|
HC U/S PULSE VOL RECORD W/O EXER
|
Facility
|
OP
|
$681.62
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
1643923
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$633.91 |
| Rate for Payer: Aetna Commercial |
$575.29
|
| Rate for Payer: Aetna Medicare |
$218.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$63.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$391.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$426.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$63.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$250.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$239.93
|
| Rate for Payer: Cash Price |
$408.97
|
| Rate for Payer: Cash Price |
$408.97
|
| Rate for Payer: Centivo All Commercial |
$370.80
|
| Rate for Payer: Cigna All Commercial |
$588.24
|
| Rate for Payer: CORVEL All Commercial |
$633.91
|
| Rate for Payer: Coventry All Commercial |
$599.83
|
| Rate for Payer: Encore All Commercial |
$627.43
|
| Rate for Payer: Frontpath All Commercial |
$627.09
|
| Rate for Payer: Humana ChoiceCare |
$588.72
|
| Rate for Payer: Humana Medicare |
$218.12
|
| Rate for Payer: Lucent All Commercial |
$370.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$613.46
|
| Rate for Payer: Managed Health Services Medicaid |
$63.60
|
| Rate for Payer: MDWise Medicaid |
$63.60
|
| Rate for Payer: PHCS All Commercial |
$511.21
|
| Rate for Payer: PHP All Commercial |
$516.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$265.83
|
| Rate for Payer: Sagamore Health Network All Products |
$526.21
|
| Rate for Payer: Signature Care EPO |
$565.74
|
| Rate for Payer: Signature Care PPO |
$599.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$579.38
|
| Rate for Payer: United Healthcare Commercial |
$537.12
|
| Rate for Payer: United Healthcare Medicare |
$218.12
|
|
|
HC U/S PULSE VOL RECORD W/O EXER
|
Facility
|
IP
|
$681.62
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
1643923
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$511.21 |
| Max. Negotiated Rate |
$633.91 |
| Rate for Payer: Aetna Commercial |
$588.92
|
| Rate for Payer: Cash Price |
$408.97
|
| Rate for Payer: Cigna All Commercial |
$588.24
|
| Rate for Payer: CORVEL All Commercial |
$633.91
|
| Rate for Payer: Coventry All Commercial |
$599.83
|
| Rate for Payer: Encore All Commercial |
$627.43
|
| Rate for Payer: Frontpath All Commercial |
$627.09
|
| Rate for Payer: Humana ChoiceCare |
$588.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$613.46
|
| Rate for Payer: PHCS All Commercial |
$511.21
|
| Rate for Payer: PHP All Commercial |
$516.94
|
| Rate for Payer: Sagamore Health Network All Products |
$526.21
|
| Rate for Payer: Signature Care EPO |
$565.74
|
| Rate for Payer: Signature Care PPO |
$599.83
|
| Rate for Payer: United Healthcare Commercial |
$537.12
|
|
|
HC U/S RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$1,215.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
1646770
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$1,130.60 |
| Rate for Payer: Aetna Commercial |
$1,026.05
|
| Rate for Payer: Aetna Medicare |
$389.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$376.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$698.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$759.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$67.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$447.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.93
|
| Rate for Payer: Cash Price |
$729.42
|
| Rate for Payer: Cash Price |
$729.42
|
| Rate for Payer: Centivo All Commercial |
$661.34
|
| Rate for Payer: Cigna All Commercial |
$1,049.15
|
| Rate for Payer: CORVEL All Commercial |
$1,130.60
|
| Rate for Payer: Coventry All Commercial |
$1,069.82
|
| Rate for Payer: Encore All Commercial |
$1,119.05
|
| Rate for Payer: Frontpath All Commercial |
$1,118.44
|
| Rate for Payer: Humana ChoiceCare |
$1,050.00
|
| Rate for Payer: Humana Medicare |
$389.02
|
| Rate for Payer: Lucent All Commercial |
$661.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.13
