|
HC RIBOSOMAL P PROT AB
|
Facility
|
IP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
|
|
HC RIBOSOMAL P PROT AB
|
Facility
|
OP
|
$95.83
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
63001881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$80.88
|
| Rate for Payer: Aetna Medicare |
$30.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$44.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.73
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Centivo All Commercial |
$52.13
|
| Rate for Payer: Cigna All Commercial |
$82.70
|
| Rate for Payer: CORVEL All Commercial |
$89.12
|
| Rate for Payer: Coventry All Commercial |
$84.33
|
| Rate for Payer: Encore All Commercial |
$88.21
|
| Rate for Payer: Frontpath All Commercial |
$88.16
|
| Rate for Payer: Humana ChoiceCare |
$82.77
|
| Rate for Payer: Humana Medicare |
$30.67
|
| Rate for Payer: Lucent All Commercial |
$52.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.25
|
| Rate for Payer: Managed Health Services Medicaid |
$17.93
|
| Rate for Payer: MDWise Medicaid |
$17.93
|
| Rate for Payer: PHCS All Commercial |
$71.87
|
| Rate for Payer: PHP All Commercial |
$72.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.37
|
| Rate for Payer: Sagamore Health Network All Products |
$73.98
|
| Rate for Payer: Signature Care EPO |
$79.54
|
| Rate for Payer: Signature Care PPO |
$84.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$75.51
|
| Rate for Payer: United Healthcare Medicare |
$30.67
|
|
|
HC RING BARRIER ADAPT 4.5MM
|
Facility
|
OP
|
$4.26
|
|
| Hospital Charge Code |
41607532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$21.01 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Centivo All Commercial |
$2.32
|
| Rate for Payer: Cigna All Commercial |
$3.68
|
| Rate for Payer: CORVEL All Commercial |
$3.96
|
| Rate for Payer: Coventry All Commercial |
$3.75
|
| Rate for Payer: Encore All Commercial |
$3.92
|
| Rate for Payer: Frontpath All Commercial |
$3.92
|
| Rate for Payer: Humana ChoiceCare |
$3.68
|
| Rate for Payer: Humana Medicare |
$1.36
|
| Rate for Payer: Lucent All Commercial |
$2.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.83
|
| Rate for Payer: Managed Health Services Medicaid |
$21.01
|
| Rate for Payer: MDWise Medicaid |
$21.01
|
| Rate for Payer: PHCS All Commercial |
$3.19
|
| Rate for Payer: PHP All Commercial |
$3.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3.29
|
| Rate for Payer: Signature Care EPO |
$3.54
|
| Rate for Payer: Signature Care PPO |
$3.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.62
|
| Rate for Payer: United Healthcare Commercial |
$3.36
|
| Rate for Payer: United Healthcare Medicare |
$1.36
|
|
|
HC RING BARRIER ADAPT 4.5MM
|
Facility
|
IP
|
$4.26
|
|
| Hospital Charge Code |
41607532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna All Commercial |
$3.68
|
| Rate for Payer: CORVEL All Commercial |
$3.96
|
| Rate for Payer: Coventry All Commercial |
$3.75
|
| Rate for Payer: Encore All Commercial |
$3.92
|
| Rate for Payer: Frontpath All Commercial |
$3.92
|
| Rate for Payer: Humana ChoiceCare |
$3.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.83
|
| Rate for Payer: PHCS All Commercial |
$3.19
|
| Rate for Payer: PHP All Commercial |
$3.23
|
| Rate for Payer: Sagamore Health Network All Products |
$3.29
|
| Rate for Payer: Signature Care EPO |
$3.54
|
| Rate for Payer: Signature Care PPO |
$3.75
|
| Rate for Payer: United Healthcare Commercial |
$3.36
|
|
|
HC ROBOTIC SRS INITIAL FRACTION
|
Facility
|
IP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
1540339
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,443.09
|
| Rate for Payer: Cash Price |
$5,863.25
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
|
|
HC ROBOTIC SRS INITIAL FRACTION
|
Facility
|
OP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
1540339
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$999.65 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,247.64
|
| Rate for Payer: Aetna Medicare |
$3,127.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$999.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,029.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,612.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,108.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$999.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,596.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,439.78
