|
HC THY BINDING GLOB
|
Facility
|
OP
|
$246.84
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
63001690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$229.56 |
| Rate for Payer: Aetna Commercial |
$208.33
|
| Rate for Payer: Aetna Medicare |
$78.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.89
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Centivo All Commercial |
$134.28
|
| Rate for Payer: Cigna All Commercial |
$213.02
|
| Rate for Payer: CORVEL All Commercial |
$229.56
|
| Rate for Payer: Coventry All Commercial |
$217.22
|
| Rate for Payer: Encore All Commercial |
$227.22
|
| Rate for Payer: Frontpath All Commercial |
$227.09
|
| Rate for Payer: Humana ChoiceCare |
$213.20
|
| Rate for Payer: Humana Medicare |
$78.99
|
| Rate for Payer: Lucent All Commercial |
$134.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.16
|
| Rate for Payer: Managed Health Services Medicaid |
$14.78
|
| Rate for Payer: MDWise Medicaid |
$14.78
|
| Rate for Payer: PHCS All Commercial |
$185.13
|
| Rate for Payer: PHP All Commercial |
$187.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.27
|
| Rate for Payer: Sagamore Health Network All Products |
$190.56
|
| Rate for Payer: Signature Care EPO |
$204.88
|
| Rate for Payer: Signature Care PPO |
$217.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.81
|
| Rate for Payer: United Healthcare Commercial |
$194.51
|
| Rate for Payer: United Healthcare Medicare |
$78.99
|
|
|
HC THY PEROX-MICROSOMAL
|
Facility
|
OP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$153.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: Aetna Medicare |
$52.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.07
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Centivo All Commercial |
$89.74
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.42
|
| Rate for Payer: Coventry All Commercial |
$145.17
|
| Rate for Payer: Encore All Commercial |
$151.85
|
| Rate for Payer: Frontpath All Commercial |
$151.77
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Humana Medicare |
$52.79
|
| Rate for Payer: Lucent All Commercial |
$89.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.47
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: MDWise Medicaid |
$14.55
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.34
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
| Rate for Payer: United Healthcare Medicare |
$52.79
|
|
|
HC THY PEROX-MICROSOMAL
|
Facility
|
IP
|
$164.97
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
63001012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$153.42 |
| Rate for Payer: Aetna Commercial |
$142.53
|
| Rate for Payer: Cash Price |
$98.98
|
| Rate for Payer: Cigna All Commercial |
$142.37
|
| Rate for Payer: CORVEL All Commercial |
$153.42
|
| Rate for Payer: Coventry All Commercial |
$145.17
|
| Rate for Payer: Encore All Commercial |
$151.85
|
| Rate for Payer: Frontpath All Commercial |
$151.77
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.47
|
| Rate for Payer: PHCS All Commercial |
$123.73
|
| Rate for Payer: PHP All Commercial |
$125.11
|
| Rate for Payer: Sagamore Health Network All Products |
$127.36
|
| Rate for Payer: Signature Care EPO |
$136.93
|
| Rate for Payer: Signature Care PPO |
$145.17
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$188.50
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
63001021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$175.31 |
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Medicare |
$60.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.35
|
| Rate for Payer: Cash Price |
$113.10
|
| Rate for Payer: Cash Price |
$113.10
|
| Rate for Payer: Centivo All Commercial |
$102.54
|
| Rate for Payer: Cigna All Commercial |
$162.68
|
| Rate for Payer: CORVEL All Commercial |
$175.31
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.81
|
| Rate for Payer: Humana Medicare |
$60.32
|
| Rate for Payer: Lucent All Commercial |
$102.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: Managed Health Services Medicaid |
$16.06
|
| Rate for Payer: MDWise Medicaid |
$16.06
|
| Rate for Payer: PHCS All Commercial |
$141.38
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.52
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.46
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.22
|