|
| Rate for Payer: Managed Health Services Medicaid |
$67.05
|
| Rate for Payer: MDWise Medicaid |
$67.05
|
| Rate for Payer: PHCS All Commercial |
$911.77
|
| Rate for Payer: PHP All Commercial |
$921.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$474.12
|
| Rate for Payer: Sagamore Health Network All Products |
$938.52
|
| Rate for Payer: Signature Care EPO |
$1,009.03
|
| Rate for Payer: Signature Care PPO |
$1,069.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,033.35
|
| Rate for Payer: United Healthcare Commercial |
$957.97
|
| Rate for Payer: United Healthcare Medicare |
$389.02
|
|
|
HC U/S RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$1,215.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
1646770
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$911.77 |
| Max. Negotiated Rate |
$1,130.60 |
| Rate for Payer: Aetna Commercial |
$1,050.36
|
| Rate for Payer: Cash Price |
$729.42
|
| Rate for Payer: Cigna All Commercial |
$1,049.15
|
| Rate for Payer: CORVEL All Commercial |
$1,130.60
|
| Rate for Payer: Coventry All Commercial |
$1,069.82
|
| Rate for Payer: Encore All Commercial |
$1,119.05
|
| Rate for Payer: Frontpath All Commercial |
$1,118.44
|
| Rate for Payer: Humana ChoiceCare |
$1,050.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.13
|
| Rate for Payer: PHCS All Commercial |
$911.77
|
| Rate for Payer: PHP All Commercial |
$921.99
|
| Rate for Payer: Sagamore Health Network All Products |
$938.52
|
| Rate for Payer: Signature Care EPO |
$1,009.03
|
| Rate for Payer: Signature Care PPO |
$1,069.82
|
| Rate for Payer: United Healthcare Commercial |
$957.97
|
|
|
HC U/S RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$1,038.99
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
1646775
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$966.26 |
| Rate for Payer: Aetna Commercial |
$876.91
|
| Rate for Payer: Aetna Medicare |
$332.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$322.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$596.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$649.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$382.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.72
|
| Rate for Payer: Cash Price |
$623.39
|
| Rate for Payer: Cash Price |
$623.39
|
| Rate for Payer: Centivo All Commercial |
$565.21
|
| Rate for Payer: Cigna All Commercial |
$896.65
|
| Rate for Payer: CORVEL All Commercial |
$966.26
|
| Rate for Payer: Coventry All Commercial |
$914.31
|
| Rate for Payer: Encore All Commercial |
$956.39
|
| Rate for Payer: Frontpath All Commercial |
$955.87
|
| Rate for Payer: Humana ChoiceCare |
$897.38
|
| Rate for Payer: Humana Medicare |
$332.48
|
| Rate for Payer: Lucent All Commercial |
$565.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$935.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.43
|
| Rate for Payer: MDWise Medicaid |
$25.43
|
| Rate for Payer: PHCS All Commercial |
$779.24
|
| Rate for Payer: PHP All Commercial |
$787.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$405.21
|
| Rate for Payer: Sagamore Health Network All Products |
$802.10
|
| Rate for Payer: Signature Care EPO |
$862.36
|
| Rate for Payer: Signature Care PPO |
$914.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$883.14
|
| Rate for Payer: United Healthcare Commercial |
$818.72
|
| Rate for Payer: United Healthcare Medicare |
$332.48
|
|
|
HC U/S RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$1,038.99
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
1646775
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$779.24 |
| Max. Negotiated Rate |
$966.26 |
| Rate for Payer: Aetna Commercial |
$897.69
|
| Rate for Payer: Cash Price |
$623.39
|
| Rate for Payer: Cigna All Commercial |
$896.65
|
| Rate for Payer: CORVEL All Commercial |
$966.26
|
| Rate for Payer: Coventry All Commercial |
$914.31
|
| Rate for Payer: Encore All Commercial |
$956.39
|
| Rate for Payer: Frontpath All Commercial |
$955.87
|
| Rate for Payer: Humana ChoiceCare |
