Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON

Facility

$488.57

Service Code	CPT 26410
Hospital Revenue Code	360
Min. Negotiated Rate	$488.57
Max. Negotiated Rate	$488.57
Rate for Payer: Anthem Blue Cross of IN Medicaid	$488.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$488.57
Rate for Payer: Managed Health Services Medicaid	$488.57
Rate for Payer: MDWise Medicaid	$488.57

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS

Facility

$166.20

Service Code	CPT 12041
Hospital Revenue Code	360
Min. Negotiated Rate	$166.20
Max. Negotiated Rate	$166.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$166.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$166.20
Rate for Payer: Managed Health Services Medicaid	$166.20
Rate for Payer: MDWise Medicaid	$166.20

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM

Facility

$443.28

Service Code	CPT 12035
Hospital Revenue Code	360
Min. Negotiated Rate	$443.28
Max. Negotiated Rate	$443.28
Rate for Payer: Anthem Blue Cross of IN Medicaid	$443.28
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$443.28
Rate for Payer: Managed Health Services Medicaid	$443.28
Rate for Payer: MDWise Medicaid	$443.28

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM

Facility

$443.28

Service Code	CPT 12036
Hospital Revenue Code	360
Min. Negotiated Rate	$443.28
Max. Negotiated Rate	$443.28
Rate for Payer: Anthem Blue Cross of IN Medicaid	$443.28
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$443.28
Rate for Payer: Managed Health Services Medicaid	$443.28
Rate for Payer: MDWise Medicaid	$443.28

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE

Facility

$3,346.60

Service Code	CPT 49615
Hospital Revenue Code	360
Min. Negotiated Rate	$3,346.60
Max. Negotiated Rate	$3,346.60
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,346.60
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,346.60
Rate for Payer: Managed Health Services Medicaid	$3,346.60
Rate for Payer: MDWise Medicaid	$3,346.60

Facility

$3,346.60

Service Code	CPT 49614
Hospital Revenue Code	360
Min. Negotiated Rate	$3,346.60
Max. Negotiated Rate	$3,346.60
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,346.60
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,346.60
Rate for Payer: Managed Health Services Medicaid	$3,346.60
Rate for Payer: MDWise Medicaid	$3,346.60

REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)

Facility

$582.98

Service Code	CPT 55060
Hospital Revenue Code	360
Min. Negotiated Rate	$582.98
Max. Negotiated Rate	$582.98
Rate for Payer: Anthem Blue Cross of IN Medicaid	$582.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$582.98
Rate for Payer: Managed Health Services Medicaid	$582.98
Rate for Payer: MDWise Medicaid	$582.98

REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;

Facility

$488.57

Service Code	CPT 27650
Hospital Revenue Code	360
Min. Negotiated Rate	$488.57
Max. Negotiated Rate	$488.57
Rate for Payer: Anthem Blue Cross of IN Medicaid	$488.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$488.57
Rate for Payer: Managed Health Services Medicaid	$488.57
Rate for Payer: MDWise Medicaid	$488.57

REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED

Facility

$1,014.81

Service Code	CPT 49521
Hospital Revenue Code	360
Min. Negotiated Rate	$1,014.81
Max. Negotiated Rate	$1,014.81
Rate for Payer: Anthem Blue Cross of IN Medicaid	$1,014.81
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$1,014.81
Rate for Payer: Managed Health Services Medicaid	$1,014.81
Rate for Payer: MDWise Medicaid	$1,014.81

REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE

Facility

$582.98

Service Code	CPT 25270
Hospital Revenue Code	360
Min. Negotiated Rate	$582.98
Max. Negotiated Rate	$582.98
Rate for Payer: Anthem Blue Cross of IN Medicaid	$582.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$582.98
Rate for Payer: Managed Health Services Medicaid	$582.98
Rate for Payer: MDWise Medicaid	$582.98

REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EXCLUDES ROTATOR CUFF)

