|
HC WEST NILE IGG
|
Facility
|
IP
|
$89.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63001198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.14 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Aetna Commercial |
$77.34
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna All Commercial |
$77.25
|
| Rate for Payer: CORVEL All Commercial |
$83.25
|
| Rate for Payer: Coventry All Commercial |
$78.77
|
| Rate for Payer: Encore All Commercial |
$82.40
|
| Rate for Payer: Frontpath All Commercial |
$82.35
|
| Rate for Payer: Humana ChoiceCare |
$77.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.56
|
| Rate for Payer: PHCS All Commercial |
$67.14
|
| Rate for Payer: PHP All Commercial |
$67.89
|
| Rate for Payer: Sagamore Health Network All Products |
$69.11
|
| Rate for Payer: Signature Care EPO |
$74.30
|
| Rate for Payer: Signature Care PPO |
$78.77
|
| Rate for Payer: United Healthcare Commercial |
$70.54
|
|
|
HC WEST NILE IGG
|
Facility
|
OP
|
$89.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63001198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Aetna Commercial |
$75.55
|
| Rate for Payer: Aetna Medicare |
$29.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.49
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Centivo All Commercial |
$45.65
|
| Rate for Payer: Cigna All Commercial |
$77.25
|
| Rate for Payer: CORVEL All Commercial |
$83.25
|
| Rate for Payer: Coventry All Commercial |
$78.77
|
| Rate for Payer: Encore All Commercial |
$82.40
|
| Rate for Payer: Frontpath All Commercial |
$82.35
|
| Rate for Payer: Humana ChoiceCare |
$77.31
|
| Rate for Payer: Humana Medicare |
$45.65
|
| Rate for Payer: Lucent All Commercial |
$45.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.56
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$67.14
|
| Rate for Payer: PHP All Commercial |
$67.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.91
|
| Rate for Payer: Sagamore Health Network All Products |
$69.11
|
| Rate for Payer: Signature Care EPO |
$74.30
|
| Rate for Payer: Signature Care PPO |
$78.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.09
|
| Rate for Payer: United Healthcare Commercial |
$70.54
|
| Rate for Payer: United Healthcare Medicare |
$29.54
|
|
|
HC WEST NILE IGG, IGM
|
Facility
|
OP
|
$191.25
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63001976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$177.86 |
| Rate for Payer: Aetna Commercial |
$161.42
|
| Rate for Payer: Aetna Medicare |
$63.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.42
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Centivo All Commercial |
$97.54
|
| Rate for Payer: Cigna All Commercial |
$165.05
|
| Rate for Payer: CORVEL All Commercial |
$177.86
|
| Rate for Payer: Coventry All Commercial |
$168.30
|
| Rate for Payer: Encore All Commercial |
$176.05
|
| Rate for Payer: Frontpath All Commercial |
$175.95
|
| Rate for Payer: Humana ChoiceCare |
$165.18
|
| Rate for Payer: Humana Medicare |
$97.54
|
| Rate for Payer: Lucent All Commercial |
$97.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.12
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$143.44
|
| Rate for Payer: PHP All Commercial |
$145.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.59
|
| Rate for Payer: Sagamore Health Network All Products |
$147.64
|
| Rate for Payer: Signature Care EPO |
$158.74
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.56
|
| Rate for Payer: United Healthcare Commercial |
$150.70
|
| Rate for Payer: United Healthcare Medicare |
$63.11
|
|
|
HC WEST NILE IGG, IGM
|
Facility
|
IP
|
$191.25
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63001976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$177.86 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cigna All Commercial |
$165.05
|
| Rate for Payer: CORVEL All Commercial |
$177.86
|
| Rate for Payer: Coventry All Commercial |
$168.30
|
| Rate for Payer: Encore All Commercial |
$176.05
|