$897.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$935.09
|
| Rate for Payer: PHCS All Commercial |
$779.24
|
| Rate for Payer: PHP All Commercial |
$787.97
|
| Rate for Payer: Sagamore Health Network All Products |
$802.10
|
| Rate for Payer: Signature Care EPO |
$862.36
|
| Rate for Payer: Signature Care PPO |
$914.31
|
| Rate for Payer: United Healthcare Commercial |
$818.72
|
|
|
HC U/S SOFT TISSUE ABDOMEN
|
Facility
|
IP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
1647705
|
|
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 SOFT TISSUE ABDOMEN
|
Facility
|
OP
|
$1,280.04
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
1647705
|
|
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 SOFT TISSUE PELVIS
|
Facility
|
IP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
1646857
|
|
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 SOFT TISSUE PELVIS
|
Facility
|
OP
|
$886.43
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
1646857
|
|
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 SPINAL CANAL/CONTENTS
|
Facility
|
OP
|
$448.80
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
1646801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$417.38 |
| Rate for Payer: Aetna Commercial |
$378.79
|
| Rate for Payer: Aetna Medicare |
$143.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$57.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$257.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$280.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$57.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.98
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Centivo All Commercial |
$244.15
|
| Rate for Payer: Cigna All Commercial |
$387.31
|
| Rate for Payer: CORVEL All Commercial |
$417.38
|
| Rate for Payer: Coventry All Commercial |
$394.94
|
| Rate for Payer: Encore All Commercial |
$413.12
|
| Rate for Payer: Frontpath All Commercial |
$412.90
|
| Rate for Payer: Humana ChoiceCare |
$387.63
|
| Rate for Payer: Humana Medicare |
$143.62
|
| Rate for Payer: Lucent All Commercial |
$244.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$403.92
|
| Rate for Payer: Managed Health Services Medicaid |
$57.39
|
| Rate for Payer: MDWise Medicaid |
$57.39
|
| Rate for Payer: PHCS All Commercial |
$336.60
|
| Rate for Payer: PHP All Commercial |
$340.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.03
|
| Rate for Payer: Sagamore Health Network All Products |
$346.47
|
| Rate for Payer: Signature Care EPO |
$372.50
|
| Rate for Payer: Signature Care PPO |
$394.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$381.48
|
| Rate for Payer: United Healthcare Commercial |
$353.65
|
| Rate for Payer: United Healthcare Medicare |
$143.62
|
|
|
HC U/S SPINAL CANAL/CONTENTS
|
Facility
|
IP
|
$448.80
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
1646801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$417.38 |
| Rate for Payer: Aetna Commercial |
$387.76
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cigna All Commercial |
$387.31
|
| Rate for Payer: CORVEL All Commercial |
$417.38
|
| Rate for Payer: Coventry All Commercial |
$394.94
|
| Rate for Payer: Encore All Commercial |
$413.12
|
| Rate for Payer: Frontpath All Commercial |
$412.90
|
| Rate for Payer: Humana ChoiceCare |
$387.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$403.92
|
| Rate for Payer: PHCS All Commercial |
$336.60
|
| Rate for Payer: PHP All Commercial |
$340.37
|
| Rate for Payer: Sagamore Health Network All Products |
$346.47
|
| Rate for Payer: Signature Care EPO |
$372.50
|
| Rate for Payer: Signature Care PPO |
$394.94
|
| Rate for Payer: United Healthcare Commercial |
$353.65
|
|
|
HC U/S TESTICULAR
|
Facility
|
OP
|
$1,282.30
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
1640001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$29.15 |
| Max. Negotiated Rate |
$1,192.54 |
| Rate for Payer: Aetna Commercial |
$1,082.26
|
| Rate for Payer: Aetna Medicare |
