|
HC URIC ACID SERUM
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
63001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.21
|
| Rate for Payer: Coventry All Commercial |
$50.35
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.91
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.17
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.35
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC URIC ACID SERUM
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
63001104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$53.21 |
| Rate for Payer: Aetna Commercial |
$48.29
|
| Rate for Payer: Aetna Medicare |
$18.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.14
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Centivo All Commercial |
$31.13
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.21
|
| Rate for Payer: Coventry All Commercial |
$50.35
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$18.31
|
| Rate for Payer: Lucent All Commercial |
$31.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$4.52
|
| Rate for Payer: MDWise Medicaid |
$4.52
|
| Rate for Payer: PHCS All Commercial |
$42.91
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.17
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.31
|
|
|
HC URIC UR
|
Facility
|
IP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna Commercial |
$78.52
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Cigna All Commercial |
$78.43
|
| Rate for Payer: CORVEL All Commercial |
$84.52
|
| Rate for Payer: Coventry All Commercial |
$79.97
|
| Rate for Payer: Encore All Commercial |
$83.66
|
| Rate for Payer: Frontpath All Commercial |
$83.61
|
| Rate for Payer: Humana ChoiceCare |
$78.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.79
|
| Rate for Payer: PHCS All Commercial |
$68.16
|
| Rate for Payer: PHP All Commercial |
$68.92
|
| Rate for Payer: Sagamore Health Network All Products |
$70.16
|
| Rate for Payer: Signature Care EPO |
$75.43
|
| Rate for Payer: Signature Care PPO |
$79.97
|
| Rate for Payer: United Healthcare Commercial |
$71.61
|
|
|
HC URIC UR
|
Facility
|
OP
|
$90.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
63001176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna Medicare |
$29.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.99
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Centivo All Commercial |
$49.44
|
| Rate for Payer: Cigna All Commercial |
$78.43
|
| Rate for Payer: CORVEL All Commercial |
$84.52
|
| Rate for Payer: Coventry All Commercial |
$79.97
|
| Rate for Payer: Encore All Commercial |
$83.66
|
| Rate for Payer: Frontpath All Commercial |
$83.61
|
| Rate for Payer: Humana ChoiceCare |
$78.49
|
| Rate for Payer: Humana Medicare |
$29.08
|
| Rate for Payer: Lucent All Commercial |
$49.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.79
|
| Rate for Payer: Managed Health Services Medicaid |
$5.08
|
| Rate for Payer: MDWise Medicaid |
$5.08
|
| Rate for Payer: PHCS All Commercial |
$68.16
|
| Rate for Payer: PHP All Commercial |
$68.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.44
|
| Rate for Payer: Sagamore Health Network All Products |
$70.16
|
| Rate for Payer: Signature Care EPO |
$75.43
|
| Rate for Payer: Signature Care PPO |
$79.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$71.61
|
| Rate for Payer: United Healthcare Medicare |
$29.08
|
|
|
HC URINE MEASURE 24 HR
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
63001054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$17.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.75
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Centivo All Commercial |
$30.52
|
| Rate for Payer: Cigna All Commercial |
$48.41
|
| Rate for Payer: CORVEL All Commercial |
$52.17
|
| Rate for Payer: Coventry All Commercial |
$49.37
|
| Rate for Payer: Encore All Commercial |
$51.64
|
| Rate for Payer: Frontpath All Commercial |
$51.61
|
| Rate for Payer: Humana ChoiceCare |
$48.45
|
| Rate for Payer: Humana Medicare |
$17.95
|
| Rate for Payer: Lucent All Commercial |
$30.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.49
|
| Rate for Payer: Managed Health Services Medicaid |
$3.64
|
| Rate for Payer: MDWise Medicaid |
$3.64
|