Facility

$1,079.83

Service Code	CPT 24341
Hospital Revenue Code	360
Min. Negotiated Rate	$1,079.83
Max. Negotiated Rate	$1,079.83
Rate for Payer: Anthem Blue Cross of IN Medicaid	$1,079.83
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$1,079.83
Rate for Payer: Managed Health Services Medicaid	$1,079.83
Rate for Payer: MDWise Medicaid	$1,079.83

REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT

Facility

$166.20

Service Code	CPT 43762
Hospital Revenue Code	361
Min. Negotiated Rate	$166.20
Max. Negotiated Rate	$166.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$166.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$166.20
Rate for Payer: Managed Health Services Medicaid	$166.20
Rate for Payer: MDWise Medicaid	$166.20

REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT

Facility

$6,693.20

Service Code	CPT 27486
Hospital Revenue Code	360
Min. Negotiated Rate	$6,693.20
Max. Negotiated Rate	$6,693.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,693.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,693.20
Rate for Payer: Managed Health Services Medicaid	$6,693.20
Rate for Payer: MDWise Medicaid	$6,693.20

REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT

Facility

$6,693.20

Service Code	CPT 27487
Hospital Revenue Code	360
Min. Negotiated Rate	$6,693.20
Max. Negotiated Rate	$6,693.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,693.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,693.20
Rate for Payer: Managed Health Services Medicaid	$6,693.20
Rate for Payer: MDWise Medicaid	$6,693.20

REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND GLENOID COMPONENT

Facility

$6,693.20

Service Code	CPT 23474
Hospital Revenue Code	360
Min. Negotiated Rate	$6,693.20
Max. Negotiated Rate	$6,693.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,693.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,693.20
Rate for Payer: Managed Health Services Medicaid	$6,693.20
Rate for Payer: MDWise Medicaid	$6,693.20

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJ SYRG

Facility

$450.00

Service Code	HCPCS J2791
Hospital Charge Code	38072
Hospital Revenue Code	636
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$418.50
Rate for Payer: Aetna Commercial	$379.80
Rate for Payer: Aetna Medicare	$144.00
Rate for Payer: Anthem Blue Cross of IN Medicaid	$10.83
Rate for Payer: Anthem Blue Cross of IN Medicare	$139.50
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$258.44
Rate for Payer: Anthem Blue Cross of IN Traditional	$281.30
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$10.83
Rate for Payer: CareSource Indiana of IN Just 4 Me	$165.60
Rate for Payer: CareSource Indiana of IN Medicare	$158.40
Rate for Payer: Cash Price	$279.00
Rate for Payer: Cash Price	$279.00
Rate for Payer: Centivo All Commercial	$244.80
Rate for Payer: Cigna All Commercial	$388.35
Rate for Payer: CORVEL All Commercial	$418.50
Rate for Payer: Coventry All Commercial	$396.00
Rate for Payer: Encore All Commercial	$414.23
Rate for Payer: Frontpath All Commercial	$414.00
Rate for Payer: Humana ChoiceCare	$388.67
Rate for Payer: Humana Medicare	$144.00
Rate for Payer: Lucent All Commercial	$244.80
Rate for Payer: Lutheran Preferred All Commercial	$405.00
Rate for Payer: Managed Health Services Medicaid	$10.83
Rate for Payer: MDWise Medicaid	$10.83
Rate for Payer: PHCS All Commercial	$337.50
Rate for Payer: PHP All Commercial	$341.28
Rate for Payer: Plain Church Group Ministry All Commercial	$175.50
Rate for Payer: Sagamore Health Network All Products	$347.40
Rate for Payer: Signature Care EPO	$373.50
Rate for Payer: Signature Care PPO	$396.00
Rate for Payer: Three Rivers Preferred All Commercial	$382.50
Rate for Payer: United Healthcare Commercial	$354.60
Rate for Payer: United Healthcare Medicare	$144.00