| Rate for Payer: Frontpath All Commercial |
$175.95
|
| Rate for Payer: Humana ChoiceCare |
$165.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.12
|
| Rate for Payer: PHCS All Commercial |
$143.44
|
| Rate for Payer: PHP All Commercial |
$145.04
|
| Rate for Payer: Sagamore Health Network All Products |
$147.64
|
| Rate for Payer: Signature Care EPO |
$158.74
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$150.70
|
|
|
HC WEST NILE IGM
|
Facility
|
IP
|
$87.30
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
63001199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.48 |
| Max. Negotiated Rate |
$81.19 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Cigna All Commercial |
$75.34
|
| Rate for Payer: CORVEL All Commercial |
$81.19
|
| Rate for Payer: Coventry All Commercial |
$76.83
|
| Rate for Payer: Encore All Commercial |
$80.36
|
| Rate for Payer: Frontpath All Commercial |
$80.32
|
| Rate for Payer: Humana ChoiceCare |
$75.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.57
|
| Rate for Payer: PHCS All Commercial |
$65.48
|
| Rate for Payer: PHP All Commercial |
$66.21
|
| Rate for Payer: Sagamore Health Network All Products |
$67.40
|
| Rate for Payer: Signature Care EPO |
$72.46
|
| Rate for Payer: Signature Care PPO |
$76.83
|
| Rate for Payer: United Healthcare Commercial |
$68.79
|
|
|
HC WEST NILE IGM
|
Facility
|
OP
|
$87.30
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
63001199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$81.19 |
| Rate for Payer: Aetna Commercial |
$73.68
|
| Rate for Payer: Aetna Medicare |
$28.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.69
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Centivo All Commercial |
$44.52
|
| Rate for Payer: Cigna All Commercial |
$75.34
|
| Rate for Payer: CORVEL All Commercial |
$81.19
|
| Rate for Payer: Coventry All Commercial |
$76.83
|
| Rate for Payer: Encore All Commercial |
$80.36
|
| Rate for Payer: Frontpath All Commercial |
$80.32
|
| Rate for Payer: Humana ChoiceCare |
$75.40
|
| Rate for Payer: Humana Medicare |
$44.52
|
| Rate for Payer: Lucent All Commercial |
$44.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.57
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$65.48
|
| Rate for Payer: PHP All Commercial |
$66.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.05
|
| Rate for Payer: Sagamore Health Network All Products |
$67.40
|
| Rate for Payer: Signature Care EPO |
$72.46
|
| Rate for Payer: Signature Care PPO |
$76.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.21
|
| Rate for Payer: United Healthcare Commercial |
$68.79
|
| Rate for Payer: United Healthcare Medicare |
$28.81
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
63044084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
63044084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Aetna Medicare |
$19.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.10
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Centivo All Commercial |
$29.65
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Humana Medicare |
$29.65
|
| Rate for Payer: Lucent All Commercial |
$29.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: Managed Health Services Medicaid |
$13.91
|
| Rate for Payer: MDWise Medicaid |
$13.91
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.67
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.42
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
| Rate for Payer: United Healthcare Medicare |
$19.19
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY-B
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63044085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
|
|
HC WEST NILE VIRUS (WNV) ANTIBODY-B
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
63044085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Aetna Medicare |
$19.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$14.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.10
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Centivo All Commercial |