| Rate for Payer: PHCS All Commercial |
$42.08
|
| Rate for Payer: PHP All Commercial |
$42.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.88
|
| Rate for Payer: Sagamore Health Network All Products |
$43.31
|
| Rate for Payer: Signature Care EPO |
$46.56
|
| Rate for Payer: Signature Care PPO |
$49.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.69
|
| Rate for Payer: United Healthcare Commercial |
$44.21
|
| Rate for Payer: United Healthcare Medicare |
$17.95
|
|
|
HC URINE MEASURE 24 HR
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
63001054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cigna All Commercial |
$48.41
|
| Rate for Payer: CORVEL All Commercial |
$52.17
|
| Rate for Payer: Coventry All Commercial |
$49.37
|
| Rate for Payer: Encore All Commercial |
$51.64
|
| Rate for Payer: Frontpath All Commercial |
$51.61
|
| Rate for Payer: Humana ChoiceCare |
$48.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.49
|
| Rate for Payer: PHCS All Commercial |
$42.08
|
| Rate for Payer: PHP All Commercial |
$42.55
|
| Rate for Payer: Sagamore Health Network All Products |
$43.31
|
| Rate for Payer: Signature Care EPO |
$46.56
|
| Rate for Payer: Signature Care PPO |
$49.37
|
| Rate for Payer: United Healthcare Commercial |
$44.21
|
|
|
HC URINE MICROSCOPIC
|
Facility
|
IP
|
$71.81
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
63001293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$62.04
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.07
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: United Healthcare Commercial |
$56.59
|
|
|
HC URINE MICROSCOPIC
|
Facility
|
OP
|
$71.81
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
63001293
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Aetna Commercial |
$60.61
|
| Rate for Payer: Aetna Medicare |
$22.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.28
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Centivo All Commercial |
$39.06
|
| Rate for Payer: Cigna All Commercial |
$61.97
|
| Rate for Payer: CORVEL All Commercial |
$66.78
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Encore All Commercial |
$66.10
|
| Rate for Payer: Frontpath All Commercial |
$66.07
|
| Rate for Payer: Humana ChoiceCare |
$62.02
|
| Rate for Payer: Humana Medicare |
$22.98
|
| Rate for Payer: Lucent All Commercial |
$39.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.63
|
| Rate for Payer: Managed Health Services Medicaid |
$3.17
|
| Rate for Payer: MDWise Medicaid |
$3.17
|
| Rate for Payer: PHCS All Commercial |
$53.86
|
| Rate for Payer: PHP All Commercial |
$54.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.01
|
| Rate for Payer: Sagamore Health Network All Products |
$55.44
|
| Rate for Payer: Signature Care EPO |
$59.60
|
| Rate for Payer: Signature Care PPO |
$63.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.04
|
| Rate for Payer: United Healthcare Commercial |
$56.59
|
| Rate for Payer: United Healthcare Medicare |
$22.98
|
|
|
HC URINE PREGNANCY POC
|
Facility
|
OP
|
$125.38
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1422000
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$116.60 |
| Rate for Payer: Aetna Commercial |
$105.82
|
| Rate for Payer: Aetna Medicare |
$40.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$57.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.13
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Centivo All Commercial |
$68.21
|
| Rate for Payer: Cigna All Commercial |
$108.20
|
| Rate for Payer: CORVEL All Commercial |
$116.60
|
| Rate for Payer: Coventry All Commercial |
$110.33
|
| Rate for Payer: Encore All Commercial |
$115.41
|
| Rate for Payer: Frontpath All Commercial |
$115.35
|
| Rate for Payer: Humana ChoiceCare |
$108.29
|
| Rate for Payer: Humana Medicare |
$40.12
|
| Rate for Payer: Lucent All Commercial |
$68.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.84
|
| Rate for Payer: Managed Health Services Medicaid |
$8.61
|
| Rate for Payer: MDWise Medicaid |
$8.61
|
| Rate for Payer: PHCS All Commercial |
$94.03
|
| Rate for Payer: PHP All Commercial |
$95.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.90
|
| Rate for Payer: Sagamore Health Network All Products |
$96.79
|