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJ SYRG

Facility

$450.00

Service Code	HCPCS J2791
Hospital Charge Code	38072
Hospital Revenue Code	250
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$418.50
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Cash Price	$279.00
Rate for Payer: Cigna All Commercial	$388.35
Rate for Payer: CORVEL All Commercial	$418.50
Rate for Payer: Coventry All Commercial	$396.00
Rate for Payer: Encore All Commercial	$414.23
Rate for Payer: Frontpath All Commercial	$414.00
Rate for Payer: Humana ChoiceCare	$388.67
Rate for Payer: Lutheran Preferred All Commercial	$405.00
Rate for Payer: PHCS All Commercial	$337.50
Rate for Payer: PHP All Commercial	$341.28
Rate for Payer: Sagamore Health Network All Products	$347.40
Rate for Payer: Signature Care EPO	$373.50
Rate for Payer: Signature Care PPO	$396.00
Rate for Payer: United Healthcare Commercial	$354.60

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG

Facility

$444.00

Service Code	HCPCS J2790
Hospital Charge Code	11283
Hospital Revenue Code	636
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$412.92
Rate for Payer: Aetna Commercial	$374.74
Rate for Payer: Aetna Medicare	$142.08
Rate for Payer: Anthem Blue Cross of IN Medicaid	$86.97
Rate for Payer: Anthem Blue Cross of IN Medicare	$137.64
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$254.99
Rate for Payer: Anthem Blue Cross of IN Traditional	$277.54
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$86.97
Rate for Payer: CareSource Indiana of IN Just 4 Me	$163.39
Rate for Payer: CareSource Indiana of IN Medicare	$156.29
Rate for Payer: Cash Price	$275.28
Rate for Payer: Cash Price	$275.28
Rate for Payer: Centivo All Commercial	$241.54
Rate for Payer: Cigna All Commercial	$383.17
Rate for Payer: CORVEL All Commercial	$412.92
Rate for Payer: Coventry All Commercial	$390.72
Rate for Payer: Encore All Commercial	$408.70
Rate for Payer: Frontpath All Commercial	$408.48
Rate for Payer: Humana ChoiceCare	$383.48
Rate for Payer: Humana Medicare	$142.08
Rate for Payer: Lucent All Commercial	$241.54
Rate for Payer: Lutheran Preferred All Commercial	$399.60
Rate for Payer: Managed Health Services Medicaid	$86.97
Rate for Payer: MDWise Medicaid	$86.97
Rate for Payer: PHCS All Commercial	$333.00
Rate for Payer: PHP All Commercial	$336.73
Rate for Payer: Plain Church Group Ministry All Commercial	$173.16
Rate for Payer: Sagamore Health Network All Products	$342.77
Rate for Payer: Signature Care EPO	$368.52
Rate for Payer: Signature Care PPO	$390.72
Rate for Payer: Three Rivers Preferred All Commercial	$377.40
Rate for Payer: United Healthcare Commercial	$349.87
Rate for Payer: United Healthcare Medicare	$142.08

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG

Facility

$444.00

Service Code	HCPCS J2790
Hospital Charge Code	11283
Hospital Revenue Code	250
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$412.92
Rate for Payer: Aetna Commercial	$383.62
Rate for Payer: Cash Price	$275.28
Rate for Payer: Cigna All Commercial	$383.17
Rate for Payer: CORVEL All Commercial	$412.92
Rate for Payer: Coventry All Commercial	$390.72
Rate for Payer: Encore All Commercial	$408.70
Rate for Payer: Frontpath All Commercial	$408.48
Rate for Payer: Humana ChoiceCare	$383.48
Rate for Payer: Lutheran Preferred All Commercial	$399.60
Rate for Payer: PHCS All Commercial	$333.00
Rate for Payer: PHP All Commercial	$336.73
Rate for Payer: Sagamore Health Network All Products	$342.77
Rate for Payer: Signature Care EPO	$368.52
Rate for Payer: Signature Care PPO	$390.72
Rate for Payer: United Healthcare Commercial	$349.87