$410.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$397.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$736.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$801.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$471.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$451.37
|
| Rate for Payer: Cash Price |
$769.38
|
| Rate for Payer: Cash Price |
$769.38
|
| Rate for Payer: Centivo All Commercial |
$697.57
|
| Rate for Payer: Cigna All Commercial |
$1,106.62
|
| Rate for Payer: CORVEL All Commercial |
$1,192.54
|
| Rate for Payer: Coventry All Commercial |
$1,128.42
|
| Rate for Payer: Encore All Commercial |
$1,180.36
|
| Rate for Payer: Frontpath All Commercial |
$1,179.72
|
| Rate for Payer: Humana ChoiceCare |
$1,107.52
|
| Rate for Payer: Humana Medicare |
$410.34
|
| Rate for Payer: Lucent All Commercial |
$697.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,154.07
|
| Rate for Payer: Managed Health Services Medicaid |
$29.15
|
| Rate for Payer: MDWise Medicaid |
$29.15
|
| Rate for Payer: PHCS All Commercial |
$961.73
|
| Rate for Payer: PHP All Commercial |
$972.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$500.10
|
| Rate for Payer: Sagamore Health Network All Products |
$989.94
|
| Rate for Payer: Signature Care EPO |
$1,064.31
|
| Rate for Payer: Signature Care PPO |
$1,128.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,089.95
|
| Rate for Payer: United Healthcare Commercial |
$1,010.45
|
| Rate for Payer: United Healthcare Medicare |
$410.34
|
|
|
HC U/S TESTICULAR
|
Facility
|
IP
|
$1,282.30
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
1640001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$961.73 |
| Max. Negotiated Rate |
$1,192.54 |
| Rate for Payer: Aetna Commercial |
$1,107.91
|
| Rate for Payer: Cash Price |
$769.38
|
| Rate for Payer: Cigna All Commercial |
$1,106.62
|
| Rate for Payer: CORVEL All Commercial |
$1,192.54
|
| Rate for Payer: Coventry All Commercial |
$1,128.42
|
| Rate for Payer: Encore All Commercial |
$1,180.36
|
| Rate for Payer: Frontpath All Commercial |
$1,179.72
|
| Rate for Payer: Humana ChoiceCare |
$1,107.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,154.07
|
| Rate for Payer: PHCS All Commercial |
$961.73
|
| Rate for Payer: PHP All Commercial |
$972.50
|
| Rate for Payer: Sagamore Health Network All Products |
$989.94
|
| Rate for Payer: Signature Care EPO |
$1,064.31
|
| Rate for Payer: Signature Care PPO |
$1,128.42
|
| Rate for Payer: United Healthcare Commercial |
$1,010.45
|
|
|
HC U/S THYROID
|
Facility
|
IP
|
$1,193.19
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1646530
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$894.89 |
| Max. Negotiated Rate |
$1,109.67 |
| Rate for Payer: Aetna Commercial |
$1,030.92
|
| Rate for Payer: Cash Price |
$715.91
|
| Rate for Payer: Cigna All Commercial |
$1,029.72
|
| Rate for Payer: CORVEL All Commercial |
$1,109.67
|
| Rate for Payer: Coventry All Commercial |
$1,050.01
|
| Rate for Payer: Encore All Commercial |
$1,098.33
|
| Rate for Payer: Frontpath All Commercial |
$1,097.73
|
| Rate for Payer: Humana ChoiceCare |
$1,030.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,073.87
|
| Rate for Payer: PHCS All Commercial |
$894.89
|
| Rate for Payer: PHP All Commercial |
$904.92
|
| Rate for Payer: Sagamore Health Network All Products |
$921.14
|
| Rate for Payer: Signature Care EPO |
$990.35
|
| Rate for Payer: Signature Care PPO |
$1,050.01
|
| Rate for Payer: United Healthcare Commercial |
$940.23
|
|
|
HC U/S THYROID
|
Facility
|
OP
|
$1,193.19
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
1646530
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.56 |
| Max. Negotiated Rate |
$1,109.67 |
| Rate for Payer: Aetna Commercial |
$1,007.05
|
| Rate for Payer: Aetna Medicare |
$381.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$369.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$685.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$745.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$439.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$420.00