| Rate for Payer: Signature Care EPO |
$104.07
|
| Rate for Payer: Signature Care PPO |
$110.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.57
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
| Rate for Payer: United Healthcare Medicare |
$40.12
|
|
|
HC URINE PREGNANCY POC
|
Facility
|
IP
|
$125.38
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1422000
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$116.60 |
| Rate for Payer: Aetna Commercial |
$108.33
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cigna All Commercial |
$108.20
|
| Rate for Payer: CORVEL All Commercial |
$116.60
|
| Rate for Payer: Coventry All Commercial |
$110.33
|
| Rate for Payer: Encore All Commercial |
$115.41
|
| Rate for Payer: Frontpath All Commercial |
$115.35
|
| Rate for Payer: Humana ChoiceCare |
$108.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.84
|
| Rate for Payer: PHCS All Commercial |
$94.03
|
| Rate for Payer: PHP All Commercial |
$95.09
|
| Rate for Payer: Sagamore Health Network All Products |
$96.79
|
| Rate for Payer: Signature Care EPO |
$104.07
|
| Rate for Payer: Signature Care PPO |
$110.33
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
63003030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$93.98 |
| Rate for Payer: Aetna Commercial |
$85.29
|
| Rate for Payer: Aetna Medicare |
$32.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.57
|
| Rate for Payer: Cash Price |
$60.63
|
| Rate for Payer: Cash Price |
$60.63
|
| Rate for Payer: Centivo All Commercial |
$54.97
|
| Rate for Payer: Cigna All Commercial |
$87.21
|
| Rate for Payer: CORVEL All Commercial |
$93.98
|
| Rate for Payer: Coventry All Commercial |
$88.92
|
| Rate for Payer: Encore All Commercial |
$93.02
|
| Rate for Payer: Frontpath All Commercial |
$92.97
|
| Rate for Payer: Humana ChoiceCare |
$87.28
|
| Rate for Payer: Humana Medicare |
$32.34
|
| Rate for Payer: Lucent All Commercial |
$54.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.94
|
| Rate for Payer: Managed Health Services Medicaid |
$8.61
|
| Rate for Payer: MDWise Medicaid |
$8.61
|
| Rate for Payer: PHCS All Commercial |
$75.79
|
| Rate for Payer: PHP All Commercial |
$76.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.41
|
| Rate for Payer: Sagamore Health Network All Products |
$78.01
|
| Rate for Payer: Signature Care EPO |
$83.87
|
| Rate for Payer: Signature Care PPO |
$88.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.89
|
| Rate for Payer: United Healthcare Commercial |
$79.63
|
| Rate for Payer: United Healthcare Medicare |
$32.34
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
63003030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$93.98 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: Cash Price |
$60.63
|
| Rate for Payer: Cigna All Commercial |
$87.21
|
| Rate for Payer: CORVEL All Commercial |
$93.98
|
| Rate for Payer: Coventry All Commercial |
$88.92
|
| Rate for Payer: Encore All Commercial |
$93.02
|
| Rate for Payer: Frontpath All Commercial |
$92.97
|
| Rate for Payer: Humana ChoiceCare |
$87.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.94
|
| Rate for Payer: PHCS All Commercial |
$75.79
|
| Rate for Payer: PHP All Commercial |
$76.64
|
| Rate for Payer: Sagamore Health Network All Products |
$78.01
|
| Rate for Payer: Signature Care EPO |
$83.87
|
| Rate for Payer: Signature Care PPO |
$88.92
|
| Rate for Payer: United Healthcare Commercial |
$79.63
|
|
|
HC URINE REAG STRIP
|
Facility
|
OP
|
$56.98
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
63001294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Aetna Commercial |
$48.09
|
| Rate for Payer: Aetna Medicare |
$18.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$26.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.06
|
| Rate for Payer: Cash Price |
$34.19
|
| Rate for Payer: Cash Price |
$34.19
|
| Rate for Payer: Centivo All Commercial |
$31.00
|
| Rate for Payer: Cigna All Commercial |
$49.17
|
| Rate for Payer: CORVEL All Commercial |
$52.99
|
| Rate for Payer: Coventry All Commercial |
$50.14
|
| Rate for Payer: Encore All Commercial |
$52.45
|
| Rate for Payer: Frontpath All Commercial |
$52.42
|
| Rate for Payer: Humana ChoiceCare |
$49.21
|
