PPO |
$118.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.44
|
| Rate for Payer: United Healthcare Commercial |
$106.10
|
| Rate for Payer: United Healthcare Medicare |
$44.43
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE BY NUCLEIC ACID AMPLIFICATION (NAA) WITHOUT CAP-MANDATED CULTURE, NONSPUTUM
|
Facility
IP
|
$122.40
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63044067
|
|
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 |
$75.89
|
| 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 BY NUCLEIC ACID AMPLIFICATION (NAA) WITHOUT CAP-MANDATED CULTURE, NONSPUTUM
|
Facility
OP
|
$122.40
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63044067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$41.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| 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 |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| 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 |
$40.39
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE BY NUCLEIC ACID AMPLIFICATION (NAA) WITHOUT CAP-MANDATED CULTURE, NONSPUTUM-B
|
Facility
OP
|
$122.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044068
|
|
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 |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| 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 |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| 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 |
$40.39
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE BY NUCLEIC ACID AMPLIFICATION (NAA) WITHOUT CAP-MANDATED CULTURE, NONSPUTUM-B
|
Facility
IP
|
$122.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
63044068
|
|
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 |
$75.89
|
| 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
|
Facility
OP
|
$122.40
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63044069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$103.31
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$41.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| 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 |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| 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 |
$40.39
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS COMPLEX DETECTION AND RIFAMPIN RESISTANCE, NAA WITHOUT CAP-MANDATED CULTURE
|
Facility
IP
|
$122.40
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
63044069
|
|
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 |
$75.89
|
| 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
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 |
$75.89
|
| 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 |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.43
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Centivo All Commercial |
$62.42
|
| 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 |
$62.42
|
| Rate for Payer: Lucent All Commercial |
$62.42
|
| 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 |
$40.39
|
|
|
HC MYCOPHENOLIC ACID
|
Facility
OP
|
$1,241.03
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
63001040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$1,154.16 |
| Rate for Payer: Aetna Commercial |
$1,047.43
|
| Rate for Payer: Aetna Medicare |
$409.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$409.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$712.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$775.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$18.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$470.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$450.50
|
| Rate for Payer: Cash Price |
$769.44
|
| Rate for Payer: Cash Price |
$769.44
|
| Rate for Payer: Centivo All Commercial |
$632.93
|
| Rate for Payer: Cigna All Commercial |
$1,071.01
|
| Rate for Payer: CORVEL All Commercial |
$1,154.16
|
| Rate for Payer: Coventry All Commercial |
$1,092.11
|
| Rate for Payer: Encore All Commercial |
$1,142.37
|
| Rate for Payer: Frontpath All Commercial |
$1,141.75
|
| Rate for Payer: Humana ChoiceCare |
$1,071.88
|
| Rate for Payer: Humana Medicare |
$632.93
|
| Rate for Payer: Lucent All Commercial |
$632.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,116.93
|
| Rate for Payer: Managed Health Services Medicaid |
$18.05
|
| Rate for Payer: MDWise Medicaid |
$18.05
|
| Rate for Payer: PHCS All Commercial |
$930.78
|
| Rate for Payer: PHP All Commercial |
$941.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$484.00
|
| Rate for Payer: Sagamore Health Network All Products |
$958.08
|
| Rate for Payer: Signature Care EPO |
$1,030.06
|
| Rate for Payer: Signature Care PPO |
$1,092.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,054.88
|
| Rate for Payer: United Healthcare Commercial |
$977.93
|
| Rate for Payer: United Healthcare Medicare |
$409.54
|
|
|
HC MYCOPHENOLIC ACID
|
Facility
IP
|
$1,241.03
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
63001040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$930.78 |
| Max. Negotiated Rate |
$1,154.16 |
| Rate for Payer: Cigna All Commercial |
$1,071.01
|
| Rate for Payer: Aetna Commercial |
$1,072.25
|
| Rate for Payer: Cash Price |
$769.44
|
| Rate for Payer: CORVEL All Commercial |
$1,154.16
|
| Rate for Payer: Coventry All Commercial |
$1,092.11
|
| Rate for Payer: Encore All Commercial |
$1,142.37
|
| Rate for Payer: Frontpath All Commercial |
$1,141.75
|
| Rate for Payer: Humana ChoiceCare |
$1,071.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,116.93
|
| Rate for Payer: PHCS All Commercial |
$930.78
|
| Rate for Payer: PHP All Commercial |
$941.20
|
| Rate for Payer: Sagamore Health Network All Products |
$958.08
|
| Rate for Payer: Signature Care EPO |
$1,030.06
|
| Rate for Payer: Signature Care PPO |
$1,092.11
|
| Rate for Payer: United Healthcare Commercial |
$977.93
|
|
|
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 |
$369.26 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$150.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.13
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Cash Price |
$246.17
|
| Rate for Payer: Centivo All Commercial |
$202.50
|
| Rate for Payer: Cigna All Commercial |
$342.66
|
| Rate for Payer: CORVEL All Commercial |
$369.26
|
| Rate for Payer: Coventry All Commercial |
$349.41
|
| Rate for Payer: Encore All Commercial |
$365.49
|
| Rate for Payer: Frontpath All Commercial |
$365.29
|
| Rate for Payer: Humana ChoiceCare |
$342.94
|
| Rate for Payer: Humana Medicare |
$202.50
|
| Rate for Payer: Lucent All Commercial |
$202.50
|
| 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 |
$297.79
|
| 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 |
$131.03
|
|