|
| Rate for Payer: Cash Price |
$715.91
|
| Rate for Payer: Cash Price |
$715.91
|
| Rate for Payer: Centivo All Commercial |
$649.10
|
| Rate for Payer: Cigna All Commercial |
$1,029.72
|
| Rate for Payer: CORVEL All Commercial |
$1,109.67
|
| Rate for Payer: Coventry All Commercial |
$1,050.01
|
| Rate for Payer: Encore All Commercial |
$1,098.33
|
| Rate for Payer: Frontpath All Commercial |
$1,097.73
|
| Rate for Payer: Humana ChoiceCare |
$1,030.56
|
| Rate for Payer: Humana Medicare |
$381.82
|
| Rate for Payer: Lucent All Commercial |
$649.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,073.87
|
| Rate for Payer: Managed Health Services Medicaid |
$65.56
|
| Rate for Payer: MDWise Medicaid |
$65.56
|
| Rate for Payer: PHCS All Commercial |
$894.89
|
| Rate for Payer: PHP All Commercial |
$904.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.34
|
| Rate for Payer: Sagamore Health Network All Products |
$921.14
|
| Rate for Payer: Signature Care EPO |
$990.35
|
| Rate for Payer: Signature Care PPO |
$1,050.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,014.21
|
| Rate for Payer: United Healthcare Commercial |
$940.23
|
| Rate for Payer: United Healthcare Medicare |
$381.82
|
|
|
HC U/S TRANSVAGINAL MATERNITY
|
Facility
|
IP
|
$898.49
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
1646817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$673.87 |
| Max. Negotiated Rate |
$835.60 |
| Rate for Payer: Aetna Commercial |
$776.30
|
| Rate for Payer: Cash Price |
$539.09
|
| Rate for Payer: Cigna All Commercial |
$775.40
|
| Rate for Payer: CORVEL All Commercial |
$835.60
|
| Rate for Payer: Coventry All Commercial |
$790.67
|
| Rate for Payer: Encore All Commercial |
$827.06
|
| Rate for Payer: Frontpath All Commercial |
$826.61
|
| Rate for Payer: Humana ChoiceCare |
$776.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.64
|
| Rate for Payer: PHCS All Commercial |
$673.87
|
| Rate for Payer: PHP All Commercial |
$681.41
|
| Rate for Payer: Sagamore Health Network All Products |
$693.63
|
| Rate for Payer: Signature Care EPO |
$745.75
|
| Rate for Payer: Signature Care PPO |
$790.67
|
| Rate for Payer: United Healthcare Commercial |
$708.01
|
|
|
HC U/S TRANSVAGINAL MATERNITY
|
Facility
|
OP
|
$898.49
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
1646817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.51 |
| Max. Negotiated Rate |
$835.60 |
| Rate for Payer: Aetna Commercial |
$758.33
|
| Rate for Payer: Aetna Medicare |
$287.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$44.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$278.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$44.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$330.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$316.27
|
| Rate for Payer: Cash Price |
$539.09
|
| Rate for Payer: Cash Price |
$539.09
|
| Rate for Payer: Centivo All Commercial |
$488.78
|
| Rate for Payer: Cigna All Commercial |
$775.40
|
| Rate for Payer: CORVEL All Commercial |
$835.60
|
| Rate for Payer: Coventry All Commercial |
$790.67
|
| Rate for Payer: Encore All Commercial |
$827.06
|
| Rate for Payer: Frontpath All Commercial |
$826.61
|
| Rate for Payer: Humana ChoiceCare |
$776.03
|
| Rate for Payer: Humana Medicare |
$287.52
|
| Rate for Payer: Lucent All Commercial |
$488.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.64
|
| Rate for Payer: Managed Health Services Medicaid |
$44.51
|
| Rate for Payer: MDWise Medicaid |
$44.51
|
| Rate for Payer: PHCS All Commercial |
$673.87
|
| Rate for Payer: PHP All Commercial |
$681.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.41
|
| Rate for Payer: Sagamore Health Network All Products |
$693.63
|
| Rate for Payer: Signature Care EPO |
$745.75
|
| Rate for Payer: Signature Care PPO |
$790.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$763.72
|
| Rate for Payer: United Healthcare Commercial |
$708.01
|
| Rate for Payer: United Healthcare Medicare |
$287.52
|
|
|
HC U/S TRANSVAGINAL NON-MATERNITY
