|
HC U/S GUIDED NEEDLE PLACMNT SUBS
|
Facility
|
OP
|
$1,051.36
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
1697937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$977.76 |
| Rate for Payer: Aetna Commercial |
$887.35
|
| Rate for Payer: Aetna Medicare |
$336.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$27.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$657.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$27.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$370.08
|
| Rate for Payer: Cash Price |
$630.82
|
| Rate for Payer: Cash Price |
$630.82
|
| Rate for Payer: Centivo All Commercial |
$571.94
|
| Rate for Payer: Cigna All Commercial |
$907.32
|
| Rate for Payer: CORVEL All Commercial |
$977.76
|
| Rate for Payer: Coventry All Commercial |
$925.20
|
| Rate for Payer: Encore All Commercial |
$967.78
|
| Rate for Payer: Frontpath All Commercial |
$967.25
|
| Rate for Payer: Humana ChoiceCare |
$908.06
|
| Rate for Payer: Humana Medicare |
$336.44
|
| Rate for Payer: Lucent All Commercial |
$571.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$946.22
|
| Rate for Payer: Managed Health Services Medicaid |
$27.66
|
| Rate for Payer: MDWise Medicaid |
$27.66
|
| Rate for Payer: PHCS All Commercial |
$788.52
|
| Rate for Payer: PHP All Commercial |
$797.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.03
|
| Rate for Payer: Sagamore Health Network All Products |
$811.65
|
| Rate for Payer: Signature Care EPO |
$872.63
|
| Rate for Payer: Signature Care PPO |
$925.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$893.66
|
| Rate for Payer: United Healthcare Commercial |
$828.47
|
| Rate for Payer: United Healthcare Medicare |
$336.44
|
|
|
HC U/S INFANT HIPS
|
Facility
|
IP
|
$364.84
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
1646885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.63 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna Commercial |
$315.22
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cigna All Commercial |
$314.86
|
| Rate for Payer: CORVEL All Commercial |
$339.30
|
| Rate for Payer: Coventry All Commercial |
$321.06
|
| Rate for Payer: Encore All Commercial |
$335.84
|
| Rate for Payer: Frontpath All Commercial |
$335.65
|
| Rate for Payer: Humana ChoiceCare |
$315.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.36
|
| Rate for Payer: PHCS All Commercial |
$273.63
|
| Rate for Payer: PHP All Commercial |
$276.69
|
| Rate for Payer: Sagamore Health Network All Products |
$281.66
|
| Rate for Payer: Signature Care EPO |
$302.82
|
| Rate for Payer: Signature Care PPO |
$321.06
|
| Rate for Payer: United Healthcare Commercial |
$287.49
|
|
|
HC U/S INFANT HIPS
|
Facility
|
OP
|
$364.84
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
1646885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna Commercial |
$307.92
|
| Rate for Payer: Aetna Medicare |
$116.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$77.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$209.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$77.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.42
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Centivo All Commercial |
$198.47
|
| Rate for Payer: Cigna All Commercial |
$314.86
|
| Rate for Payer: CORVEL All Commercial |
$339.30
|
| Rate for Payer: Coventry All Commercial |
$321.06
|
| Rate for Payer: Encore All Commercial |
$335.84
|
| Rate for Payer: Frontpath All Commercial |
$335.65
|
| Rate for Payer: Humana ChoiceCare |
$315.11
|
| Rate for Payer: Humana Medicare |
$116.75
|
| Rate for Payer: Lucent All Commercial |
$198.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$328.36
|
| Rate for Payer: Managed Health Services Medicaid |
$77.95
|
| Rate for Payer: MDWise Medicaid |
$77.95
|
| Rate for Payer: PHCS All Commercial |
$273.63
|
| Rate for Payer: PHP All Commercial |
$276.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.29
|