| Rate for Payer: United Healthcare Commercial |
$148.54
|
| Rate for Payer: United Healthcare Medicare |
$60.32
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$188.50
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
63001021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.38 |
| Max. Negotiated Rate |
$175.31 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Cash Price |
$113.10
|
| Rate for Payer: Cigna All Commercial |
$162.68
|
| Rate for Payer: CORVEL All Commercial |
$175.31
|
| Rate for Payer: Coventry All Commercial |
$165.88
|
| Rate for Payer: Encore All Commercial |
$173.51
|
| Rate for Payer: Frontpath All Commercial |
$173.42
|
| Rate for Payer: Humana ChoiceCare |
$162.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$169.65
|
| Rate for Payer: PHCS All Commercial |
$141.38
|
| Rate for Payer: PHP All Commercial |
$142.96
|
| Rate for Payer: Sagamore Health Network All Products |
$145.52
|
| Rate for Payer: Signature Care EPO |
$156.46
|
| Rate for Payer: Signature Care PPO |
$165.88
|
| Rate for Payer: United Healthcare Commercial |
$148.54
|
|
|
HC THYROGLOBULIN AB
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
63001011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
|
|
HC THYROGLOBULIN AB
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
63001011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Aetna Commercial |
$142.05
|
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$77.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.24
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Centivo All Commercial |
$91.56
|
| Rate for Payer: Cigna All Commercial |
$145.24
|
| Rate for Payer: CORVEL All Commercial |
$156.52
|
| Rate for Payer: Coventry All Commercial |
$148.10
|
| Rate for Payer: Encore All Commercial |
$154.92
|
| Rate for Payer: Frontpath All Commercial |
$154.84
|
| Rate for Payer: Humana ChoiceCare |
$145.36
|
| Rate for Payer: Humana Medicare |
$53.86
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.47
|
| Rate for Payer: Managed Health Services Medicaid |
$15.91
|
| Rate for Payer: MDWise Medicaid |
$15.91
|
| Rate for Payer: PHCS All Commercial |
$126.22
|
| Rate for Payer: PHP All Commercial |
$127.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.64
|
| Rate for Payer: Sagamore Health Network All Products |
$129.93
|
| Rate for Payer: Signature Care EPO |
$139.69
|
| Rate for Payer: Signature Care PPO |
$148.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$132.62
|
| Rate for Payer: United Healthcare Medicare |
$53.86
|
|
|
HC THYROID STIM IMMUNO
|
Facility
|
OP
|
$427.48
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
63001694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$397.56 |
| Rate for Payer: Aetna Commercial |
$360.79
|
| Rate for Payer: Aetna Medicare |
$136.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$50.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$196.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$50.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.47
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Centivo All Commercial |
$232.55
|
| Rate for Payer: Cigna All Commercial |
$368.92
|
| Rate for Payer: CORVEL All Commercial |
$397.56
|
| Rate for Payer: Coventry All Commercial |
$376.18
|
| Rate for Payer: Encore All Commercial |
$393.50
|
| Rate for Payer: Frontpath All Commercial |
$393.28
|
| Rate for Payer: Humana ChoiceCare |
$369.21
|
| Rate for Payer: Humana Medicare |
$136.79
|
| Rate for Payer: Lucent All Commercial |
$232.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.73
|
| Rate for Payer: Managed Health Services Medicaid |
$50.86
|
| Rate for Payer: MDWise Medicaid |
$50.86
|
| Rate for Payer: PHCS All Commercial |
$320.61
|
| Rate for Payer: PHP All Commercial |
$324.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.72
|
| Rate for Payer: Sagamore Health Network All Products |
$330.01
|
| Rate for Payer: Signature Care EPO |
$354.81
|
| Rate for Payer: Signature Care PPO |
$376.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$363.36
|
| Rate for Payer: United Healthcare Commercial |
$336.85
|
| Rate for Payer: United Healthcare Medicare |
$136.79
|
|
|
HC THYROID STIM IMMUNO
|
Facility
|
IP
|
$427.48
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
63001694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.61 |