| Rate for Payer: Humana Medicare |
$18.23
|
| Rate for Payer: Lucent All Commercial |
$31.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.28
|
| Rate for Payer: Managed Health Services Medicaid |
$2.25
|
| Rate for Payer: MDWise Medicaid |
$2.25
|
| Rate for Payer: PHCS All Commercial |
$42.73
|
| Rate for Payer: PHP All Commercial |
$43.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.22
|
| Rate for Payer: Sagamore Health Network All Products |
$43.99
|
| Rate for Payer: Signature Care EPO |
$47.29
|
| Rate for Payer: Signature Care PPO |
$50.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.43
|
| Rate for Payer: United Healthcare Commercial |
$44.90
|
| Rate for Payer: United Healthcare Medicare |
$18.23
|
|
|
HC URINE REAG STRIP
|
Facility
|
IP
|
$56.98
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
63001294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Aetna Commercial |
$49.23
|
| Rate for Payer: Cash Price |
$34.19
|
| Rate for Payer: Cigna All Commercial |
$49.17
|
| Rate for Payer: CORVEL All Commercial |
$52.99
|
| Rate for Payer: Coventry All Commercial |
$50.14
|
| Rate for Payer: Encore All Commercial |
$52.45
|
| Rate for Payer: Frontpath All Commercial |
$52.42
|
| Rate for Payer: Humana ChoiceCare |
$49.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.28
|
| Rate for Payer: PHCS All Commercial |
$42.73
|
| Rate for Payer: PHP All Commercial |
$43.21
|
| Rate for Payer: Sagamore Health Network All Products |
$43.99
|
| Rate for Payer: Signature Care EPO |
$47.29
|
| Rate for Payer: Signature Care PPO |
$50.14
|
| Rate for Payer: United Healthcare Commercial |
$44.90
|
|
|
HC URINE TRIC
|
Facility
|
IP
|
$235.41
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
63087591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.56 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna Commercial |
$203.39
|
| Rate for Payer: Cash Price |
$141.25
|
| Rate for Payer: Cigna All Commercial |
$203.16
|
| Rate for Payer: CORVEL All Commercial |
$218.93
|
| Rate for Payer: Coventry All Commercial |
$207.16
|
| Rate for Payer: Encore All Commercial |
$216.69
|
| Rate for Payer: Frontpath All Commercial |
$216.58
|
| Rate for Payer: Humana ChoiceCare |
$203.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.87
|
| Rate for Payer: PHCS All Commercial |
$176.56
|
| Rate for Payer: PHP All Commercial |
$178.53
|
| Rate for Payer: Sagamore Health Network All Products |
$181.74
|
| Rate for Payer: Signature Care EPO |
$195.39
|
| Rate for Payer: Signature Care PPO |
$207.16
|
| Rate for Payer: United Healthcare Commercial |
$185.50
|
|
|
HC URINE TRIC
|
Facility
|
OP
|
$235.41
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
63087591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna Commercial |
$198.69
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$108.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.86
|
| Rate for Payer: Cash Price |
$141.25
|
| Rate for Payer: Cash Price |
$141.25
|
| Rate for Payer: Centivo All Commercial |
$128.06
|
| Rate for Payer: Cigna All Commercial |
$203.16
|
| Rate for Payer: CORVEL All Commercial |
$218.93
|
| Rate for Payer: Coventry All Commercial |
$207.16
|
| Rate for Payer: Encore All Commercial |
$216.69
|
| Rate for Payer: Frontpath All Commercial |
$216.58
|
| Rate for Payer: Humana ChoiceCare |
$203.32
|
| Rate for Payer: Humana Medicare |
$75.33
|
| Rate for Payer: Lucent All Commercial |
$128.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.87
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$176.56
|
| Rate for Payer: PHP All Commercial |
$178.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.81
|
| Rate for Payer: Sagamore Health Network All Products |
$181.74
|
| Rate for Payer: Signature Care EPO |
$195.39
|
| Rate for Payer: Signature Care PPO |
$207.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.10
|
| Rate for Payer: United Healthcare Commercial |
$185.50
|
| Rate for Payer: United Healthcare Medicare |
$75.33
|
|
|
HC UROVYSION FISH
|
Facility
|
IP
|
$981.50
|
|
|
Service Code
|
CPT 88121
|
| Hospital Charge Code |
63002062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$736.12 |
| Max. Negotiated Rate |
$912.79 |
| Rate for Payer: Aetna Commercial |