|
Facility
|
OP
|
$902.12
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
1646830
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.08 |
| Max. Negotiated Rate |
$838.97 |
| Rate for Payer: Aetna Commercial |
$761.39
|
| Rate for Payer: Aetna Medicare |
$288.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$64.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$518.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$563.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$64.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$331.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.55
|
| Rate for Payer: Cash Price |
$541.27
|
| Rate for Payer: Cash Price |
$541.27
|
| Rate for Payer: Centivo All Commercial |
$490.75
|
| Rate for Payer: Cigna All Commercial |
$778.53
|
| Rate for Payer: CORVEL All Commercial |
$838.97
|
| Rate for Payer: Coventry All Commercial |
$793.87
|
| Rate for Payer: Encore All Commercial |
$830.40
|
| Rate for Payer: Frontpath All Commercial |
$829.95
|
| Rate for Payer: Humana ChoiceCare |
$779.16
|
| Rate for Payer: Humana Medicare |
$288.68
|
| Rate for Payer: Lucent All Commercial |
$490.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$811.91
|
| Rate for Payer: Managed Health Services Medicaid |
$64.08
|
| Rate for Payer: MDWise Medicaid |
$64.08
|
| Rate for Payer: PHCS All Commercial |
$676.59
|
| Rate for Payer: PHP All Commercial |
$684.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$351.83
|
| Rate for Payer: Sagamore Health Network All Products |
$696.44
|
| Rate for Payer: Signature Care EPO |
$748.76
|
| Rate for Payer: Signature Care PPO |
$793.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$766.80
|
| Rate for Payer: United Healthcare Commercial |
$710.87
|
| Rate for Payer: United Healthcare Medicare |
$288.68
|
|
|
HC U/S TRANSVAGINAL NON-MATERNITY
|
Facility
|
IP
|
$902.12
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
1646830
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$676.59 |
| Max. Negotiated Rate |
$838.97 |
| Rate for Payer: Aetna Commercial |
$779.43
|
| Rate for Payer: Cash Price |
$541.27
|
| Rate for Payer: Cigna All Commercial |
$778.53
|
| Rate for Payer: CORVEL All Commercial |
$838.97
|
| Rate for Payer: Coventry All Commercial |
$793.87
|
| Rate for Payer: Encore All Commercial |
$830.40
|
| Rate for Payer: Frontpath All Commercial |
$829.95
|
| Rate for Payer: Humana ChoiceCare |
$779.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$811.91
|
| Rate for Payer: PHCS All Commercial |
$676.59
|
| Rate for Payer: PHP All Commercial |
$684.17
|
| Rate for Payer: Sagamore Health Network All Products |
$696.44
|
| Rate for Payer: Signature Care EPO |
$748.76
|
| Rate for Payer: Signature Care PPO |
$793.87
|
| Rate for Payer: United Healthcare Commercial |
$710.87
|
|
|
HC U/S VENOUS IMAGING LOW EXT UNI
|
Facility
|
OP
|
$1,026.96
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1649642
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.85 |
| Max. Negotiated Rate |
$955.07 |
| Rate for Payer: Aetna Commercial |
$866.75
|
| Rate for Payer: Aetna Medicare |
$328.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$589.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$361.49
|
| Rate for Payer: Cash Price |
$616.18
|
| Rate for Payer: Cash Price |
$616.18
|
| Rate for Payer: Centivo All Commercial |
$558.67
|
| Rate for Payer: Cigna All Commercial |
$886.27
|
| Rate for Payer: CORVEL All Commercial |
$955.07
|
| Rate for Payer: Coventry All Commercial |
$903.72
|
| Rate for Payer: Encore All Commercial |
$945.32
|
| Rate for Payer: Frontpath All Commercial |
$944.80
|
| Rate for Payer: Humana ChoiceCare |
$886.99
|
| Rate for Payer: Humana Medicare |
$328.63
|
| Rate for Payer: Lucent All Commercial |
$558.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.26
|
| Rate for Payer: Managed Health Services Medicaid |
$134.85
|
| Rate for Payer: MDWise Medicaid |
$134.85
|
| Rate for Payer: PHCS All Commercial |
$770.22
|
| Rate for Payer: PHP All Commercial |