$29.65
|
| Rate for Payer: Cigna All Commercial |
$50.17
|
| Rate for Payer: CORVEL All Commercial |
$54.07
|
| Rate for Payer: Coventry All Commercial |
$51.16
|
| Rate for Payer: Encore All Commercial |
$53.52
|
| Rate for Payer: Frontpath All Commercial |
$53.49
|
| Rate for Payer: Humana ChoiceCare |
$50.22
|
| Rate for Payer: Humana Medicare |
$29.65
|
| Rate for Payer: Lucent All Commercial |
$29.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.33
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: MDWise Medicaid |
$14.39
|
| Rate for Payer: PHCS All Commercial |
$43.60
|
| Rate for Payer: PHP All Commercial |
$44.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.67
|
| Rate for Payer: Sagamore Health Network All Products |
$44.88
|
| Rate for Payer: Signature Care EPO |
$48.26
|
| Rate for Payer: Signature Care PPO |
$51.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.42
|
| Rate for Payer: United Healthcare Commercial |
$45.81
|
| Rate for Payer: United Healthcare Medicare |
$19.19
|
|
|
HC WET PREP
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna All Commercial |
$89.08
|
| Rate for Payer: CORVEL All Commercial |
$96.00
|
| Rate for Payer: Coventry All Commercial |
$90.84
|
| Rate for Payer: Encore All Commercial |
$95.02
|
| Rate for Payer: Frontpath All Commercial |
$94.97
|
| Rate for Payer: Humana ChoiceCare |
$89.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.90
|
| Rate for Payer: PHCS All Commercial |
$77.42
|
| Rate for Payer: PHP All Commercial |
$78.29
|
| Rate for Payer: Sagamore Health Network All Products |
$79.69
|
| Rate for Payer: Signature Care EPO |
$85.68
|
| Rate for Payer: Signature Care PPO |
$90.84
|
| Rate for Payer: United Healthcare Commercial |
$81.34
|
|
|
HC WET PREP
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
63001062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$87.12
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.47
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Centivo All Commercial |
$52.64
|
| Rate for Payer: Cigna All Commercial |
$89.08
|
| Rate for Payer: CORVEL All Commercial |
$96.00
|
| Rate for Payer: Coventry All Commercial |
$90.84
|
| Rate for Payer: Encore All Commercial |
$95.02
|
| Rate for Payer: Frontpath All Commercial |
$94.97
|
| Rate for Payer: Humana ChoiceCare |
$89.15
|
| Rate for Payer: Humana Medicare |
$52.64
|
| Rate for Payer: Lucent All Commercial |
$52.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.90
|
| Rate for Payer: Managed Health Services Medicaid |
$5.81
|
| Rate for Payer: MDWise Medicaid |
$5.81
|
| Rate for Payer: PHCS All Commercial |
$77.42
|
| Rate for Payer: PHP All Commercial |
$78.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.26
|
| Rate for Payer: Sagamore Health Network All Products |
$79.69
|
| Rate for Payer: Signature Care EPO |
$85.68
|
| Rate for Payer: Signature Care PPO |
$90.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.74
|
| Rate for Payer: United Healthcare Commercial |
$81.34
|
| Rate for Payer: United Healthcare Medicare |
$34.06
|
|
|
HC W FUSIONFLEX 10X10X10
|
Facility
|
IP
|
$1,915.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,781.14 |
| Rate for Payer: Aetna Commercial |
$1,654.73
|
| Rate for Payer: Cash Price |
$1,187.42
|
| Rate for Payer: Cigna All Commercial |
$1,652.82
|
| Rate for Payer: CORVEL All Commercial |
$1,781.14
|
| Rate for Payer: Coventry All Commercial |
$1,685.38
|
| Rate for Payer: Encore All Commercial |
$1,762.94
|
| Rate for Payer: Frontpath All Commercial |
$1,761.98
|
| Rate for Payer: Humana ChoiceCare |
$1,654.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,723.68
|
| Rate for Payer: PHCS All Commercial |
$1,436.40
|
| Rate for Payer: PHP All Commercial |
$1,452.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,478.53
|
| Rate for Payer: Signature Care EPO |
$1,589.62
|
| Rate for Payer: Signature Care PPO |
$1,685.38
|
| Rate for Payer: United Healthcare Commercial |