$848.02
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Cigna All Commercial |
$847.03
|
| Rate for Payer: CORVEL All Commercial |
$912.79
|
| Rate for Payer: Coventry All Commercial |
$863.72
|
| Rate for Payer: Encore All Commercial |
$903.47
|
| Rate for Payer: Frontpath All Commercial |
$902.98
|
| Rate for Payer: Humana ChoiceCare |
$847.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$883.35
|
| Rate for Payer: PHCS All Commercial |
$736.12
|
| Rate for Payer: PHP All Commercial |
$744.37
|
| Rate for Payer: Sagamore Health Network All Products |
$757.72
|
| Rate for Payer: Signature Care EPO |
$814.64
|
| Rate for Payer: Signature Care PPO |
$863.72
|
| Rate for Payer: United Healthcare Commercial |
$773.42
|
|
|
HC UROVYSION FISH
|
Facility
|
OP
|
$981.50
|
|
|
Service Code
|
CPT 88121
|
| Hospital Charge Code |
63002062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$912.79 |
| Rate for Payer: Aetna Commercial |
$828.39
|
| Rate for Payer: Aetna Medicare |
$314.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$304.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$451.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$56.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$361.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$345.49
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Centivo All Commercial |
$533.94
|
| Rate for Payer: Cigna All Commercial |
$847.03
|
| Rate for Payer: CORVEL All Commercial |
$912.79
|
| Rate for Payer: Coventry All Commercial |
$863.72
|
| Rate for Payer: Encore All Commercial |
$903.47
|
| Rate for Payer: Frontpath All Commercial |
$902.98
|
| Rate for Payer: Humana ChoiceCare |
$847.72
|
| Rate for Payer: Humana Medicare |
$314.08
|
| Rate for Payer: Lucent All Commercial |
$533.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$883.35
|
| Rate for Payer: Managed Health Services Medicaid |
$56.42
|
| Rate for Payer: MDWise Medicaid |
$56.42
|
| Rate for Payer: PHCS All Commercial |
$736.12
|
| Rate for Payer: PHP All Commercial |
$744.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$382.79
|
| Rate for Payer: Sagamore Health Network All Products |
$757.72
|
| Rate for Payer: Signature Care EPO |
$814.64
|
| Rate for Payer: Signature Care PPO |
$863.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$834.27
|
| Rate for Payer: United Healthcare Commercial |
$773.42
|
| Rate for Payer: United Healthcare Medicare |
$314.08
|
|
|
HC U/S AAA SCREEN
|
Facility
|
IP
|
$652.90
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
1640389
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$489.68 |
| Max. Negotiated Rate |
$607.20 |
| Rate for Payer: Aetna Commercial |
$564.11
|
| Rate for Payer: Cash Price |
$391.74
|
| Rate for Payer: Cigna All Commercial |
$563.45
|
| Rate for Payer: CORVEL All Commercial |
$607.20
|
| Rate for Payer: Coventry All Commercial |
$574.55
|
| Rate for Payer: Encore All Commercial |
$600.99
|
| Rate for Payer: Frontpath All Commercial |
$600.67
|
| Rate for Payer: Humana ChoiceCare |
$563.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$587.61
|
| Rate for Payer: PHCS All Commercial |
$489.68
|
| Rate for Payer: PHP All Commercial |
$495.16
|
| Rate for Payer: Sagamore Health Network All Products |
$504.04
|
| Rate for Payer: Signature Care EPO |
$541.91
|
| Rate for Payer: Signature Care PPO |
$574.55
|
| Rate for Payer: United Healthcare Commercial |
$514.49
|
|
|
HC U/S AAA SCREEN
|
Facility
|
OP
|
$652.90
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
1640389
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.73 |
| Max. Negotiated Rate |
$607.20 |
| Rate for Payer: Aetna Commercial |
$551.05
|
| Rate for Payer: Aetna Medicare |
$208.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$374.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$408.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$112.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$240.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$229.82
|
| Rate for Payer: Cash Price |
$391.74
|
| Rate for Payer: Cash Price |
$391.74
|
| Rate for Payer: Centivo All Commercial |
$355.18
|
| Rate for Payer: Cigna All Commercial |
$563.45
|
| Rate for Payer: CORVEL All Commercial |
