|
CONJUGATED ESTROGENS 0.625 MG ORAL TAB
|
Facility
|
IP
|
$46.40
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cigna All Commercial |
$40.05
|
| Rate for Payer: CORVEL All Commercial |
$43.15
|
| Rate for Payer: Coventry All Commercial |
$40.83
|
| Rate for Payer: Encore All Commercial |
$42.71
|
| Rate for Payer: Frontpath All Commercial |
$42.69
|
| Rate for Payer: Humana ChoiceCare |
$40.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.76
|
| Rate for Payer: PHCS All Commercial |
$34.80
|
| Rate for Payer: PHP All Commercial |
$35.19
|
| Rate for Payer: Sagamore Health Network All Products |
$35.82
|
| Rate for Payer: Signature Care EPO |
$38.51
|
| Rate for Payer: Signature Care PPO |
$40.83
|
| Rate for Payer: United Healthcare Commercial |
$36.57
|
|
|
CONJUGATED ESTROGENS 25 MG INJ SOLR
|
Facility
|
IP
|
$1,413.32
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,059.99 |
| Max. Negotiated Rate |
$1,314.39 |
| Rate for Payer: Aetna Commercial |
$1,221.11
|
| Rate for Payer: Cash Price |
$847.99
|
| Rate for Payer: Cigna All Commercial |
$1,219.70
|
| Rate for Payer: CORVEL All Commercial |
$1,314.39
|
| Rate for Payer: Coventry All Commercial |
$1,243.72
|
| Rate for Payer: Encore All Commercial |
$1,300.96
|
| Rate for Payer: Frontpath All Commercial |
$1,300.25
|
| Rate for Payer: Humana ChoiceCare |
$1,220.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,271.99
|
| Rate for Payer: PHCS All Commercial |
$1,059.99
|
| Rate for Payer: PHP All Commercial |
$1,071.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.08
|
| Rate for Payer: Signature Care EPO |
$1,173.06
|
| Rate for Payer: Signature Care PPO |
$1,243.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.70
|
|
|
CONJUGATED ESTROGENS 25 MG INJ SOLR
|
Facility
|
OP
|
$1,413.32
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$395.72 |
| Max. Negotiated Rate |
$1,314.39 |
| Rate for Payer: Aetna Commercial |
$1,192.84
|
| Rate for Payer: Aetna Medicare |
$452.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$395.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$811.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$883.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$395.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$520.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$497.49
|
| Rate for Payer: Cash Price |
$847.99
|
| Rate for Payer: Cash Price |
$847.99
|
| Rate for Payer: Centivo All Commercial |
$768.85
|
| Rate for Payer: Cigna All Commercial |
$1,219.70
|
| Rate for Payer: CORVEL All Commercial |
$1,314.39
|
| Rate for Payer: Coventry All Commercial |
$1,243.72
|
| Rate for Payer: Encore All Commercial |
$1,300.96
|
| Rate for Payer: Frontpath All Commercial |
$1,300.25
|
| Rate for Payer: Humana ChoiceCare |
$1,220.68
|
| Rate for Payer: Humana Medicare |
$452.26
|
| Rate for Payer: Lucent All Commercial |
$768.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,271.99
|
| Rate for Payer: Managed Health Services Medicaid |
$395.72
|
| Rate for Payer: MDWise Medicaid |
$395.72
|
| Rate for Payer: PHCS All Commercial |
$1,059.99
|
| Rate for Payer: PHP All Commercial |
$1,071.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$551.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,091.08
|
| Rate for Payer: Signature Care EPO |
$1,173.06
|
| Rate for Payer: Signature Care PPO |
$1,243.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,201.32
|
| Rate for Payer: United Healthcare Commercial |
$1,113.70
|
| Rate for Payer: United Healthcare Medicare |
$452.26
|
|
|
COPPER 380 SQUARE MM IU IUD
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
165649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$739.97 |
| Max. Negotiated Rate |
$2,219.91 |
| Rate for Payer: Aetna Commercial |
$2,014.63
|
| Rate for Payer: Aetna Medicare |
$763.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,195.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$739.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,370.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,492.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,195.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$878.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$840.22
|
| Rate for Payer: Cash Price |
$1,432.20
|
| Rate for Payer: Cash Price |
$1,432.20
|
| Rate for Payer: Centivo All Commercial |
$1,298.53
|