RIFAMPIN 150 MG ORAL CAP

Facility

$5.42

Service Code	NDC 68180065806
Hospital Charge Code	11292
Hospital Revenue Code	637
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$5.04
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: Aetna Medicare	$1.73
Rate for Payer: Anthem Blue Cross of IN Medicare	$1.68
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$3.11
Rate for Payer: Anthem Blue Cross of IN Traditional	$3.39
Rate for Payer: CareSource Indiana of IN Just 4 Me	$1.99
Rate for Payer: CareSource Indiana of IN Medicare	$1.91
Rate for Payer: Cash Price	$3.36
Rate for Payer: Centivo All Commercial	$2.95
Rate for Payer: Cigna All Commercial	$4.68
Rate for Payer: CORVEL All Commercial	$5.04
Rate for Payer: Coventry All Commercial	$4.77
Rate for Payer: Encore All Commercial	$4.99
Rate for Payer: Frontpath All Commercial	$4.98
Rate for Payer: Humana ChoiceCare	$4.68
Rate for Payer: Humana Medicare	$1.73
Rate for Payer: Lucent All Commercial	$2.95
Rate for Payer: Lutheran Preferred All Commercial	$4.88
Rate for Payer: PHCS All Commercial	$4.06
Rate for Payer: PHP All Commercial	$4.11
Rate for Payer: Plain Church Group Ministry All Commercial	$2.11
Rate for Payer: Sagamore Health Network All Products	$4.18
Rate for Payer: Signature Care EPO	$4.50
Rate for Payer: Signature Care PPO	$4.77
Rate for Payer: Three Rivers Preferred All Commercial	$4.61
Rate for Payer: United Healthcare Commercial	$4.27
Rate for Payer: United Healthcare Medicare	$1.73

RIFAMPIN 150 MG ORAL CAP

Facility

$5.42

Service Code	NDC 68180065806
Hospital Charge Code	11292
Hospital Revenue Code	250
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$5.04
Rate for Payer: Aetna Commercial	$4.68
Rate for Payer: Cash Price	$3.36
Rate for Payer: Cigna All Commercial	$4.68
Rate for Payer: CORVEL All Commercial	$5.04
Rate for Payer: Coventry All Commercial	$4.77
Rate for Payer: Encore All Commercial	$4.99
Rate for Payer: Frontpath All Commercial	$4.98
Rate for Payer: Humana ChoiceCare	$4.68
Rate for Payer: Lutheran Preferred All Commercial	$4.88
Rate for Payer: PHCS All Commercial	$4.06
Rate for Payer: PHP All Commercial	$4.11
Rate for Payer: Sagamore Health Network All Products	$4.18
Rate for Payer: Signature Care EPO	$4.50
Rate for Payer: Signature Care PPO	$4.77
Rate for Payer: United Healthcare Commercial	$4.27

RIFAXIMIN 200 MG ORAL TAB

Facility

$73.67

Service Code	NDC 65649030103
Hospital Charge Code	39063
Hospital Revenue Code	250
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$68.51
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Cash Price	$45.67
Rate for Payer: Cigna All Commercial	$63.58
Rate for Payer: CORVEL All Commercial	$68.51
Rate for Payer: Coventry All Commercial	$64.83
Rate for Payer: Encore All Commercial	$67.81
Rate for Payer: Frontpath All Commercial	$67.77
Rate for Payer: Humana ChoiceCare	$63.63
Rate for Payer: Lutheran Preferred All Commercial	$66.30
Rate for Payer: PHCS All Commercial	$55.25
Rate for Payer: PHP All Commercial	$55.87
Rate for Payer: Sagamore Health Network All Products	$56.87
Rate for Payer: Signature Care EPO	$61.14
Rate for Payer: Signature Care PPO	$64.83
Rate for Payer: United Healthcare Commercial	$58.05