$1,509.18
|
|
|
HC W FUSIONFLEX 10X10X10
|
Facility
|
OP
|
$1,915.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,781.14 |
| Rate for Payer: Aetna Commercial |
$1,616.43
|
| Rate for Payer: Aetna Medicare |
$632.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,099.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,197.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$726.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.22
|
| Rate for Payer: Cash Price |
$1,187.42
|
| Rate for Payer: Cash Price |
$1,187.42
|
| Rate for Payer: Centivo All Commercial |
$976.75
|
| Rate for Payer: Cigna All Commercial |
$1,652.82
|
| Rate for Payer: CORVEL All Commercial |
$1,781.14
|
| Rate for Payer: Coventry All Commercial |
$1,685.38
|
| Rate for Payer: Encore All Commercial |
$1,762.94
|
| Rate for Payer: Frontpath All Commercial |
$1,761.98
|
| Rate for Payer: Humana ChoiceCare |
$1,654.16
|
| Rate for Payer: Humana Medicare |
$976.75
|
| Rate for Payer: Lucent All Commercial |
$976.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,723.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,436.40
|
| Rate for Payer: PHP All Commercial |
$1,452.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$746.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,478.53
|
| Rate for Payer: Signature Care EPO |
$1,589.62
|
| Rate for Payer: Signature Care PPO |
$1,685.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,627.92
|
| Rate for Payer: United Healthcare Commercial |
$1,509.18
|
| Rate for Payer: United Healthcare Medicare |
$632.02
|
|
|
HC W FUSIONFLEX 10X20X4
|
Facility
|
IP
|
$3,139.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.40 |
| Max. Negotiated Rate |
$2,919.46 |
| Rate for Payer: Aetna Commercial |
$2,712.27
|
| Rate for Payer: Cash Price |
$1,946.30
|
| Rate for Payer: Cigna All Commercial |
$2,709.13
|
| Rate for Payer: CORVEL All Commercial |
$2,919.46
|
| Rate for Payer: Coventry All Commercial |
$2,762.50
|
| Rate for Payer: Encore All Commercial |
$2,889.63
|
| Rate for Payer: Frontpath All Commercial |
$2,888.06
|
| Rate for Payer: Humana ChoiceCare |
$2,711.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,825.28
|
| Rate for Payer: PHCS All Commercial |
$2,354.40
|
| Rate for Payer: PHP All Commercial |
$2,380.77
|
| Rate for Payer: Sagamore Health Network All Products |
$2,423.46
|
| Rate for Payer: Signature Care EPO |
$2,605.54
|
| Rate for Payer: Signature Care PPO |
$2,762.50
|
| Rate for Payer: United Healthcare Commercial |
$2,473.69
|
|
|
HC W FUSIONFLEX 10X20X4
|
Facility
|
OP
|
$3,139.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,919.46 |
| Rate for Payer: Aetna Commercial |
$2,649.48
|
| Rate for Payer: Aetna Medicare |
$1,035.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,035.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,802.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,962.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,191.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,139.53
|
| Rate for Payer: Cash Price |
$1,946.30
|
| Rate for Payer: Cash Price |
$1,946.30
|
| Rate for Payer: Centivo All Commercial |
$1,600.99
|
| Rate for Payer: Cigna All Commercial |
$2,709.13
|
| Rate for Payer: CORVEL All Commercial |
$2,919.46
|
| Rate for Payer: Coventry All Commercial |
$2,762.50
|
| Rate for Payer: Encore All Commercial |
$2,889.63
|
| Rate for Payer: Frontpath All Commercial |
$2,888.06
|
| Rate for Payer: Humana ChoiceCare |
$2,711.33
|
| Rate for Payer: Humana Medicare |
$1,600.99
|
| Rate for Payer: Lucent All Commercial |
$1,600.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,825.28
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,354.40
|
| Rate for Payer: PHP All Commercial |
$2,380.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,224.29
|
| Rate for Payer: Sagamore Health Network All Products |
$2,423.46
|
| Rate for Payer: Signature Care EPO |
$2,605.54
|
| Rate for Payer: Signature Care PPO |