| Rate for Payer: Cigna All Commercial |
$2,059.98
|
| Rate for Payer: CORVEL All Commercial |
$2,219.91
|
| Rate for Payer: Coventry All Commercial |
$2,100.56
|
| Rate for Payer: Encore All Commercial |
$2,197.23
|
| Rate for Payer: Frontpath All Commercial |
$2,196.04
|
| Rate for Payer: Humana ChoiceCare |
$2,061.65
|
| Rate for Payer: Humana Medicare |
$763.84
|
| Rate for Payer: Lucent All Commercial |
$1,298.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,148.30
|
| Rate for Payer: Managed Health Services Medicaid |
$1,195.95
|
| Rate for Payer: MDWise Medicaid |
$1,195.95
|
| Rate for Payer: PHCS All Commercial |
$1,790.25
|
| Rate for Payer: PHP All Commercial |
$1,810.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$930.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,842.76
|
| Rate for Payer: Signature Care EPO |
$1,981.21
|
| Rate for Payer: Signature Care PPO |
$2,100.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,028.95
|
| Rate for Payer: United Healthcare Commercial |
$1,880.96
|
| Rate for Payer: United Healthcare Medicare |
$763.84
|
|
|
COPPER 380 SQUARE MM IU IUD
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
165649
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,790.25 |
| Max. Negotiated Rate |
$2,219.91 |
| Rate for Payer: Aetna Commercial |
$2,062.37
|
| Rate for Payer: Cash Price |
$1,432.20
|
| Rate for Payer: Cigna All Commercial |
$2,059.98
|
| Rate for Payer: CORVEL All Commercial |
$2,219.91
|
| Rate for Payer: Coventry All Commercial |
$2,100.56
|
| Rate for Payer: Encore All Commercial |
$2,197.23
|
| Rate for Payer: Frontpath All Commercial |
$2,196.04
|
| Rate for Payer: Humana ChoiceCare |
$2,061.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,148.30
|
| Rate for Payer: PHCS All Commercial |
$1,790.25
|
| Rate for Payer: PHP All Commercial |
$1,810.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,842.76
|
| Rate for Payer: Signature Care EPO |
$1,981.21
|
| Rate for Payer: Signature Care PPO |
$2,100.56
|
| Rate for Payer: United Healthcare Commercial |
$1,880.96
|
|
|
COPPER CU-64 DOTATATE 148 MBQ/4 ML (4 MCI/4 ML) IV SOLN
|
Facility
|
OP
|
$14,175.00
|
|
|
Service Code
|
HCPCS A9592
|
| Hospital Charge Code |
192491
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4,394.25 |
| Max. Negotiated Rate |
$13,182.75 |
| Rate for Payer: Aetna Commercial |
$11,963.70
|
| Rate for Payer: Aetna Medicare |
$4,536.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,394.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,140.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,860.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,216.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,989.60
|
| Rate for Payer: Cash Price |
$8,505.00
|
| Rate for Payer: Centivo All Commercial |
$7,711.20
|
| Rate for Payer: Cigna All Commercial |
$12,233.02
|
| Rate for Payer: CORVEL All Commercial |
$13,182.75
|
| Rate for Payer: Coventry All Commercial |
$12,474.00
|
| Rate for Payer: Encore All Commercial |
$13,048.09
|
| Rate for Payer: Frontpath All Commercial |
$13,041.00
|
| Rate for Payer: Humana ChoiceCare |
$12,242.95
|
| Rate for Payer: Humana Medicare |
$4,536.00
|
| Rate for Payer: Lucent All Commercial |
$7,711.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,757.50
|
| Rate for Payer: PHCS All Commercial |
$10,631.25
|
| Rate for Payer: PHP All Commercial |
$10,750.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,528.25
|
| Rate for Payer: Sagamore Health Network All Products |
$10,943.10
|
| Rate for Payer: Signature Care EPO |
$11,765.25
|
| Rate for Payer: Signature Care PPO |
$12,474.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,048.75
|
| Rate for Payer: United Healthcare Commercial |
$11,169.90
|
| Rate for Payer: United Healthcare Medicare |
$4,536.00
|
|
|
COPPER CU-64 DOTATATE 148 MBQ/4 ML (4 MCI/4 ML) IV SOLN
|
Facility
|
IP
|
$14,175.00
|
|
|
Service Code
|
HCPCS A9592
|
| Hospital Charge Code |
192491
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$10,631.25 |
| Max. Negotiated Rate |
$13,182.75 |
| Rate for Payer: Aetna Commercial |
$12,247.20
|
| Rate for Payer: Cash Price |
$8,505.00
|
| Rate for Payer: Cigna All Commercial |
$12,233.02
|
| Rate for Payer: CORVEL All Commercial |
$13,182.75
|
| Rate for Payer: Coventry All Commercial |
$12,474.00
|
| Rate for Payer: Encore All Commercial |
$13,048.09
|