| Rate for Payer: Sagamore Health Network All Products |
$281.66
|
| Rate for Payer: Signature Care EPO |
$302.82
|
| Rate for Payer: Signature Care PPO |
$321.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$310.11
|
| Rate for Payer: United Healthcare Commercial |
$287.49
|
| Rate for Payer: United Healthcare Medicare |
$116.75
|
|
|
HC U/S MATERNITY < 14 WEEKS INITIAL GESTATION
|
Facility
|
OP
|
$1,025.50
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
1647801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$953.72 |
| Rate for Payer: Aetna Commercial |
$865.52
|
| Rate for Payer: Aetna Medicare |
$328.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$53.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$588.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.98
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Centivo All Commercial |
$557.87
|
| Rate for Payer: Cigna All Commercial |
$885.01
|
| Rate for Payer: CORVEL All Commercial |
$953.72
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Humana Medicare |
$328.16
|
| Rate for Payer: Lucent All Commercial |
$557.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: Managed Health Services Medicaid |
$53.92
|
| Rate for Payer: MDWise Medicaid |
$53.92
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.94
|
| Rate for Payer: Sagamore Health Network All Products |
$791.69
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.67
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
| Rate for Payer: United Healthcare Medicare |
$328.16
|
|
|
HC U/S MATERNITY < 14 WEEKS INITIAL GESTATION
|
Facility
|
IP
|
$1,025.50
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
1647801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$769.12 |
| Max. Negotiated Rate |
$953.72 |
| Rate for Payer: Aetna Commercial |
$886.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna All Commercial |
$885.01
|
| Rate for Payer: CORVEL All Commercial |
$953.72
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Sagamore Health Network All Products |
$791.69
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
|
|
HC U/S MATERNITY > 14 WEEKS INITIAL GESTATION
|
Facility
|
IP
|
$1,025.50
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
1646800
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$769.12 |
| Max. Negotiated Rate |
$953.72 |
| Rate for Payer: Aetna Commercial |
$886.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna All Commercial |
$885.01
|
| Rate for Payer: CORVEL All Commercial |
$953.72
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Sagamore Health Network All Products |
$791.69
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
|
|
HC U/S MATERNITY > 14 WEEKS INITIAL GESTATION
|
Facility
|
OP
|
$1,025.50
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
1646800
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$953.72 |
| Rate for Payer: Aetna Commercial |
$865.52
|
| Rate for Payer: Aetna Medicare |
$328.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$588.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$67.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.98
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Centivo All Commercial |
$557.87
|
| Rate for Payer: Cigna All Commercial |
$885.01
|
| Rate for Payer: CORVEL All Commercial |
$953.72
|
| Rate for Payer: Coventry All Commercial |
$902.44
|
| Rate for Payer: Encore All Commercial |
$943.97
|
| Rate for Payer: Frontpath All Commercial |
$943.46
|
| Rate for Payer: Humana ChoiceCare |
$885.72
|
| Rate for Payer: Humana Medicare |
$328.16
|
| Rate for Payer: Lucent All Commercial |
$557.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.95
|
| Rate for Payer: Managed Health Services Medicaid |
$67.54
|
| Rate for Payer: MDWise Medicaid |
$67.54
|
| Rate for Payer: PHCS All Commercial |
$769.12
|
| Rate for Payer: PHP All Commercial |
$777.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.94
|