| Max. Negotiated Rate |
$397.56 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cigna All Commercial |
$368.92
|
| Rate for Payer: CORVEL All Commercial |
$397.56
|
| Rate for Payer: Coventry All Commercial |
$376.18
|
| Rate for Payer: Encore All Commercial |
$393.50
|
| Rate for Payer: Frontpath All Commercial |
$393.28
|
| Rate for Payer: Humana ChoiceCare |
$369.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.73
|
| Rate for Payer: PHCS All Commercial |
$320.61
|
| Rate for Payer: PHP All Commercial |
$324.20
|
| Rate for Payer: Sagamore Health Network All Products |
$330.01
|
| Rate for Payer: Signature Care EPO |
$354.81
|
| Rate for Payer: Signature Care PPO |
$376.18
|
| Rate for Payer: United Healthcare Commercial |
$336.85
|
|
|
HC THYROID UPTAKE & SCAN W/BLD FL
|
Facility
|
OP
|
$1,690.34
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
1638080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.13 |
| Max. Negotiated Rate |
$1,572.02 |
| Rate for Payer: Aetna Commercial |
$1,426.65
|
| Rate for Payer: Aetna Medicare |
$540.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$148.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$524.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$970.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,056.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$148.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$622.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$595.00
|
| Rate for Payer: Cash Price |
$1,014.20
|
| Rate for Payer: Cash Price |
$1,014.20
|
| Rate for Payer: Centivo All Commercial |
$919.54
|
| Rate for Payer: Cigna All Commercial |
$1,458.76
|
| Rate for Payer: CORVEL All Commercial |
$1,572.02
|
| Rate for Payer: Coventry All Commercial |
$1,487.50
|
| Rate for Payer: Encore All Commercial |
$1,555.96
|
| Rate for Payer: Frontpath All Commercial |
$1,555.11
|
| Rate for Payer: Humana ChoiceCare |
$1,459.95
|
| Rate for Payer: Humana Medicare |
$540.91
|
| Rate for Payer: Lucent All Commercial |
$919.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,521.31
|
| Rate for Payer: Managed Health Services Medicaid |
$148.13
|
| Rate for Payer: MDWise Medicaid |
$148.13
|
| Rate for Payer: PHCS All Commercial |
$1,267.76
|
| Rate for Payer: PHP All Commercial |
$1,281.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$659.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,304.94
|
| Rate for Payer: Signature Care EPO |
$1,402.98
|
| Rate for Payer: Signature Care PPO |
$1,487.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,436.79
|
| Rate for Payer: United Healthcare Commercial |
$1,331.99
|
| Rate for Payer: United Healthcare Medicare |
$540.91
|
|
|
HC THYROID UPTAKE & SCAN W/BLD FL
|
Facility
|
IP
|
$1,690.34
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
1638080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,267.76 |
| Max. Negotiated Rate |
$1,572.02 |
| Rate for Payer: Aetna Commercial |
$1,460.45
|
| Rate for Payer: Cash Price |
$1,014.20
|
| Rate for Payer: Cigna All Commercial |
$1,458.76
|
| Rate for Payer: CORVEL All Commercial |
$1,572.02
|
| Rate for Payer: Coventry All Commercial |
$1,487.50
|
| Rate for Payer: Encore All Commercial |
$1,555.96
|
| Rate for Payer: Frontpath All Commercial |
$1,555.11
|
| Rate for Payer: Humana ChoiceCare |
$1,459.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,521.31
|
| Rate for Payer: PHCS All Commercial |
$1,267.76
|
| Rate for Payer: PHP All Commercial |
$1,281.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,304.94
|
| Rate for Payer: Signature Care EPO |
$1,402.98
|
| Rate for Payer: Signature Care PPO |
$1,487.50
|
| Rate for Payer: United Healthcare Commercial |
$1,331.99
|
|
|
HC TILT TABLE STUDY
|
Facility
|
OP
|
$1,586.96
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
1593660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$1,475.87 |
| Rate for Payer: Aetna Commercial |
$1,339.39
|
| Rate for Payer: Aetna Medicare |
$507.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$166.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$911.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$166.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$584.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$558.61
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Centivo All Commercial |