RIFAXIMIN 200 MG ORAL TAB

Facility

$73.67

Service Code	NDC 65649030103
Hospital Charge Code	39063
Hospital Revenue Code	637
Min. Negotiated Rate	$22.84
Max. Negotiated Rate	$68.51
Rate for Payer: Aetna Commercial	$62.18
Rate for Payer: Aetna Medicare	$23.57
Rate for Payer: Anthem Blue Cross of IN Medicare	$22.84
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$42.31
Rate for Payer: Anthem Blue Cross of IN Traditional	$46.05
Rate for Payer: CareSource Indiana of IN Just 4 Me	$27.11
Rate for Payer: CareSource Indiana of IN Medicare	$25.93
Rate for Payer: Cash Price	$45.67
Rate for Payer: Centivo All Commercial	$40.08
Rate for Payer: Cigna All Commercial	$63.58
Rate for Payer: CORVEL All Commercial	$68.51
Rate for Payer: Coventry All Commercial	$64.83
Rate for Payer: Encore All Commercial	$67.81
Rate for Payer: Frontpath All Commercial	$67.77
Rate for Payer: Humana ChoiceCare	$63.63
Rate for Payer: Humana Medicare	$23.57
Rate for Payer: Lucent All Commercial	$40.08
Rate for Payer: Lutheran Preferred All Commercial	$66.30
Rate for Payer: PHCS All Commercial	$55.25
Rate for Payer: PHP All Commercial	$55.87
Rate for Payer: Plain Church Group Ministry All Commercial	$28.73
Rate for Payer: Sagamore Health Network All Products	$56.87
Rate for Payer: Signature Care EPO	$61.14
Rate for Payer: Signature Care PPO	$64.83
Rate for Payer: Three Rivers Preferred All Commercial	$62.62
Rate for Payer: United Healthcare Commercial	$58.05
Rate for Payer: United Healthcare Medicare	$23.57

RIFAXIMIN 550 MG ORAL TAB

Facility

$324.68

Service Code	NDC 65649030302
Hospital Charge Code	104604
Hospital Revenue Code	250
Min. Negotiated Rate	$243.51
Max. Negotiated Rate	$301.95
Rate for Payer: Aetna Commercial	$280.52
Rate for Payer: Cash Price	$201.30
Rate for Payer: Cigna All Commercial	$280.20
Rate for Payer: CORVEL All Commercial	$301.95
Rate for Payer: Coventry All Commercial	$285.72
Rate for Payer: Encore All Commercial	$298.87
Rate for Payer: Frontpath All Commercial	$298.70
Rate for Payer: Humana ChoiceCare	$280.42
Rate for Payer: Lutheran Preferred All Commercial	$292.21
Rate for Payer: PHCS All Commercial	$243.51
Rate for Payer: PHP All Commercial	$246.24
Rate for Payer: Sagamore Health Network All Products	$250.65
Rate for Payer: Signature Care EPO	$269.48
Rate for Payer: Signature Care PPO	$285.72
Rate for Payer: United Healthcare Commercial	$255.85

RIFAXIMIN 550 MG ORAL TAB

Facility

$324.68

Service Code	NDC 65649030302
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$301.95
Rate for Payer: Aetna Commercial	$274.03
Rate for Payer: Aetna Medicare	$103.90
Rate for Payer: Anthem Blue Cross of IN Medicare	$100.65
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$186.46
Rate for Payer: Anthem Blue Cross of IN Traditional	$202.96
Rate for Payer: CareSource Indiana of IN Just 4 Me	$119.48
Rate for Payer: CareSource Indiana of IN Medicare	$114.29
Rate for Payer: Cash Price	$201.30
Rate for Payer: Centivo All Commercial	$176.62
Rate for Payer: Cigna All Commercial	$280.20
Rate for Payer: CORVEL All Commercial	$301.95
Rate for Payer: Coventry All Commercial	$285.72
Rate for Payer: Encore All Commercial	$298.87
Rate for Payer: Frontpath All Commercial	$298.70
Rate for Payer: Humana ChoiceCare	$280.42
Rate for Payer: Humana Medicare	$103.90
Rate for Payer: Lucent All Commercial	$176.62
Rate for Payer: Lutheran Preferred All Commercial	$292.21
Rate for Payer: PHCS All Commercial	$243.51
Rate for Payer: PHP All Commercial	$246.24
Rate for Payer: Plain Church Group Ministry All Commercial	$126.62
Rate for Payer: Sagamore Health Network All Products	$250.65
Rate for Payer: Signature Care EPO	$269.48
Rate for Payer: Signature Care PPO	$285.72
Rate for Payer: Three Rivers Preferred All Commercial	$275.98
Rate for Payer: United Healthcare Commercial	$255.85
Rate for Payer: United Healthcare Medicare	$103.90

Know your out-of-pocket cost for care.

All Charges