| Rate for Payer: Sagamore Health Network All Products |
$791.69
|
| Rate for Payer: Signature Care EPO |
$851.16
|
| Rate for Payer: Signature Care PPO |
$902.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.67
|
| Rate for Payer: United Healthcare Commercial |
$808.09
|
| Rate for Payer: United Healthcare Medicare |
$328.16
|
|
|
HC U/S MATERNITY < 14 WKS EA ADD GESTATION
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
1646802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$745.86 |
| Rate for Payer: Aetna Commercial |
$676.89
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$460.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.30
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Centivo All Commercial |
$436.29
|
| Rate for Payer: Cigna All Commercial |
$692.13
|
| Rate for Payer: CORVEL All Commercial |
$745.86
|
| Rate for Payer: Coventry All Commercial |
$705.76
|
| Rate for Payer: Encore All Commercial |
$738.24
|
| Rate for Payer: Frontpath All Commercial |
$737.84
|
| Rate for Payer: Humana ChoiceCare |
$692.69
|
| Rate for Payer: Humana Medicare |
$256.64
|
| Rate for Payer: Lucent All Commercial |
$436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.80
|
| Rate for Payer: Managed Health Services Medicaid |
$17.75
|
| Rate for Payer: MDWise Medicaid |
$17.75
|
| Rate for Payer: PHCS All Commercial |
$601.50
|
| Rate for Payer: PHP All Commercial |
$608.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.78
|
| Rate for Payer: Sagamore Health Network All Products |
$619.14
|
| Rate for Payer: Signature Care EPO |
$665.66
|
| Rate for Payer: Signature Care PPO |
$705.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$681.70
|
| Rate for Payer: United Healthcare Commercial |
$631.98
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC U/S MATERNITY < 14 WKS EA ADD GESTATION
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
1646802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$601.50 |
| Max. Negotiated Rate |
$745.86 |
| Rate for Payer: Aetna Commercial |
$692.93
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna All Commercial |
$692.13
|
| Rate for Payer: CORVEL All Commercial |
$745.86
|
| Rate for Payer: Coventry All Commercial |
$705.76
|
| Rate for Payer: Encore All Commercial |
$738.24
|
| Rate for Payer: Frontpath All Commercial |
$737.84
|
| Rate for Payer: Humana ChoiceCare |
$692.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.80
|
| Rate for Payer: PHCS All Commercial |
$601.50
|
| Rate for Payer: PHP All Commercial |
$608.24
|
| Rate for Payer: Sagamore Health Network All Products |
$619.14
|
| Rate for Payer: Signature Care EPO |
$665.66
|
| Rate for Payer: Signature Care PPO |
$705.76
|
| Rate for Payer: United Healthcare Commercial |
$631.98
|
|
|
HC U/S MATERNITY > 14 WKS EA ADD GESTATION
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
1646811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$745.86 |
| Rate for Payer: Aetna Commercial |
$676.89
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$460.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$33.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.30
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Centivo All Commercial |
$436.29
|
| Rate for Payer: Cigna All Commercial |
$692.13
|
| Rate for Payer: CORVEL All Commercial |
$745.86
|
| Rate for Payer: Coventry All Commercial |
$705.76
|
| Rate for Payer: Encore All Commercial |
$738.24
|
| Rate for Payer: Frontpath All Commercial |
$737.84
|
| Rate for Payer: Humana ChoiceCare |
$692.69
|
| Rate for Payer: Humana Medicare |
$256.64
|
| Rate for Payer: Lucent All Commercial |
$436.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.80
|
| Rate for Payer: Managed Health Services Medicaid |
$33.36
|
| Rate for Payer: MDWise Medicaid |
$33.36
|
| Rate for Payer: PHCS All Commercial |
$601.50
|
| Rate for Payer: PHP All Commercial |
$608.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.78