$863.31
|
| Rate for Payer: Cigna All Commercial |
$1,369.55
|
| Rate for Payer: CORVEL All Commercial |
$1,475.87
|
| Rate for Payer: Coventry All Commercial |
$1,396.52
|
| Rate for Payer: Encore All Commercial |
$1,460.80
|
| Rate for Payer: Frontpath All Commercial |
$1,460.00
|
| Rate for Payer: Humana ChoiceCare |
$1,370.66
|
| Rate for Payer: Humana Medicare |
$507.83
|
| Rate for Payer: Lucent All Commercial |
$863.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,428.26
|
| Rate for Payer: Managed Health Services Medicaid |
$166.32
|
| Rate for Payer: MDWise Medicaid |
$166.32
|
| Rate for Payer: PHCS All Commercial |
$1,190.22
|
| Rate for Payer: PHP All Commercial |
$1,203.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$618.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,225.13
|
| Rate for Payer: Signature Care EPO |
$1,317.18
|
| Rate for Payer: Signature Care PPO |
$1,396.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,348.92
|
| Rate for Payer: United Healthcare Commercial |
$1,250.52
|
| Rate for Payer: United Healthcare Medicare |
$507.83
|
|
|
HC TILT TABLE STUDY
|
Facility
|
IP
|
$1,586.96
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
1593660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,190.22 |
| Max. Negotiated Rate |
$1,475.87 |
| Rate for Payer: Aetna Commercial |
$1,371.13
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cigna All Commercial |
$1,369.55
|
| Rate for Payer: CORVEL All Commercial |
$1,475.87
|
| Rate for Payer: Coventry All Commercial |
$1,396.52
|
| Rate for Payer: Encore All Commercial |
$1,460.80
|
| Rate for Payer: Frontpath All Commercial |
$1,460.00
|
| Rate for Payer: Humana ChoiceCare |
$1,370.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,428.26
|
| Rate for Payer: PHCS All Commercial |
$1,190.22
|
| Rate for Payer: PHP All Commercial |
$1,203.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,225.13
|
| Rate for Payer: Signature Care EPO |
$1,317.18
|
| Rate for Payer: Signature Care PPO |
$1,396.52
|
| Rate for Payer: United Healthcare Commercial |
$1,250.52
|
|
|
HC TISSUE CULT-NON-NEOP
|
Facility
|
IP
|
$324.18
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
63002075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.13 |
| Max. Negotiated Rate |
$301.49 |
| Rate for Payer: Aetna Commercial |
$280.09
|
| Rate for Payer: Cash Price |
$194.51
|
| Rate for Payer: Cigna All Commercial |
$279.77
|
| Rate for Payer: CORVEL All Commercial |
$301.49
|
| Rate for Payer: Coventry All Commercial |
$285.28
|
| Rate for Payer: Encore All Commercial |
$298.41
|
| Rate for Payer: Frontpath All Commercial |
$298.25
|
| Rate for Payer: Humana ChoiceCare |
$279.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.76
|
| Rate for Payer: PHCS All Commercial |
$243.13
|
| Rate for Payer: PHP All Commercial |
$245.86
|
| Rate for Payer: Sagamore Health Network All Products |
$250.27
|
| Rate for Payer: Signature Care EPO |
$269.07
|
| Rate for Payer: Signature Care PPO |
$285.28
|
| Rate for Payer: United Healthcare Commercial |
$255.45
|
|
|
HC TISSUE CULT-NON-NEOP
|
Facility
|
OP
|
$324.18
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
63002075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$301.49 |
| Rate for Payer: Aetna Commercial |
$273.61
|
| Rate for Payer: Aetna Medicare |
$103.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$116.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$100.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$148.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.11
|
| Rate for Payer: Cash Price |
$194.51
|
| Rate for Payer: Cash Price |
$194.51
|
| Rate for Payer: Centivo All Commercial |
$176.35
|
| Rate for Payer: Cigna All Commercial |
$279.77
|
| Rate for Payer: CORVEL All Commercial |
$301.49
|
| Rate for Payer: Coventry All Commercial |
$285.28
|
| Rate for Payer: Encore All Commercial |
$298.41
|
| Rate for Payer: Frontpath All Commercial |
$298.25
|
| Rate for Payer: Humana ChoiceCare |
$279.99
|
| Rate for Payer: Humana Medicare |
$103.74
|
| Rate for Payer: Lucent All Commercial |
$176.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.76
|
| Rate for Payer: Managed Health Services Medicaid |
$116.49
|
| Rate for Payer: MDWise Medicaid |
$116.49
|
| Rate for Payer: PHCS All Commercial |
$243.13