|
| Rate for Payer: Cash Price |
$5,863.25
|
| Rate for Payer: Cash Price |
$5,863.25
|
| Rate for Payer: Centivo All Commercial |
$5,316.02
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Humana Medicare |
$3,127.07
|
| Rate for Payer: Lucent All Commercial |
$5,316.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: Managed Health Services Medicaid |
$999.65
|
| Rate for Payer: MDWise Medicaid |
$999.65
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,811.12
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,306.28
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
| Rate for Payer: United Healthcare Medicare |
$3,127.07
|
|
|
HC ROBOTIC SRS SUBSEQUENT FRACT
|
Facility
|
OP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
1540340
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$999.65 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,247.64
|
| Rate for Payer: Aetna Medicare |
$3,127.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$999.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,029.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,612.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,108.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$999.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,596.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,439.78
|
| Rate for Payer: Cash Price |
$5,863.25
|
| Rate for Payer: Cash Price |
$5,863.25
|
| Rate for Payer: Centivo All Commercial |
$5,316.02
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Humana Medicare |
$3,127.07
|
| Rate for Payer: Lucent All Commercial |
$5,316.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: Managed Health Services Medicaid |
$999.65
|
| Rate for Payer: MDWise Medicaid |
$999.65
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,811.12
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,306.28
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
| Rate for Payer: United Healthcare Medicare |
$3,127.07
|
|
|
HC ROBOTIC SRS SUBSEQUENT FRACT
|
Facility
|
IP
|
$9,772.09
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
1540340
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$9,088.04 |
| Rate for Payer: Aetna Commercial |
$8,443.09
|
| Rate for Payer: Cash Price |
$5,863.25
|
| Rate for Payer: Cigna All Commercial |
$8,433.31
|
| Rate for Payer: CORVEL All Commercial |
$9,088.04
|
| Rate for Payer: Coventry All Commercial |
$8,599.44
|
| Rate for Payer: Encore All Commercial |
$8,995.21
|
| Rate for Payer: Frontpath All Commercial |
$8,990.32
|
| Rate for Payer: Humana ChoiceCare |
$8,440.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,794.88
|
| Rate for Payer: PHCS All Commercial |
$7,329.07
|
| Rate for Payer: PHP All Commercial |
$7,411.15
|
| Rate for Payer: Sagamore Health Network All Products |
$7,544.05
|
| Rate for Payer: Signature Care EPO |
$8,110.83
|
| Rate for Payer: Signature Care PPO |
$8,599.44
|
| Rate for Payer: United Healthcare Commercial |
$7,700.41
|
|
|
HC ROM RUPTURE OF MEMBRANE
|
Facility
|
IP
|
$468.44
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
63001660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$351.33 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$404.73
|
| Rate for Payer: Cash Price |
$281.06
|
| Rate for Payer: Cigna All Commercial |
$404.26
|
| Rate for Payer: CORVEL All Commercial |
$435.65
|
| Rate for Payer: Coventry All Commercial |
$412.23
|
| Rate for Payer: Encore All Commercial |
$431.20
|
| Rate for Payer: Frontpath All Commercial |
$430.96
|
| Rate for Payer: Humana ChoiceCare |
$404.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.60
|
| Rate for Payer: PHCS All Commercial |
$351.33
|
| Rate for Payer: PHP All Commercial |
$355.26
|
| Rate for Payer: Sagamore Health Network All Products |
$361.64
|
| Rate for Payer: Signature Care EPO |
$388.81
|
| Rate for Payer: Signature Care PPO |
$412.23
|
| Rate for Payer: United Healthcare Commercial |
$369.13
|
|
|
HC ROM RUPTURE OF MEMBRANE
|
Facility
|
OP
|
$468.44
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