|
| Rate for Payer: Sagamore Health Network All Products |
$619.14
|
| Rate for Payer: Signature Care EPO |
$665.66
|
| Rate for Payer: Signature Care PPO |
$705.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$681.70
|
| Rate for Payer: United Healthcare Commercial |
$631.98
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC U/S MATERNITY > 14 WKS EA ADD GESTATION
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
1646811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$601.50 |
| Max. Negotiated Rate |
$745.86 |
| Rate for Payer: Aetna Commercial |
$692.93
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna All Commercial |
$692.13
|
| Rate for Payer: CORVEL All Commercial |
$745.86
|
| Rate for Payer: Coventry All Commercial |
$705.76
|
| Rate for Payer: Encore All Commercial |
$738.24
|
| Rate for Payer: Frontpath All Commercial |
$737.84
|
| Rate for Payer: Humana ChoiceCare |
$692.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$721.80
|
| Rate for Payer: PHCS All Commercial |
$601.50
|
| Rate for Payer: PHP All Commercial |
$608.24
|
| Rate for Payer: Sagamore Health Network All Products |
$619.14
|
| Rate for Payer: Signature Care EPO |
$665.66
|
| Rate for Payer: Signature Care PPO |
$705.76
|
| Rate for Payer: United Healthcare Commercial |
$631.98
|
|
|
HC U/S MATERNITY LIMITED 1 OR MORE FETUS(S)
|
Facility
|
IP
|
$877.61
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1646815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$658.21 |
| Max. Negotiated Rate |
$816.18 |
| Rate for Payer: Aetna Commercial |
$758.26
|
| Rate for Payer: Cash Price |
$526.57
|
| Rate for Payer: Cigna All Commercial |
$757.38
|
| Rate for Payer: CORVEL All Commercial |
$816.18
|
| Rate for Payer: Coventry All Commercial |
$772.30
|
| Rate for Payer: Encore All Commercial |
$807.84
|
| Rate for Payer: Frontpath All Commercial |
$807.40
|
| Rate for Payer: Humana ChoiceCare |
$757.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$789.85
|
| Rate for Payer: PHCS All Commercial |
$658.21
|
| Rate for Payer: PHP All Commercial |
$665.58
|
| Rate for Payer: Sagamore Health Network All Products |
$677.51
|
| Rate for Payer: Signature Care EPO |
$728.42
|
| Rate for Payer: Signature Care PPO |
$772.30
|
| Rate for Payer: United Healthcare Commercial |
$691.56
|
|
|
HC U/S MATERNITY LIMITED 1 OR MORE FETUS(S)
|
Facility
|
OP
|
$877.61
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1646815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.54 |
| Max. Negotiated Rate |
$816.18 |
| Rate for Payer: Aetna Commercial |
$740.70
|
| Rate for Payer: Aetna Medicare |
$280.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$504.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$548.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.92
|
| Rate for Payer: Cash Price |
$526.57
|
| Rate for Payer: Cash Price |
$526.57
|
| Rate for Payer: Centivo All Commercial |
$477.42
|
| Rate for Payer: Cigna All Commercial |
$757.38
|
| Rate for Payer: CORVEL All Commercial |
$816.18
|
| Rate for Payer: Coventry All Commercial |
$772.30
|
| Rate for Payer: Encore All Commercial |
$807.84
|
| Rate for Payer: Frontpath All Commercial |
$807.40
|
| Rate for Payer: Humana ChoiceCare |
$757.99
|
| Rate for Payer: Humana Medicare |
$280.84
|
| Rate for Payer: Lucent All Commercial |
$477.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$789.85
|
| Rate for Payer: Managed Health Services Medicaid |
$40.54
|
| Rate for Payer: MDWise Medicaid |
$40.54
|
| Rate for Payer: PHCS All Commercial |
$658.21
|
| Rate for Payer: PHP All Commercial |
$665.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$342.27
|
| Rate for Payer: Sagamore Health Network All Products |
$677.51
|
| Rate for Payer: Signature Care EPO |
$728.42
|
| Rate for Payer: Signature Care PPO |
$772.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$745.97
|
| Rate for Payer: United Healthcare Commercial |
$691.56
|