|
| Rate for Payer: PHP All Commercial |
$245.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.43
|
| Rate for Payer: Sagamore Health Network All Products |
$250.27
|
| Rate for Payer: Signature Care EPO |
$269.07
|
| Rate for Payer: Signature Care PPO |
$285.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$275.55
|
| Rate for Payer: United Healthcare Commercial |
$255.45
|
| Rate for Payer: United Healthcare Medicare |
$103.74
|
|
|
HC TISSUE TRANSGLUT IGA
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$41.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$41.88
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.04
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
| Rate for Payer: United Healthcare Medicare |
$41.88
|
|
|
HC TISSUE TRANSGLUT IGA
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
|
|
HC TISSUE TRANSGLUT IGG
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
|
|
HC TISSUE TRANSGLUT IGG
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$41.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Cash Price |
$78.52
|
| Rate for Payer: Centivo All Commercial |
$71.19
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.16
|
| Rate for Payer: Encore All Commercial |
$120.46
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$41.88
|
| Rate for Payer: Lucent All Commercial |
$71.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.04
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.12
|
| Rate for Payer: United Healthcare Medicare |
$41.88
|
|
|
HC TOBRAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
|
OP
|
$107.37
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$99.85 |
| Rate for Payer: Aetna Commercial |
$90.62
|
| Rate for Payer: Aetna Medicare |
$34.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.79
|
| Rate for Payer: Cash Price |
$64.42
|
| Rate for Payer: Cash Price |
$64.42
|
| Rate for Payer: Centivo All Commercial |
$58.41
|
| Rate for Payer: Cigna All Commercial |
$92.66
|
| Rate for Payer: CORVEL All Commercial |
$99.85
|
| Rate for Payer: Coventry All Commercial |
$94.49
|
| Rate for Payer: Encore All Commercial |
$98.83
|
| Rate for Payer: Frontpath All Commercial |
$98.78
|
| Rate for Payer: Humana ChoiceCare |
$92.74
|
| Rate for Payer: Humana Medicare |
$34.36
|
| Rate for Payer: Lucent All Commercial |
$58.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.63
|
| Rate for Payer: Managed Health Services Medicaid |
$16.13
|
| Rate for Payer: MDWise Medicaid |
$16.13
|
| Rate for Payer: PHCS All Commercial |
$80.53
|
| Rate for Payer: PHP All Commercial |
$81.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.87
|
| Rate for Payer: Sagamore Health Network All Products |
$82.89
|
| Rate for Payer: Signature Care EPO |
$89.12
|
| Rate for Payer: Signature Care PPO |
$94.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.26
|
| Rate for Payer: United Healthcare Commercial |
$84.61
|
| Rate for Payer: United Healthcare Medicare |
$34.36
|
|
|
HC TOBRAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
|
IP
|
$107.37
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.53 |
| Max. Negotiated Rate |
$99.85 |
| Rate for Payer: Aetna Commercial |
$92.77
|
| Rate for Payer: Cash Price |
$64.42
|
| Rate for Payer: Cigna All Commercial |
$92.66
|
| Rate for Payer: CORVEL All Commercial |
$99.85
|
| Rate for Payer: Coventry All Commercial |
$94.49
|
| Rate for Payer: Encore All Commercial |
$98.83
|
| Rate for Payer: Frontpath All Commercial |
$98.78
|
| Rate for Payer: Humana ChoiceCare |
$92.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.63
|
| Rate for Payer: PHCS All Commercial |
$80.53
|
| Rate for Payer: PHP All Commercial |
$81.43
|
| Rate for Payer: Sagamore Health Network All Products |
$82.89
|
| Rate for Payer: Signature Care EPO |
$89.12
|
| Rate for Payer: Signature Care PPO |
$94.49
|
| Rate for Payer: United Healthcare Commercial |
$84.61
|
|
|
HC TOPIRAMATE
|
Facility
|
OP
|
$229.45
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
63001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$213.39 |
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: Aetna Medicare |
$73.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.77
|
| Rate for Payer: Cash Price |
$137.67
|
| Rate for Payer: Cash Price |
$137.67
|
| Rate for Payer: Centivo All Commercial |
$124.82
|