$607.20
|
| Rate for Payer: Coventry All Commercial |
$574.55
|
| Rate for Payer: Encore All Commercial |
$600.99
|
| Rate for Payer: Frontpath All Commercial |
$600.67
|
| Rate for Payer: Humana ChoiceCare |
$563.91
|
| Rate for Payer: Humana Medicare |
$208.93
|
| Rate for Payer: Lucent All Commercial |
$355.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$587.61
|
| Rate for Payer: Managed Health Services Medicaid |
$112.73
|
| Rate for Payer: MDWise Medicaid |
$112.73
|
| Rate for Payer: PHCS All Commercial |
$489.68
|
| Rate for Payer: PHP All Commercial |
$495.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$254.63
|
| Rate for Payer: Sagamore Health Network All Products |
$504.04
|
| Rate for Payer: Signature Care EPO |
$541.91
|
| Rate for Payer: Signature Care PPO |
$574.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$554.97
|
| Rate for Payer: United Healthcare Commercial |
$514.49
|
| Rate for Payer: United Healthcare Medicare |
$208.93
|
|
|
HC U/S ABDOMEN COMPLETE
|
Facility
|
OP
|
$1,292.16
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1646700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$1,201.71 |
| Rate for Payer: Aetna Commercial |
$1,090.58
|
| Rate for Payer: Aetna Medicare |
$413.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$70.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$400.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$742.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$807.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$70.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$475.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$454.84
|
| Rate for Payer: Cash Price |
$775.30
|
| Rate for Payer: Cash Price |
$775.30
|
| Rate for Payer: Centivo All Commercial |
$702.94
|
| Rate for Payer: Cigna All Commercial |
$1,115.13
|
| Rate for Payer: CORVEL All Commercial |
$1,201.71
|
| Rate for Payer: Coventry All Commercial |
$1,137.10
|
| Rate for Payer: Encore All Commercial |
$1,189.43
|
| Rate for Payer: Frontpath All Commercial |
$1,188.79
|
| Rate for Payer: Humana ChoiceCare |
$1,116.04
|
| Rate for Payer: Humana Medicare |
$413.49
|
| Rate for Payer: Lucent All Commercial |
$702.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,162.94
|
| Rate for Payer: Managed Health Services Medicaid |
$70.27
|
| Rate for Payer: MDWise Medicaid |
$70.27
|
| Rate for Payer: PHCS All Commercial |
$969.12
|
| Rate for Payer: PHP All Commercial |
$979.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$503.94
|
| Rate for Payer: Sagamore Health Network All Products |
$997.55
|
| Rate for Payer: Signature Care EPO |
$1,072.49
|
| Rate for Payer: Signature Care PPO |
$1,137.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,098.34
|
| Rate for Payer: United Healthcare Commercial |
$1,018.22
|
| Rate for Payer: United Healthcare Medicare |
$413.49
|
|
|
HC U/S ABDOMEN COMPLETE
|
Facility
|
IP
|
$1,292.16
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
1646700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$969.12 |
| Max. Negotiated Rate |
$1,201.71 |
| Rate for Payer: Aetna Commercial |
$1,116.43
|
| Rate for Payer: Cash Price |
$775.30
|
| Rate for Payer: Cigna All Commercial |
$1,115.13
|
| Rate for Payer: CORVEL All Commercial |
$1,201.71
|
| Rate for Payer: Coventry All Commercial |
$1,137.10
|
| Rate for Payer: Encore All Commercial |
$1,189.43
|
| Rate for Payer: Frontpath All Commercial |
$1,188.79
|
| Rate for Payer: Humana ChoiceCare |
$1,116.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,162.94
|
| Rate for Payer: PHCS All Commercial |
$969.12
|
| Rate for Payer: PHP All Commercial |
$979.97
|
| Rate for Payer: Sagamore Health Network All Products |
$997.55
|
| Rate for Payer: Signature Care EPO |
$1,072.49
|
| Rate for Payer: Signature Care PPO |
$1,137.10
|
| Rate for Payer: United Healthcare Commercial |
$1,018.22
|
|
|
HC U/S ABDOMEN LIMITED
|
Facility
|
IP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
1646705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$960.03 |
| Max. Negotiated Rate |
$1,190.44 |
| Rate for Payer: Aetna Commercial |
$1,105.95
|
| Rate for Payer: Cash Price |
$768.02
|
| Rate for Payer: Cigna All Commercial |
$1,104.67
|