| Rate for Payer: United Healthcare Medicare |
$280.84
|
|
|
HC U/S MATERNITY RE-EVAL PER FETUS
|
Facility
|
OP
|
$1,032.75
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1646816
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$960.46 |
| Rate for Payer: Aetna Commercial |
$871.64
|
| Rate for Payer: Aetna Medicare |
$330.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$593.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$645.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$51.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.53
|
| Rate for Payer: Cash Price |
$619.65
|
| Rate for Payer: Cash Price |
$619.65
|
| Rate for Payer: Centivo All Commercial |
$561.82
|
| Rate for Payer: Cigna All Commercial |
$891.26
|
| Rate for Payer: CORVEL All Commercial |
$960.46
|
| Rate for Payer: Coventry All Commercial |
$908.82
|
| Rate for Payer: Encore All Commercial |
$950.65
|
| Rate for Payer: Frontpath All Commercial |
$950.13
|
| Rate for Payer: Humana ChoiceCare |
$891.99
|
| Rate for Payer: Humana Medicare |
$330.48
|
| Rate for Payer: Lucent All Commercial |
$561.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.48
|
| Rate for Payer: Managed Health Services Medicaid |
$51.44
|
| Rate for Payer: MDWise Medicaid |
$51.44
|
| Rate for Payer: PHCS All Commercial |
$774.56
|
| Rate for Payer: PHP All Commercial |
$783.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.77
|
| Rate for Payer: Sagamore Health Network All Products |
$797.28
|
| Rate for Payer: Signature Care EPO |
$857.18
|
| Rate for Payer: Signature Care PPO |
$908.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$877.84
|
| Rate for Payer: United Healthcare Commercial |
$813.81
|
| Rate for Payer: United Healthcare Medicare |
$330.48
|
|
|
HC U/S MATERNITY RE-EVAL PER FETUS
|
Facility
|
IP
|
$1,032.75
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
1646816
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$774.56 |
| Max. Negotiated Rate |
$960.46 |
| Rate for Payer: Aetna Commercial |
$892.30
|
| Rate for Payer: Cash Price |
$619.65
|
| Rate for Payer: Cigna All Commercial |
$891.26
|
| Rate for Payer: CORVEL All Commercial |
$960.46
|
| Rate for Payer: Coventry All Commercial |
$908.82
|
| Rate for Payer: Encore All Commercial |
$950.65
|
| Rate for Payer: Frontpath All Commercial |
$950.13
|
| Rate for Payer: Humana ChoiceCare |
$891.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$929.48
|
| Rate for Payer: PHCS All Commercial |
$774.56
|
| Rate for Payer: PHP All Commercial |
$783.24
|
| Rate for Payer: Sagamore Health Network All Products |
$797.28
|
| Rate for Payer: Signature Care EPO |
$857.18
|
| Rate for Payer: Signature Care PPO |
$908.82
|
| Rate for Payer: United Healthcare Commercial |
$813.81
|
|
|
HC U/S MISC UNLISTED
|
Facility
|
IP
|
$771.11
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
1646999
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$578.33 |
| Max. Negotiated Rate |
$717.13 |
| Rate for Payer: Aetna Commercial |
$666.24
|
| Rate for Payer: Cash Price |
$462.67
|
| Rate for Payer: Cigna All Commercial |
$665.47
|
| Rate for Payer: CORVEL All Commercial |
$717.13
|
| Rate for Payer: Coventry All Commercial |
$678.58
|
| Rate for Payer: Encore All Commercial |
$709.81
|
| Rate for Payer: Frontpath All Commercial |
$709.42
|
| Rate for Payer: Humana ChoiceCare |
$666.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$694.00
|
| Rate for Payer: PHCS All Commercial |
$578.33
|
| Rate for Payer: PHP All Commercial |
$584.81
|
| Rate for Payer: Sagamore Health Network All Products |
$595.30
|
| Rate for Payer: Signature Care EPO |
$640.02
|
| Rate for Payer: Signature Care PPO |
$678.58
|
| Rate for Payer: United Healthcare Commercial |
$607.63
|
|
|
HC U/S MISC UNLISTED
|
Facility
|
OP
|
$771.11
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
1646999
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$717.13 |
| Rate for Payer: Aetna Commercial |