| Rate for Payer: Frontpath All Commercial |
$13,041.00
|
| Rate for Payer: Humana ChoiceCare |
$12,242.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12,757.50
|
| Rate for Payer: PHCS All Commercial |
$10,631.25
|
| Rate for Payer: PHP All Commercial |
$10,750.32
|
| Rate for Payer: Sagamore Health Network All Products |
$10,943.10
|
| Rate for Payer: Signature Care EPO |
$11,765.25
|
| Rate for Payer: Signature Care PPO |
$12,474.00
|
| Rate for Payer: United Healthcare Commercial |
$11,169.90
|
|
|
COSYNTROPIN 0.25 MG INJ SOLR
|
Facility
|
IP
|
$145.17
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.87 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cigna All Commercial |
$125.28
|
| Rate for Payer: CORVEL All Commercial |
$135.00
|
| Rate for Payer: Coventry All Commercial |
$127.75
|
| Rate for Payer: Encore All Commercial |
$133.63
|
| Rate for Payer: Frontpath All Commercial |
$133.55
|
| Rate for Payer: Humana ChoiceCare |
$125.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.65
|
| Rate for Payer: PHCS All Commercial |
$108.87
|
| Rate for Payer: PHP All Commercial |
$110.09
|
| Rate for Payer: Sagamore Health Network All Products |
$112.07
|
| Rate for Payer: Signature Care EPO |
$120.49
|
| Rate for Payer: Signature Care PPO |
$127.75
|
| Rate for Payer: United Healthcare Commercial |
$114.39
|
|
|
COSYNTROPIN 0.25 MG INJ SOLR
|
Facility
|
OP
|
$145.17
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$122.52
|
| Rate for Payer: Aetna Medicare |
$46.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$84.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$84.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Centivo All Commercial |
$78.97
|
| Rate for Payer: Cigna All Commercial |
$125.28
|
| Rate for Payer: CORVEL All Commercial |
$135.00
|
| Rate for Payer: Coventry All Commercial |
$127.75
|
| Rate for Payer: Encore All Commercial |
$133.63
|
| Rate for Payer: Frontpath All Commercial |
$133.55
|
| Rate for Payer: Humana ChoiceCare |
$125.38
|
| Rate for Payer: Humana Medicare |
$46.45
|
| Rate for Payer: Lucent All Commercial |
$78.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.65
|
| Rate for Payer: Managed Health Services Medicaid |
$84.21
|
| Rate for Payer: MDWise Medicaid |
$84.21
|
| Rate for Payer: PHCS All Commercial |
$108.87
|
| Rate for Payer: PHP All Commercial |
$110.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.61
|
| Rate for Payer: Sagamore Health Network All Products |
$112.07
|
| Rate for Payer: Signature Care EPO |
$120.49
|
| Rate for Payer: Signature Care PPO |
$127.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.39
|
| Rate for Payer: United Healthcare Commercial |
$114.39
|
| Rate for Payer: United Healthcare Medicare |
$46.45
|
|
|
COVID VAC 24-25(12UP)(PFI)(PF) 30 MCG/0.3 ML IM SYRG
|
Facility
|
OP
|
$656.40
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
206044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.59 |
| Max. Negotiated Rate |
$610.45 |
| Rate for Payer: Aetna Commercial |
$554.00
|
| Rate for Payer: Aetna Medicare |
$210.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$376.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$410.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$143.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.05
|
| Rate for Payer: Cash Price |
$393.84
|
| Rate for Payer: Cash Price |
$393.84
|
| Rate for Payer: Centivo All Commercial |
$357.08
|
| Rate for Payer: Cigna All Commercial |
$566.47
|
| Rate for Payer: CORVEL All Commercial |
$610.45
|
| Rate for Payer: Coventry All Commercial |
$577.63
|
| Rate for Payer: Encore All Commercial |
$604.22
|
| Rate for Payer: Frontpath All Commercial |
$603.89
|
| Rate for Payer: Humana ChoiceCare |
$566.93
|
| Rate for Payer: Humana Medicare |
$210.05
|
| Rate for Payer: Lucent All Commercial |
$357.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$590.76
|
| Rate for Payer: Managed Health Services Medicaid |
$143.59
|
| Rate for Payer: MDWise Medicaid |
$143.59
|
| Rate for Payer: PHCS All Commercial |
$492.30
|
| Rate for Payer: PHP All Commercial |
$497.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.00
|
| Rate for Payer: Sagamore Health Network All Products |
$506.74
|
| Rate for Payer: Signature Care EPO |
$544.81
|
| Rate for Payer: Signature Care PPO |
$577.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$557.94
|