| Rate for Payer: CORVEL All Commercial |
$1,190.44
|
| Rate for Payer: Coventry All Commercial |
$1,126.44
|
| Rate for Payer: Encore All Commercial |
$1,178.28
|
| Rate for Payer: Frontpath All Commercial |
$1,177.64
|
| Rate for Payer: Humana ChoiceCare |
$1,105.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.04
|
| Rate for Payer: PHCS All Commercial |
$960.03
|
| Rate for Payer: PHP All Commercial |
$970.78
|
| Rate for Payer: Sagamore Health Network All Products |
$988.19
|
| Rate for Payer: Signature Care EPO |
$1,062.43
|
| Rate for Payer: Signature Care PPO |
$1,126.44
|
| Rate for Payer: United Healthcare Commercial |
$1,008.67
|
|
|
HC U/S ABDOMEN LIMITED
|
Facility
|
OP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
1646705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.41 |
| Max. Negotiated Rate |
$1,190.44 |
| Rate for Payer: Aetna Commercial |
$1,080.35
|
| Rate for Payer: Aetna Medicare |
$409.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$55.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$396.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$735.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$800.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$471.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$450.57
|
| Rate for Payer: Cash Price |
$768.02
|
| Rate for Payer: Cash Price |
$768.02
|
| Rate for Payer: Centivo All Commercial |
$696.34
|
| Rate for Payer: Cigna All Commercial |
$1,104.67
|
| Rate for Payer: CORVEL All Commercial |
$1,190.44
|
| Rate for Payer: Coventry All Commercial |
$1,126.44
|
| Rate for Payer: Encore All Commercial |
$1,178.28
|
| Rate for Payer: Frontpath All Commercial |
$1,177.64
|
| Rate for Payer: Humana ChoiceCare |
$1,105.57
|
| Rate for Payer: Humana Medicare |
$409.61
|
| Rate for Payer: Lucent All Commercial |
$696.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,152.04
|
| Rate for Payer: Managed Health Services Medicaid |
$55.41
|
| Rate for Payer: MDWise Medicaid |
$55.41
|
| Rate for Payer: PHCS All Commercial |
$960.03
|
| Rate for Payer: PHP All Commercial |
$970.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.22
|
| Rate for Payer: Sagamore Health Network All Products |
$988.19
|
| Rate for Payer: Signature Care EPO |
$1,062.43
|
| Rate for Payer: Signature Care PPO |
$1,126.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,088.03
|
| Rate for Payer: United Healthcare Commercial |
$1,008.67
|
| Rate for Payer: United Healthcare Medicare |
$409.61
|
|
|
HC U/S ABDOMINAL DOPPLER LIMITED
|
Facility
|
OP
|
$1,337.02
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
1643976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$1,243.43 |
| Rate for Payer: Aetna Commercial |
$1,128.44
|
| Rate for Payer: Aetna Medicare |
$427.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$767.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$835.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$492.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$470.63
|
| Rate for Payer: Cash Price |
$802.21
|
| Rate for Payer: Cash Price |
$802.21
|
| Rate for Payer: Centivo All Commercial |
$727.34
|
| Rate for Payer: Cigna All Commercial |
$1,153.85
|
| Rate for Payer: CORVEL All Commercial |
$1,243.43
|
| Rate for Payer: Coventry All Commercial |
$1,176.58
|
| Rate for Payer: Encore All Commercial |
$1,230.73
|
| Rate for Payer: Frontpath All Commercial |
$1,230.06
|
| Rate for Payer: Humana ChoiceCare |
$1,154.78
|
| Rate for Payer: Humana Medicare |
$427.85
|
| Rate for Payer: Lucent All Commercial |
$727.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,203.32
|
| Rate for Payer: Managed Health Services Medicaid |
$97.43
|
| Rate for Payer: MDWise Medicaid |
$97.43
|
| Rate for Payer: PHCS All Commercial |
$1,002.76
|
| Rate for Payer: PHP All Commercial |
$1,014.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$521.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,032.18
|
| Rate for Payer: Signature Care EPO |
$1,109.73
|
| Rate for Payer: Signature Care PPO |
$1,176.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,136.47
|
| Rate for Payer: United Healthcare Commercial |
$1,053.57
|
| Rate for Payer: United Healthcare Medicare |
$427.85
|
|