$650.82
|
| Rate for Payer: Aetna Medicare |
$246.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$115.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$482.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.43
|
| Rate for Payer: Cash Price |
$462.67
|
| Rate for Payer: Centivo All Commercial |
$419.48
|
| Rate for Payer: Cigna All Commercial |
$665.47
|
| Rate for Payer: CORVEL All Commercial |
$717.13
|
| Rate for Payer: Coventry All Commercial |
$678.58
|
| Rate for Payer: Encore All Commercial |
$709.81
|
| Rate for Payer: Frontpath All Commercial |
$709.42
|
| Rate for Payer: Humana ChoiceCare |
$666.01
|
| Rate for Payer: Humana Medicare |
$246.76
|
| Rate for Payer: Lucent All Commercial |
$419.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$694.00
|
| Rate for Payer: Managed Health Services Medicaid |
$115.67
|
| Rate for Payer: MDWise Medicaid |
$115.67
|
| Rate for Payer: PHCS All Commercial |
$578.33
|
| Rate for Payer: PHP All Commercial |
$584.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.73
|
| Rate for Payer: Sagamore Health Network All Products |
$595.30
|
| Rate for Payer: Signature Care EPO |
$640.02
|
| Rate for Payer: Signature Care PPO |
$678.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$655.44
|
| Rate for Payer: United Healthcare Commercial |
$607.63
|
| Rate for Payer: United Healthcare Medicare |
$246.76
|
|
|
HC U/S NECK OR HEAD - SOFT TISSUE
|
Facility
|
IP
|
$1,273.13
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1646536
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$954.85 |
| Max. Negotiated Rate |
$1,184.01 |
| Rate for Payer: Aetna Commercial |
$1,099.98
|
| Rate for Payer: Cash Price |
$763.88
|
| Rate for Payer: Cigna All Commercial |
$1,098.71
|
| Rate for Payer: CORVEL All Commercial |
$1,184.01
|
| Rate for Payer: Coventry All Commercial |
$1,120.35
|
| Rate for Payer: Encore All Commercial |
$1,171.92
|
| Rate for Payer: Frontpath All Commercial |
$1,171.28
|
| Rate for Payer: Humana ChoiceCare |
$1,099.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,145.82
|
| Rate for Payer: PHCS All Commercial |
$954.85
|
| Rate for Payer: PHP All Commercial |
$965.54
|
| Rate for Payer: Sagamore Health Network All Products |
$982.86
|
| Rate for Payer: Signature Care EPO |
$1,056.70
|
| Rate for Payer: Signature Care PPO |
$1,120.35
|
| Rate for Payer: United Healthcare Commercial |
$1,003.23
|
|
|
HC U/S NECK OR HEAD - SOFT TISSUE
|
Facility
|
OP
|
$1,273.13
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1646536
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.56 |
| Max. Negotiated Rate |
$1,184.01 |
| Rate for Payer: Aetna Commercial |
$1,074.52
|
| Rate for Payer: Aetna Medicare |
$407.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$394.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$731.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$795.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$468.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.14
|
| Rate for Payer: Cash Price |
$763.88
|
| Rate for Payer: Cash Price |
$763.88
|
| Rate for Payer: Centivo All Commercial |
$692.58
|
| Rate for Payer: Cigna All Commercial |
$1,098.71
|
| Rate for Payer: CORVEL All Commercial |
$1,184.01
|
| Rate for Payer: Coventry All Commercial |
$1,120.35
|
| Rate for Payer: Encore All Commercial |
$1,171.92
|
| Rate for Payer: Frontpath All Commercial |
$1,171.28
|
| Rate for Payer: Humana ChoiceCare |
$1,099.60
|
| Rate for Payer: Humana Medicare |
$407.40
|
| Rate for Payer: Lucent All Commercial |
$692.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,145.82
|
| Rate for Payer: Managed Health Services Medicaid |
$65.56
|
| Rate for Payer: MDWise Medicaid |
$65.56
|
| Rate for Payer: PHCS All Commercial |
$954.85
|
| Rate for Payer: PHP All Commercial |
$965.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$496.52
|
| Rate for Payer: Sagamore Health Network All Products |