63001660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$395.36
|
| Rate for Payer: Aetna Medicare |
$149.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$98.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$215.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.89
|
| Rate for Payer: Cash Price |
$281.06
|
| Rate for Payer: Cash Price |
$281.06
|
| Rate for Payer: Centivo All Commercial |
$254.83
|
| Rate for Payer: Cigna All Commercial |
$404.26
|
| Rate for Payer: CORVEL All Commercial |
$435.65
|
| Rate for Payer: Coventry All Commercial |
$412.23
|
| Rate for Payer: Encore All Commercial |
$431.20
|
| Rate for Payer: Frontpath All Commercial |
$430.96
|
| Rate for Payer: Humana ChoiceCare |
$404.59
|
| Rate for Payer: Humana Medicare |
$149.90
|
| Rate for Payer: Lucent All Commercial |
$254.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.60
|
| Rate for Payer: Managed Health Services Medicaid |
$98.11
|
| Rate for Payer: MDWise Medicaid |
$98.11
|
| Rate for Payer: PHCS All Commercial |
$351.33
|
| Rate for Payer: PHP All Commercial |
$355.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.69
|
| Rate for Payer: Sagamore Health Network All Products |
$361.64
|
| Rate for Payer: Signature Care EPO |
$388.81
|
| Rate for Payer: Signature Care PPO |
$412.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.17
|
| Rate for Payer: United Healthcare Commercial |
$369.13
|
| Rate for Payer: United Healthcare Medicare |
$149.90
|
|
|
HC ROTAVIRUS
|
Facility
|
IP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cigna All Commercial |
$147.67
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Encore All Commercial |
$157.51
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Sagamore Health Network All Products |
$132.10
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.58
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
|
|
HC ROTAVIRUS
|
Facility
|
OP
|
$171.11
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
63001085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna Commercial |
$144.42
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.23
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centivo All Commercial |
$93.08
|
| Rate for Payer: Cigna All Commercial |
$147.67
|
| Rate for Payer: CORVEL All Commercial |
$159.13
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Encore All Commercial |
$157.51
|
| Rate for Payer: Frontpath All Commercial |
$157.42
|
| Rate for Payer: Humana ChoiceCare |
$147.79
|
| Rate for Payer: Humana Medicare |
$54.76
|
| Rate for Payer: Lucent All Commercial |
$93.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: MDWise Medicaid |
$11.98
|
| Rate for Payer: PHCS All Commercial |
$128.33
|
| Rate for Payer: PHP All Commercial |
$129.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.73
|
| Rate for Payer: Sagamore Health Network All Products |
$132.10
|
| Rate for Payer: Signature Care EPO |
$142.02
|
| Rate for Payer: Signature Care PPO |
$150.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.44
|
| Rate for Payer: United Healthcare Commercial |
$134.83
|
| Rate for Payer: United Healthcare Medicare |
$54.76
|
|
|
HC ROTH NET MINI FB
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
41608230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Aetna Commercial |
$725.76
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna All Commercial |
$724.92
|
| Rate for Payer: CORVEL All Commercial |
$781.20
|
| Rate for Payer: Coventry All Commercial |
$739.20
|
| Rate for Payer: Encore All Commercial |
$773.22
|
| Rate for Payer: Frontpath All Commercial |
$772.80
|
| Rate for Payer: Humana ChoiceCare |
$725.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.00
|
| Rate for Payer: PHCS All Commercial |
$630.00
|
| Rate for Payer: PHP All Commercial |
$637.06
|
| Rate for Payer: Sagamore Health Network All Products |
$648.48
|
| Rate for Payer: Signature Care EPO |
$697.20
|
| Rate for Payer: Signature Care PPO |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$661.92
|
|
|
HC ROTH NET MINI FB
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
41608230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Aetna Commercial |
$708.96
|
| Rate for Payer: Aetna Medicare |