$2,762.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,668.32
|
| Rate for Payer: United Healthcare Commercial |
$2,473.69
|
| Rate for Payer: United Healthcare Medicare |
$1,035.94
|
|
|
HC W FUSIONFLEX 12X12X12
|
Facility
|
IP
|
$2,559.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,919.70 |
| Max. Negotiated Rate |
$2,380.43 |
| Rate for Payer: Aetna Commercial |
$2,211.49
|
| Rate for Payer: Cash Price |
$1,586.95
|
| Rate for Payer: Cigna All Commercial |
$2,208.93
|
| Rate for Payer: CORVEL All Commercial |
$2,380.43
|
| Rate for Payer: Coventry All Commercial |
$2,252.45
|
| Rate for Payer: Encore All Commercial |
$2,356.11
|
| Rate for Payer: Frontpath All Commercial |
$2,354.83
|
| Rate for Payer: Humana ChoiceCare |
$2,210.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,303.64
|
| Rate for Payer: PHCS All Commercial |
$1,919.70
|
| Rate for Payer: PHP All Commercial |
$1,941.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,976.01
|
| Rate for Payer: Signature Care EPO |
$2,124.47
|
| Rate for Payer: Signature Care PPO |
$2,252.45
|
| Rate for Payer: United Healthcare Commercial |
$2,016.96
|
|
|
HC W FUSIONFLEX 12X12X12
|
Facility
|
OP
|
$2,559.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,380.43 |
| Rate for Payer: Aetna Commercial |
$2,160.30
|
| Rate for Payer: Aetna Medicare |
$844.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$844.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,469.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,600.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$971.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$929.13
|
| Rate for Payer: Cash Price |
$1,586.95
|
| Rate for Payer: Cash Price |
$1,586.95
|
| Rate for Payer: Centivo All Commercial |
$1,305.40
|
| Rate for Payer: Cigna All Commercial |
$2,208.93
|
| Rate for Payer: CORVEL All Commercial |
$2,380.43
|
| Rate for Payer: Coventry All Commercial |
$2,252.45
|
| Rate for Payer: Encore All Commercial |
$2,356.11
|
| Rate for Payer: Frontpath All Commercial |
$2,354.83
|
| Rate for Payer: Humana ChoiceCare |
$2,210.73
|
| Rate for Payer: Humana Medicare |
$1,305.40
|
| Rate for Payer: Lucent All Commercial |
$1,305.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,303.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,919.70
|
| Rate for Payer: PHP All Commercial |
$1,941.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$998.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,976.01
|
| Rate for Payer: Signature Care EPO |
$2,124.47
|
| Rate for Payer: Signature Care PPO |
$2,252.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,175.66
|
| Rate for Payer: United Healthcare Commercial |
$2,016.96
|
| Rate for Payer: United Healthcare Medicare |
$844.67
|
|
|
HC W FUSIONFLEX 20X20X20 2/PK
|
Facility
|
OP
|
$6,238.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,802.08 |
| Rate for Payer: Aetna Commercial |
$5,265.55
|
| Rate for Payer: Aetna Medicare |
$2,058.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,058.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,582.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,899.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,367.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,264.68
|
| Rate for Payer: Cash Price |
$3,868.06
|
| Rate for Payer: Cash Price |
$3,868.06
|
| Rate for Payer: Centivo All Commercial |
$3,181.79
|
| Rate for Payer: Cigna All Commercial |
$5,384.08
|
| Rate for Payer: CORVEL All Commercial |
$5,802.08
|
| Rate for Payer: Coventry All Commercial |
$5,490.14
|
| Rate for Payer: Encore All Commercial |
$5,742.82
|
| Rate for Payer: Frontpath All Commercial |
$5,739.70
|
| Rate for Payer: Humana ChoiceCare |
$5,388.45
|
| Rate for Payer: Humana Medicare |
$3,181.79
|
| Rate for Payer: Lucent All Commercial |
$3,181.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,614.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,679.10
|
| Rate for Payer: PHP All Commercial |