$982.86
|
| Rate for Payer: Signature Care EPO |
$1,056.70
|
| Rate for Payer: Signature Care PPO |
$1,120.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,082.16
|
| Rate for Payer: United Healthcare Commercial |
$1,003.23
|
| Rate for Payer: United Healthcare Medicare |
$407.40
|
|
|
HC U/S PELVIC
|
Facility
|
IP
|
$1,011.25
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
1646715
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$758.44 |
| Max. Negotiated Rate |
$940.46 |
| Rate for Payer: Aetna Commercial |
$873.72
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cigna All Commercial |
$872.71
|
| Rate for Payer: CORVEL All Commercial |
$940.46
|
| Rate for Payer: Coventry All Commercial |
$889.90
|
| Rate for Payer: Encore All Commercial |
$930.86
|
| Rate for Payer: Frontpath All Commercial |
$930.35
|
| Rate for Payer: Humana ChoiceCare |
$873.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.12
|
| Rate for Payer: PHCS All Commercial |
$758.44
|
| Rate for Payer: PHP All Commercial |
$766.93
|
| Rate for Payer: Sagamore Health Network All Products |
$780.68
|
| Rate for Payer: Signature Care EPO |
$839.34
|
| Rate for Payer: Signature Care PPO |
$889.90
|
| Rate for Payer: United Healthcare Commercial |
$796.87
|
|
|
HC U/S PELVIC
|
Facility
|
OP
|
$1,011.25
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
1646715
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$940.46 |
| Rate for Payer: Aetna Commercial |
$853.50
|
| Rate for Payer: Aetna Medicare |
$323.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$313.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$580.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$632.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.96
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Centivo All Commercial |
$550.12
|
| Rate for Payer: Cigna All Commercial |
$872.71
|
| Rate for Payer: CORVEL All Commercial |
$940.46
|
| Rate for Payer: Coventry All Commercial |
$889.90
|
| Rate for Payer: Encore All Commercial |
$930.86
|
| Rate for Payer: Frontpath All Commercial |
$930.35
|
| Rate for Payer: Humana ChoiceCare |
$873.42
|
| Rate for Payer: Humana Medicare |
$323.60
|
| Rate for Payer: Lucent All Commercial |
$550.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.12
|
| Rate for Payer: Managed Health Services Medicaid |
$62.84
|
| Rate for Payer: MDWise Medicaid |
$62.84
|
| Rate for Payer: PHCS All Commercial |
$758.44
|
| Rate for Payer: PHP All Commercial |
$766.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$394.39
|
| Rate for Payer: Sagamore Health Network All Products |
$780.68
|
| Rate for Payer: Signature Care EPO |
$839.34
|
| Rate for Payer: Signature Care PPO |
$889.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$859.56
|
| Rate for Payer: United Healthcare Commercial |
$796.87
|
| Rate for Payer: United Healthcare Medicare |
$323.60
|
|
|
HC U/S PELVIC LIMITED
|
Facility
|
IP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
1644705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$664.82 |
| Max. Negotiated Rate |
$824.38 |
| Rate for Payer: Aetna Commercial |
$765.88
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cigna All Commercial |
$764.99
|
| Rate for Payer: CORVEL All Commercial |
$824.38
|
| Rate for Payer: Coventry All Commercial |
$780.06
|
| Rate for Payer: Encore All Commercial |
$815.96
|
| Rate for Payer: Frontpath All Commercial |
$815.52
|
| Rate for Payer: Humana ChoiceCare |
$765.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$797.79
|
| Rate for Payer: PHCS All Commercial |
$664.82
|
| Rate for Payer: PHP All Commercial |
$672.27
|
| Rate for Payer: Sagamore Health Network All Products |
$684.32
|
| Rate for Payer: Signature Care EPO |
$735.74
|
| Rate for Payer: Signature Care PPO |
$780.06
|
| Rate for Payer: United Healthcare Commercial |
$698.51
|
|
|
HC U/S PELVIC LIMITED
|
Facility
|
OP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