$268.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$260.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$482.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$525.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$295.68
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Centivo All Commercial |
$456.96
|
| Rate for Payer: Cigna All Commercial |
$724.92
|
| Rate for Payer: CORVEL All Commercial |
$781.20
|
| Rate for Payer: Coventry All Commercial |
$739.20
|
| Rate for Payer: Encore All Commercial |
$773.22
|
| Rate for Payer: Frontpath All Commercial |
$772.80
|
| Rate for Payer: Humana ChoiceCare |
$725.51
|
| Rate for Payer: Humana Medicare |
$268.80
|
| Rate for Payer: Lucent All Commercial |
$456.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$630.00
|
| Rate for Payer: PHP All Commercial |
$637.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.60
|
| Rate for Payer: Sagamore Health Network All Products |
$648.48
|
| Rate for Payer: Signature Care EPO |
$697.20
|
| Rate for Payer: Signature Care PPO |
$739.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$714.00
|
| Rate for Payer: United Healthcare Commercial |
$661.92
|
| Rate for Payer: United Healthcare Medicare |
$268.80
|
|
|
HC ROTH NET PLATINUM
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
41601221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
|
|
HC ROTH NET PLATINUM
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
41601221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Aetna Commercial |
$590.80
|
| Rate for Payer: Aetna Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$402.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.40
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Centivo All Commercial |
$380.80
|
| Rate for Payer: Cigna All Commercial |
$604.10
|
| Rate for Payer: CORVEL All Commercial |
$651.00
|
| Rate for Payer: Coventry All Commercial |
$616.00
|
| Rate for Payer: Encore All Commercial |
$644.35
|
| Rate for Payer: Frontpath All Commercial |
$644.00
|
| Rate for Payer: Humana ChoiceCare |
$604.59
|
| Rate for Payer: Humana Medicare |
$224.00
|
| Rate for Payer: Lucent All Commercial |
$380.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$630.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$530.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.00
|
| Rate for Payer: Sagamore Health Network All Products |
$540.40
|
| Rate for Payer: Signature Care EPO |
$581.00
|
| Rate for Payer: Signature Care PPO |
$616.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$595.00
|
| Rate for Payer: United Healthcare Commercial |
$551.60
|
| Rate for Payer: United Healthcare Medicare |
$224.00
|
|
|
HC ROTH NET POLYP RET
|
Facility
|
OP
|
$623.00
|
|
| Hospital Charge Code |
41601984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$579.39 |
| Rate for Payer: Aetna Commercial |
$525.81
|
| Rate for Payer: Aetna Medicare |
$199.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$357.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$389.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.30
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Centivo All Commercial |
$338.91
|
| Rate for Payer: Cigna All Commercial |
$537.65
|
| Rate for Payer: CORVEL All Commercial |
$579.39
|
| Rate for Payer: Coventry All Commercial |
$548.24
|
| Rate for Payer: Encore All Commercial |
$573.47
|
| Rate for Payer: Frontpath All Commercial |
$573.16
|
| Rate for Payer: Humana ChoiceCare |
$538.09
|
| Rate for Payer: Humana Medicare |
$199.36
|
| Rate for Payer: Lucent All Commercial |
$338.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$467.25
|
| Rate for Payer: PHP All Commercial |
$472.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.97
|
| Rate for Payer: Sagamore Health Network All Products |
$480.96
|
| Rate for Payer: Signature Care EPO |
$517.09
|
| Rate for Payer: Signature Care PPO |
$548.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$529.55
|
| Rate for Payer: United Healthcare Commercial |
$490.92
|
| Rate for Payer: United Healthcare Medicare |
$199.36
|
|
|
HC ROTH NET POLYP RET
|
Facility
|
IP
|
$623.00
|
|
| Hospital Charge Code |
41601984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.25 |
| Max. Negotiated Rate |
$579.39 |