$4,731.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,433.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4,816.35
|
| Rate for Payer: Signature Care EPO |
$5,178.20
|
| Rate for Payer: Signature Care PPO |
$5,490.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,302.98
|
| Rate for Payer: United Healthcare Commercial |
$4,916.17
|
| Rate for Payer: United Healthcare Medicare |
$2,058.80
|
|
|
HC W FUSIONFLEX 20X20X20 2/PK
|
Facility
|
IP
|
$6,238.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,679.10 |
| Max. Negotiated Rate |
$5,802.08 |
| Rate for Payer: Aetna Commercial |
$5,390.32
|
| Rate for Payer: Cash Price |
$3,868.06
|
| Rate for Payer: Cigna All Commercial |
$5,384.08
|
| Rate for Payer: CORVEL All Commercial |
$5,802.08
|
| Rate for Payer: Coventry All Commercial |
$5,490.14
|
| Rate for Payer: Encore All Commercial |
$5,742.82
|
| Rate for Payer: Frontpath All Commercial |
$5,739.70
|
| Rate for Payer: Humana ChoiceCare |
$5,388.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,614.92
|
| Rate for Payer: PHCS All Commercial |
$4,679.10
|
| Rate for Payer: PHP All Commercial |
$4,731.51
|
| Rate for Payer: Sagamore Health Network All Products |
$4,816.35
|
| Rate for Payer: Signature Care EPO |
$5,178.20
|
| Rate for Payer: Signature Care PPO |
$5,490.14
|
| Rate for Payer: United Healthcare Commercial |
$4,916.17
|
|
|
HC W FUSIONFLEX 20X20X4
|
Facility
|
OP
|
$4,626.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,302.18 |
| Rate for Payer: Aetna Commercial |
$3,904.34
|
| Rate for Payer: Aetna Medicare |
$1,526.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,526.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,656.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,891.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,755.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,679.24
|
| Rate for Payer: Cash Price |
$2,868.12
|
| Rate for Payer: Cash Price |
$2,868.12
|
| Rate for Payer: Centivo All Commercial |
$2,359.26
|
| Rate for Payer: Cigna All Commercial |
$3,992.24
|
| Rate for Payer: CORVEL All Commercial |
$4,302.18
|
| Rate for Payer: Coventry All Commercial |
$4,070.88
|
| Rate for Payer: Encore All Commercial |
$4,258.23
|
| Rate for Payer: Frontpath All Commercial |
$4,255.92
|
| Rate for Payer: Humana ChoiceCare |
$3,995.48
|
| Rate for Payer: Humana Medicare |
$2,359.26
|
| Rate for Payer: Lucent All Commercial |
$2,359.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,163.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,469.50
|
| Rate for Payer: PHP All Commercial |
$3,508.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,804.14
|
| Rate for Payer: Sagamore Health Network All Products |
$3,571.27
|
| Rate for Payer: Signature Care EPO |
$3,839.58
|
| Rate for Payer: Signature Care PPO |
$4,070.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,932.10
|
| Rate for Payer: United Healthcare Commercial |
$3,645.29
|
| Rate for Payer: United Healthcare Medicare |
$1,526.58
|
|
|
HC W FUSIONFLEX 20X20X4
|
Facility
|
IP
|
$4,626.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,469.50 |
| Max. Negotiated Rate |
$4,302.18 |
| Rate for Payer: Aetna Commercial |
$3,996.86
|
| Rate for Payer: Cash Price |
$2,868.12
|
| Rate for Payer: Cigna All Commercial |
$3,992.24
|
| Rate for Payer: CORVEL All Commercial |
$4,302.18
|
| Rate for Payer: Coventry All Commercial |
$4,070.88
|
| Rate for Payer: Encore All Commercial |
$4,258.23
|
| Rate for Payer: Frontpath All Commercial |
$4,255.92
|
| Rate for Payer: Humana ChoiceCare |
$3,995.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,163.40
|
| Rate for Payer: PHCS All Commercial |
$3,469.50
|
| Rate for Payer: PHP All Commercial |
$3,508.36
|
| Rate for Payer: Sagamore Health Network All Products |
$3,571.27
|
| Rate for Payer: Signature Care EPO |
$3,839.58
|
| Rate for Payer: Signature Care PPO |
$4,070.88
|
| Rate for Payer: United Healthcare Commercial |
$3,645.29
|
|
|
HC W FUSIONFLEX 20X50X4
|
Facility
|
OP
|