$778.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$400.51
|
| Rate for Payer: Sagamore Health Network All Products |
$792.81
|
| Rate for Payer: Signature Care EPO |
$852.38
|
| Rate for Payer: Signature Care PPO |
$903.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$872.92
|
| Rate for Payer: United Healthcare Commercial |
$809.24
|
| Rate for Payer: United Healthcare Medicare |
$328.63
|
|
|
HC U/S VENOUS IMAGING LOW EXT UNI
|
Facility
|
IP
|
$1,026.96
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
1649642
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$770.22 |
| Max. Negotiated Rate |
$955.07 |
| Rate for Payer: Aetna Commercial |
$887.29
|
| Rate for Payer: Cash Price |
$616.18
|
| Rate for Payer: Cigna All Commercial |
$886.27
|
| Rate for Payer: CORVEL All Commercial |
$955.07
|
| Rate for Payer: Coventry All Commercial |
$903.72
|
| Rate for Payer: Encore All Commercial |
$945.32
|
| Rate for Payer: Frontpath All Commercial |
$944.80
|
| Rate for Payer: Humana ChoiceCare |
$886.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.26
|
| Rate for Payer: PHCS All Commercial |
$770.22
|
| Rate for Payer: PHP All Commercial |
$778.85
|
| Rate for Payer: Sagamore Health Network All Products |
$792.81
|
| Rate for Payer: Signature Care EPO |
$852.38
|
| Rate for Payer: Signature Care PPO |
$903.72
|
| Rate for Payer: United Healthcare Commercial |
$809.24
|
|
|
HC U/S VENOUS IMAGING LWR EXT BIL
|
Facility
|
OP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1643979
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$189.62 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,448.44
|
| Rate for Payer: Aetna Medicare |
$549.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$189.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$532.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$985.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$189.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$631.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$604.09
|
| Rate for Payer: Cash Price |
$1,029.70
|
| Rate for Payer: Cash Price |
$1,029.70
|
| Rate for Payer: Centivo All Commercial |
$933.59
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Humana Medicare |
$549.17
|
| Rate for Payer: Lucent All Commercial |
$933.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: Managed Health Services Medicaid |
$189.62
|
| Rate for Payer: MDWise Medicaid |
$189.62
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$669.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,458.74
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
| Rate for Payer: United Healthcare Medicare |
$549.17
|
|
|
HC U/S VENOUS IMAGING LWR EXT BIL
|
Facility
|
IP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1643979
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,287.12 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,482.76
|
| Rate for Payer: Cash Price |
$1,029.70
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
|
|
HC U/S VENOUS IMAGING UP EXT BIL
|
Facility
|
IP
|
$1,716.16
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
1643970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,287.12 |
| Max. Negotiated Rate |
$1,596.03 |
| Rate for Payer: Aetna Commercial |
$1,482.76
|
| Rate for Payer: Cash Price |
$1,029.70
|
| Rate for Payer: Cigna All Commercial |
$1,481.05
|
| Rate for Payer: CORVEL All Commercial |
$1,596.03
|
| Rate for Payer: Coventry All Commercial |
$1,510.22
|
| Rate for Payer: Encore All Commercial |
$1,579.73
|
| Rate for Payer: Frontpath All Commercial |
$1,578.87
|
| Rate for Payer: Humana ChoiceCare |
$1,482.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,544.54
|
| Rate for Payer: PHCS All Commercial |
$1,287.12
|
| Rate for Payer: PHP All Commercial |
$1,301.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,324.88
|
| Rate for Payer: Signature Care EPO |
$1,424.41
|
| Rate for Payer: Signature Care PPO |
$1,510.22
|
| Rate for Payer: United Healthcare Commercial |
$1,352.33
|
|