| Rate for Payer: Aetna Commercial |
$538.27
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cigna All Commercial |
$537.65
|
| Rate for Payer: CORVEL All Commercial |
$579.39
|
| Rate for Payer: Coventry All Commercial |
$548.24
|
| Rate for Payer: Encore All Commercial |
$573.47
|
| Rate for Payer: Frontpath All Commercial |
$573.16
|
| Rate for Payer: Humana ChoiceCare |
$538.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$560.70
|
| Rate for Payer: PHCS All Commercial |
$467.25
|
| Rate for Payer: PHP All Commercial |
$472.48
|
| Rate for Payer: Sagamore Health Network All Products |
$480.96
|
| Rate for Payer: Signature Care EPO |
$517.09
|
| Rate for Payer: Signature Care PPO |
$548.24
|
| Rate for Payer: United Healthcare Commercial |
$490.92
|
|
|
HC ROUTINE FOLLOW UP
|
Facility
|
OP
|
$112.46
|
|
|
Service Code
|
CPT 99211 25
|
| Hospital Charge Code |
410102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.59
|
| Rate for Payer: Cash Price |
$67.48
|
| Rate for Payer: Cash Price |
$67.48
|
| Rate for Payer: Centivo All Commercial |
$61.18
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.59
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.52
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Humana Medicare |
$35.99
|
| Rate for Payer: Lucent All Commercial |
$61.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.86
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.59
|
| Rate for Payer: United Healthcare Commercial |
$88.62
|
| Rate for Payer: United Healthcare Medicare |
$35.99
|
|
|
HC ROUTINE FOLLOW UP
|
Facility
|
IP
|
$112.46
|
|
|
Service Code
|
CPT 99211 25
|
| Hospital Charge Code |
410102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.34 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$97.17
|
| Rate for Payer: Cash Price |
$67.48
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.59
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.52
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: United Healthcare Commercial |
$88.62
|
|
|
HC ROUTINE FOLLOW UP
|
Facility
|
OP
|
$112.46
|
|
|
Service Code
|
CPT G0463 25
|
| Hospital Charge Code |
410102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.59
|
| Rate for Payer: Cash Price |
$67.48
|
| Rate for Payer: Cash Price |
$67.48
|
| Rate for Payer: Centivo All Commercial |
$61.18
|
| Rate for Payer: Cigna All Commercial |
$97.05
|
| Rate for Payer: CORVEL All Commercial |
$104.59
|
| Rate for Payer: Coventry All Commercial |
$98.96
|
| Rate for Payer: Encore All Commercial |
$103.52
|
| Rate for Payer: Frontpath All Commercial |
$103.46
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Humana Medicare |
$35.99
|
| Rate for Payer: Lucent All Commercial |
$61.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.21
|
| Rate for Payer: Managed Health Services Medicaid |
$40.80
|
| Rate for Payer: MDWise Medicaid |
$40.80
|
| Rate for Payer: PHCS All Commercial |
$84.34
|
| Rate for Payer: PHP All Commercial |
$85.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.86
|
| Rate for Payer: Sagamore Health Network All Products |
$86.82
|
| Rate for Payer: Signature Care EPO |
$93.34
|
| Rate for Payer: Signature Care PPO |
$98.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.59
|
| Rate for Payer: United Healthcare Commercial |
$88.62
|
| Rate for Payer: United Healthcare Medicare |
$35.99
|
|
|
HC RP LOCLZJ TUM WHBDY 1 D IMG
|
Facility
|
IP
|
$3,547.05
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
1638802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,660.29 |
| Max. Negotiated Rate |
$3,298.76 |
| Rate for Payer: Aetna Commercial |
$3,064.65
|
| Rate for Payer: Cash Price |
$2,128.23
|
| Rate for Payer: Cigna All Commercial |
$3,061.10
|
| Rate for Payer: CORVEL All Commercial |
$3,298.76
|
| Rate for Payer: Coventry All Commercial |
$3,121.40
|
| Rate for Payer: Encore All Commercial |
$3,265.06
|
| Rate for Payer: Frontpath All Commercial |
$3,263.29
|
| Rate for Payer: Humana ChoiceCare |
$3,063.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,192.34
|
| Rate for Payer: PHCS All Commercial |
$2,660.29
|
| Rate for Payer: PHP All Commercial |
$2,690.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2,738.32
|
| Rate for Payer: Signature Care EPO |