$10,357.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,632.20 |
| Rate for Payer: Aetna Commercial |
$8,741.48
|
| Rate for Payer: Aetna Medicare |
$3,417.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,417.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,948.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,474.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,930.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,759.66
|
| Rate for Payer: Cash Price |
$6,421.46
|
| Rate for Payer: Cash Price |
$6,421.46
|
| Rate for Payer: Centivo All Commercial |
$5,282.17
|
| Rate for Payer: Cigna All Commercial |
$8,938.26
|
| Rate for Payer: CORVEL All Commercial |
$9,632.20
|
| Rate for Payer: Coventry All Commercial |
$9,114.34
|
| Rate for Payer: Encore All Commercial |
$9,533.80
|
| Rate for Payer: Frontpath All Commercial |
$9,528.62
|
| Rate for Payer: Humana ChoiceCare |
$8,945.51
|
| Rate for Payer: Humana Medicare |
$5,282.17
|
| Rate for Payer: Lucent All Commercial |
$5,282.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,321.48
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,767.90
|
| Rate for Payer: PHP All Commercial |
$7,854.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,039.31
|
| Rate for Payer: Sagamore Health Network All Products |
$7,995.76
|
| Rate for Payer: Signature Care EPO |
$8,596.48
|
| Rate for Payer: Signature Care PPO |
$9,114.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,803.62
|
| Rate for Payer: United Healthcare Commercial |
$8,161.47
|
| Rate for Payer: United Healthcare Medicare |
$3,417.88
|
|
|
HC W FUSIONFLEX 20X50X4
|
Facility
|
IP
|
$10,357.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,767.90 |
| Max. Negotiated Rate |
$9,632.20 |
| Rate for Payer: Aetna Commercial |
$8,948.62
|
| Rate for Payer: Cash Price |
$6,421.46
|
| Rate for Payer: Cigna All Commercial |
$8,938.26
|
| Rate for Payer: CORVEL All Commercial |
$9,632.20
|
| Rate for Payer: Coventry All Commercial |
$9,114.34
|
| Rate for Payer: Encore All Commercial |
$9,533.80
|
| Rate for Payer: Frontpath All Commercial |
$9,528.62
|
| Rate for Payer: Humana ChoiceCare |
$8,945.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,321.48
|
| Rate for Payer: PHCS All Commercial |
$7,767.90
|
| Rate for Payer: PHP All Commercial |
$7,854.90
|
| Rate for Payer: Sagamore Health Network All Products |
$7,995.76
|
| Rate for Payer: Signature Care EPO |
$8,596.48
|
| Rate for Payer: Signature Care PPO |
$9,114.34
|
| Rate for Payer: United Healthcare Commercial |
$8,161.47
|
|
|
HC W FUSIONFLEX 8X8X8
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,841.40 |
| Rate for Payer: Aetna Commercial |
$1,671.12
|
| Rate for Payer: Aetna Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$653.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,137.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,237.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$751.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$718.74
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Centivo All Commercial |
$1,009.80
|
| Rate for Payer: Cigna All Commercial |
$1,708.74
|
| Rate for Payer: CORVEL All Commercial |
$1,841.40
|
| Rate for Payer: Coventry All Commercial |
$1,742.40
|
| Rate for Payer: Encore All Commercial |
$1,822.59
|
| Rate for Payer: Frontpath All Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$1,710.13
|
| Rate for Payer: Humana Medicare |
$1,009.80
|
| Rate for Payer: Lucent All Commercial |
$1,009.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,782.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,485.00
|
| Rate for Payer: PHP All Commercial |
$1,501.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$772.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,528.56
|
| Rate for Payer: Signature Care EPO |
$1,643.40
|
| Rate for Payer: Signature Care PPO |
$1,742.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,560.24
|
| Rate for Payer: United Healthcare Medicare |
$653.40
|
|