| Rate for Payer: United Healthcare Commercial |
$517.24
|
| Rate for Payer: United Healthcare Medicare |
$210.05
|
|
|
COVID VAC 24-25(12UP)(PFI)(PF) 30 MCG/0.3 ML IM SYRG
|
Facility
|
IP
|
$656.40
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
206044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$492.30 |
| Max. Negotiated Rate |
$610.45 |
| Rate for Payer: Aetna Commercial |
$567.13
|
| Rate for Payer: Cash Price |
$393.84
|
| Rate for Payer: Cigna All Commercial |
$566.47
|
| Rate for Payer: CORVEL All Commercial |
$610.45
|
| Rate for Payer: Coventry All Commercial |
$577.63
|
| Rate for Payer: Encore All Commercial |
$604.22
|
| Rate for Payer: Frontpath All Commercial |
$603.89
|
| Rate for Payer: Humana ChoiceCare |
$566.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$590.76
|
| Rate for Payer: PHCS All Commercial |
$492.30
|
| Rate for Payer: PHP All Commercial |
$497.81
|
| Rate for Payer: Sagamore Health Network All Products |
$506.74
|
| Rate for Payer: Signature Care EPO |
$544.81
|
| Rate for Payer: Signature Care PPO |
$577.63
|
| Rate for Payer: United Healthcare Commercial |
$517.24
|
|
|
COVID VAC 24-25(5-11Y)(PFI)-PF 10 MCG/0.3 ML IM SUSP
|
Facility
|
OP
|
$443.52
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
205895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$412.47 |
| Rate for Payer: Aetna Commercial |
$374.33
|
| Rate for Payer: Aetna Medicare |
$141.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$80.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$254.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$80.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.12
|
| Rate for Payer: Cash Price |
$266.11
|
| Rate for Payer: Cash Price |
$266.11
|
| Rate for Payer: Centivo All Commercial |
$241.27
|
| Rate for Payer: Cigna All Commercial |
$382.76
|
| Rate for Payer: CORVEL All Commercial |
$412.47
|
| Rate for Payer: Coventry All Commercial |
$390.30
|
| Rate for Payer: Encore All Commercial |
$408.26
|
| Rate for Payer: Frontpath All Commercial |
$408.04
|
| Rate for Payer: Humana ChoiceCare |
$383.07
|
| Rate for Payer: Humana Medicare |
$141.93
|
| Rate for Payer: Lucent All Commercial |
$241.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.17
|
| Rate for Payer: Managed Health Services Medicaid |
$80.85
|
| Rate for Payer: MDWise Medicaid |
$80.85
|
| Rate for Payer: PHCS All Commercial |
$332.64
|
| Rate for Payer: PHP All Commercial |
$336.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.97
|
| Rate for Payer: Sagamore Health Network All Products |
$342.40
|
| Rate for Payer: Signature Care EPO |
$368.12
|
| Rate for Payer: Signature Care PPO |
$390.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$376.99
|
| Rate for Payer: United Healthcare Commercial |
$349.49
|
| Rate for Payer: United Healthcare Medicare |
$141.93
|
|
|
COVID VAC 24-25(5-11Y)(PFI)-PF 10 MCG/0.3 ML IM SUSP
|
Facility
|
IP
|
$443.52
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
205895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$412.47 |
| Rate for Payer: Aetna Commercial |
$383.20
|
| Rate for Payer: Cash Price |
$266.11
|
| Rate for Payer: Cigna All Commercial |
$382.76
|
| Rate for Payer: CORVEL All Commercial |
$412.47
|
| Rate for Payer: Coventry All Commercial |
$390.30
|
| Rate for Payer: Encore All Commercial |
$408.26
|
| Rate for Payer: Frontpath All Commercial |
$408.04
|
| Rate for Payer: Humana ChoiceCare |
$383.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.17
|
| Rate for Payer: PHCS All Commercial |
$332.64
|
| Rate for Payer: PHP All Commercial |
$336.37
|
| Rate for Payer: Sagamore Health Network All Products |
$342.40
|
| Rate for Payer: Signature Care EPO |
$368.12
|
| Rate for Payer: Signature Care PPO |
$390.30
|
| Rate for Payer: United Healthcare Commercial |
$349.49
|
|
|
COVID VAC 24-25(6M-4Y)(PFI)-PF 3 MCG/0.3 ML IM SUSR
|
Facility
|
OP
|
$1,987.20
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
205896
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.37 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,677.20
|
| Rate for Payer: Aetna Medicare |
$635.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$60.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$616.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,242.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$60.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$731.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$699.49