| Rate for Payer: Cigna All Commercial |
$198.02
|
| Rate for Payer: CORVEL All Commercial |
$213.39
|
| Rate for Payer: Coventry All Commercial |
$201.92
|
| Rate for Payer: Encore All Commercial |
$211.21
|
| Rate for Payer: Frontpath All Commercial |
$211.09
|
| Rate for Payer: Humana ChoiceCare |
$198.18
|
| Rate for Payer: Humana Medicare |
$73.42
|
| Rate for Payer: Lucent All Commercial |
$124.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.50
|
| Rate for Payer: Managed Health Services Medicaid |
$11.92
|
| Rate for Payer: MDWise Medicaid |
$11.92
|
| Rate for Payer: PHCS All Commercial |
$172.09
|
| Rate for Payer: PHP All Commercial |
$174.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.49
|
| Rate for Payer: Sagamore Health Network All Products |
$177.14
|
| Rate for Payer: Signature Care EPO |
$190.44
|
| Rate for Payer: Signature Care PPO |
$201.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.03
|
| Rate for Payer: United Healthcare Commercial |
$180.81
|
| Rate for Payer: United Healthcare Medicare |
$73.42
|
|
|
HC TOPIRAMATE
|
Facility
|
IP
|
$229.45
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
63001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.09 |
| Max. Negotiated Rate |
$213.39 |
| Rate for Payer: Aetna Commercial |
$198.24
|
| Rate for Payer: Cash Price |
$137.67
|
| Rate for Payer: Cigna All Commercial |
$198.02
|
| Rate for Payer: CORVEL All Commercial |
$213.39
|
| Rate for Payer: Coventry All Commercial |
$201.92
|
| Rate for Payer: Encore All Commercial |
$211.21
|
| Rate for Payer: Frontpath All Commercial |
$211.09
|
| Rate for Payer: Humana ChoiceCare |
$198.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.50
|
| Rate for Payer: PHCS All Commercial |
$172.09
|
| Rate for Payer: PHP All Commercial |
$174.01
|
| Rate for Payer: Sagamore Health Network All Products |
$177.14
|
| Rate for Payer: Signature Care EPO |
$190.44
|
| Rate for Payer: Signature Care PPO |
$201.92
|
| Rate for Payer: United Healthcare Commercial |
$180.81
|
|
|
HC TOTAL COMP
|
Facility
|
IP
|
$245.16
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
63001871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.87 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Cash Price |
$147.10
|
| Rate for Payer: Cigna All Commercial |
$211.57
|
| Rate for Payer: CORVEL All Commercial |
$228.00
|
| Rate for Payer: Coventry All Commercial |
$215.74
|
| Rate for Payer: Encore All Commercial |
$225.67
|
| Rate for Payer: Frontpath All Commercial |
$225.55
|
| Rate for Payer: Humana ChoiceCare |
$211.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.64
|
| Rate for Payer: PHCS All Commercial |
$183.87
|
| Rate for Payer: PHP All Commercial |
$185.93
|
| Rate for Payer: Sagamore Health Network All Products |
$189.26
|
| Rate for Payer: Signature Care EPO |
$203.48
|
| Rate for Payer: Signature Care PPO |
$215.74
|
| Rate for Payer: United Healthcare Commercial |
$193.19
|
|
|
HC TOTAL COMP
|
Facility
|
OP
|
$245.16
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
63001871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$206.92
|
| Rate for Payer: Aetna Medicare |
$78.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.30
|
| Rate for Payer: Cash Price |
$147.10
|
| Rate for Payer: Cash Price |
$147.10
|
| Rate for Payer: Centivo All Commercial |
$133.37
|
| Rate for Payer: Cigna All Commercial |
$211.57
|
| Rate for Payer: CORVEL All Commercial |
$228.00
|
| Rate for Payer: Coventry All Commercial |
$215.74
|
| Rate for Payer: Encore All Commercial |
$225.67
|
| Rate for Payer: Frontpath All Commercial |
$225.55
|
| Rate for Payer: Humana ChoiceCare |
$211.74
|
| Rate for Payer: Humana Medicare |
$78.45
|
| Rate for Payer: Lucent All Commercial |
$133.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.32
|
| Rate for Payer: MDWise Medicaid |
$20.32
|
| Rate for Payer: PHCS All Commercial |
$183.87
|
| Rate for Payer: PHP All Commercial |
$185.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.61
|
| Rate for Payer: Sagamore Health Network All Products |
$189.26
|
| Rate for Payer: Signature Care EPO |
$203.48
|
| Rate for Payer: Signature Care PPO |
$215.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.39
|
| Rate for Payer: United Healthcare Commercial |
$193.19
|
| Rate for Payer: United Healthcare Medicare |
$78.45
|
|