$2,944.05
|
| Rate for Payer: Signature Care PPO |
$3,121.40
|
| Rate for Payer: United Healthcare Commercial |
$2,795.08
|
|
|
HC RP LOCLZJ TUM WHBDY 1 D IMG
|
Facility
|
OP
|
$3,547.05
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
1638802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.92 |
| Max. Negotiated Rate |
$3,298.76 |
| Rate for Payer: Aetna Commercial |
$2,993.71
|
| Rate for Payer: Aetna Medicare |
$1,135.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$197.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,099.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,037.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,217.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$197.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,305.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,248.56
|
| Rate for Payer: Cash Price |
$2,128.23
|
| Rate for Payer: Cash Price |
$2,128.23
|
| Rate for Payer: Centivo All Commercial |
$1,929.60
|
| Rate for Payer: Cigna All Commercial |
$3,061.10
|
| Rate for Payer: CORVEL All Commercial |
$3,298.76
|
| Rate for Payer: Coventry All Commercial |
$3,121.40
|
| Rate for Payer: Encore All Commercial |
$3,265.06
|
| Rate for Payer: Frontpath All Commercial |
$3,263.29
|
| Rate for Payer: Humana ChoiceCare |
$3,063.59
|
| Rate for Payer: Humana Medicare |
$1,135.06
|
| Rate for Payer: Lucent All Commercial |
$1,929.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,192.34
|
| Rate for Payer: Managed Health Services Medicaid |
$197.92
|
| Rate for Payer: MDWise Medicaid |
$197.92
|
| Rate for Payer: PHCS All Commercial |
$2,660.29
|
| Rate for Payer: PHP All Commercial |
$2,690.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,383.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,738.32
|
| Rate for Payer: Signature Care EPO |
$2,944.05
|
| Rate for Payer: Signature Care PPO |
$3,121.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,014.99
|
| Rate for Payer: United Healthcare Commercial |
$2,795.08
|
| Rate for Payer: United Healthcare Medicare |
$1,135.06
|
|
|
HC RPR SCREEN WTITER
|
Facility
|
OP
|
$53.88
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
63001211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Aetna Commercial |
$45.47
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.97
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Centivo All Commercial |
$29.31
|
| Rate for Payer: Cigna All Commercial |
$46.50
|
| Rate for Payer: CORVEL All Commercial |
$50.11
|
| Rate for Payer: Coventry All Commercial |
$47.41
|
| Rate for Payer: Encore All Commercial |
$49.60
|
| Rate for Payer: Frontpath All Commercial |
$49.57
|
| Rate for Payer: Humana ChoiceCare |
$46.54
|
| Rate for Payer: Humana Medicare |
$17.24
|
| Rate for Payer: Lucent All Commercial |
$29.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.49
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: MDWise Medicaid |
$4.27
|
| Rate for Payer: PHCS All Commercial |
$40.41
|
| Rate for Payer: PHP All Commercial |
$40.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.01
|
| Rate for Payer: Sagamore Health Network All Products |
$41.60
|
| Rate for Payer: Signature Care EPO |
$44.72
|
| Rate for Payer: Signature Care PPO |
$47.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.80
|
| Rate for Payer: United Healthcare Commercial |
$42.46
|
| Rate for Payer: United Healthcare Medicare |
$17.24
|
|
|
HC RPR SCREEN WTITER
|
Facility
|
IP
|
$53.88
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
63001211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cigna All Commercial |
$46.50
|
| Rate for Payer: CORVEL All Commercial |
$50.11
|
| Rate for Payer: Coventry All Commercial |
$47.41
|
| Rate for Payer: Encore All Commercial |
$49.60
|
| Rate for Payer: Frontpath All Commercial |
$49.57
|
| Rate for Payer: Humana ChoiceCare |
$46.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.49
|
| Rate for Payer: PHCS All Commercial |
$40.41
|
| Rate for Payer: PHP All Commercial |
$40.86
|
| Rate for Payer: Sagamore Health Network All Products |
$41.60
|
| Rate for Payer: Signature Care EPO |
$44.72
|
| Rate for Payer: Signature Care PPO |
$47.41
|
| Rate for Payer: United Healthcare Commercial |
$42.46
|
|