1644705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$824.38 |
| Rate for Payer: Aetna Commercial |
$748.15
|
| Rate for Payer: Aetna Medicare |
$283.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$274.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$509.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$554.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.02
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Centivo All Commercial |
$482.22
|
| Rate for Payer: Cigna All Commercial |
$764.99
|
| Rate for Payer: CORVEL All Commercial |
$824.38
|
| Rate for Payer: Coventry All Commercial |
$780.06
|
| Rate for Payer: Encore All Commercial |
$815.96
|
| Rate for Payer: Frontpath All Commercial |
$815.52
|
| Rate for Payer: Humana ChoiceCare |
$765.61
|
| Rate for Payer: Humana Medicare |
$283.66
|
| Rate for Payer: Lucent All Commercial |
$482.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$797.79
|
| Rate for Payer: Managed Health Services Medicaid |
$24.19
|
| Rate for Payer: MDWise Medicaid |
$24.19
|
| Rate for Payer: PHCS All Commercial |
$664.82
|
| Rate for Payer: PHP All Commercial |
$672.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.71
|
| Rate for Payer: Sagamore Health Network All Products |
$684.32
|
| Rate for Payer: Signature Care EPO |
$735.74
|
| Rate for Payer: Signature Care PPO |
$780.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$753.47
|
| Rate for Payer: United Healthcare Commercial |
$698.51
|
| Rate for Payer: United Healthcare Medicare |
$283.66
|
|
|
HC U/S PERC BREAST ASP CYST
|
Facility
|
OP
|
$512.07
|
|
| Hospital Charge Code |
1649000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.74 |
| Max. Negotiated Rate |
$476.23 |
| Rate for Payer: Aetna Commercial |
$432.19
|
| Rate for Payer: Aetna Medicare |
$163.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$294.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.25
|
| Rate for Payer: Cash Price |
$307.24
|
| Rate for Payer: Centivo All Commercial |
$278.57
|
| Rate for Payer: Cigna All Commercial |
$441.92
|
| Rate for Payer: CORVEL All Commercial |
$476.23
|
| Rate for Payer: Coventry All Commercial |
$450.62
|
| Rate for Payer: Encore All Commercial |
$471.36
|
| Rate for Payer: Frontpath All Commercial |
$471.10
|
| Rate for Payer: Humana ChoiceCare |
$442.27
|
| Rate for Payer: Humana Medicare |
$163.86
|
| Rate for Payer: Lucent All Commercial |
$278.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.86
|
| Rate for Payer: PHCS All Commercial |
$384.05
|
| Rate for Payer: PHP All Commercial |
$388.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.71
|
| Rate for Payer: Sagamore Health Network All Products |
$395.32
|
| Rate for Payer: Signature Care EPO |
$425.02
|
| Rate for Payer: Signature Care PPO |
$450.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.26
|
| Rate for Payer: United Healthcare Commercial |
$403.51
|
| Rate for Payer: United Healthcare Medicare |
$163.86
|
|
|
HC U/S PERC BREAST ASP CYST
|
Facility
|
IP
|
$512.07
|
|
| Hospital Charge Code |
1649000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.05 |
| Max. Negotiated Rate |
$476.23 |
| Rate for Payer: Aetna Commercial |
$442.43
|
| Rate for Payer: Cash Price |
$307.24
|
| Rate for Payer: Cigna All Commercial |
$441.92
|
| Rate for Payer: CORVEL All Commercial |
$476.23
|
| Rate for Payer: Coventry All Commercial |
$450.62
|
| Rate for Payer: Encore All Commercial |
$471.36
|
| Rate for Payer: Frontpath All Commercial |
$471.10
|
| Rate for Payer: Humana ChoiceCare |
$442.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.86
|
| Rate for Payer: PHCS All Commercial |
$384.05
|
| Rate for Payer: PHP All Commercial |
$388.35
|
| Rate for Payer: Sagamore Health Network All Products |
$395.32
|
| Rate for Payer: Signature Care EPO |
$425.02
|
| Rate for Payer: Signature Care PPO |
$450.62
|
| Rate for Payer: United Healthcare Commercial |
$403.51
|
|