|
| Rate for Payer: Cash Price |
$1,192.32
|
| Rate for Payer: Cash Price |
$1,192.32
|
| Rate for Payer: Centivo All Commercial |
$1,081.04
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Humana Medicare |
$635.90
|
| Rate for Payer: Lucent All Commercial |
$1,081.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: Managed Health Services Medicaid |
$60.37
|
| Rate for Payer: MDWise Medicaid |
$60.37
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$775.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,689.12
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
| Rate for Payer: United Healthcare Medicare |
$635.90
|
|
|
COVID VAC 24-25(6M-4Y)(PFI)-PF 3 MCG/0.3 ML IM SUSR
|
Facility
|
IP
|
$1,987.20
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
205896
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,490.40 |
| Max. Negotiated Rate |
$1,848.10 |
| Rate for Payer: Aetna Commercial |
$1,716.94
|
| Rate for Payer: Cash Price |
$1,192.32
|
| Rate for Payer: Cigna All Commercial |
$1,714.95
|
| Rate for Payer: CORVEL All Commercial |
$1,848.10
|
| Rate for Payer: Coventry All Commercial |
$1,748.74
|
| Rate for Payer: Encore All Commercial |
$1,829.22
|
| Rate for Payer: Frontpath All Commercial |
$1,828.22
|
| Rate for Payer: Humana ChoiceCare |
$1,716.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,788.48
|
| Rate for Payer: PHCS All Commercial |
$1,490.40
|
| Rate for Payer: PHP All Commercial |
$1,507.09
|
| Rate for Payer: Sagamore Health Network All Products |
$1,534.12
|
| Rate for Payer: Signature Care EPO |
$1,649.38
|
| Rate for Payer: Signature Care PPO |
$1,748.74
|
| Rate for Payer: United Healthcare Commercial |
$1,565.91
|
|
|
CULT SKIN SUBST, HUMAN-BOVINE TOP DISK
|
Facility
|
OP
|
$4,389.01
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
27649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$4,081.78 |
| Rate for Payer: Aetna Commercial |
$3,704.32
|
| Rate for Payer: Aetna Medicare |
$1,404.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,360.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,520.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,743.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,615.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,544.93
|
| Rate for Payer: Cash Price |
$2,633.41
|
| Rate for Payer: Cash Price |
$2,633.41
|
| Rate for Payer: Centivo All Commercial |
$2,387.62
|
| Rate for Payer: Cigna All Commercial |
$3,787.71
|
| Rate for Payer: CORVEL All Commercial |
$4,081.78
|
| Rate for Payer: Coventry All Commercial |
$3,862.33
|
| Rate for Payer: Encore All Commercial |
$4,040.08
|
| Rate for Payer: Frontpath All Commercial |
$4,037.89
|
| Rate for Payer: Humana ChoiceCare |
$3,790.79
|
| Rate for Payer: Humana Medicare |
$1,404.48
|
| Rate for Payer: Lucent All Commercial |
$2,387.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,950.11
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$3,291.76
|
| Rate for Payer: PHP All Commercial |
$3,328.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,711.71
|
| Rate for Payer: Sagamore Health Network All Products |
$3,388.31
|
| Rate for Payer: Signature Care EPO |
$3,642.88
|
| Rate for Payer: Signature Care PPO |
$3,862.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,730.66
|
| Rate for Payer: United Healthcare Commercial |
$3,458.54
|
| Rate for Payer: United Healthcare Medicare |
$1,404.48
|
|
|
CULT SKIN SUBST, HUMAN-BOVINE TOP DISK
|
Facility
|
IP
|
$4,389.01
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
27649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,291.76 |
| Max. Negotiated Rate |
$4,081.78 |
| Rate for Payer: Aetna Commercial |
$3,792.10
|
| Rate for Payer: Cash Price |
$2,633.41
|
| Rate for Payer: Cigna All Commercial |
$3,787.71
|
| Rate for Payer: CORVEL All Commercial |
$4,081.78
|
| Rate for Payer: Coventry All Commercial |
$3,862.33
|
| Rate for Payer: Encore All Commercial |
$4,040.08
|
| Rate for Payer: Frontpath All Commercial |
$4,037.89
|
| Rate for Payer: Humana ChoiceCare |
$3,790.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,950.11
|
| Rate for Payer: PHCS All Commercial |
$3,291.76
|
| Rate for Payer: PHP All Commercial |
$3,328.62
|
| Rate for Payer: Sagamore Health Network All Products |
$3,388.31
|
| Rate for Payer: Signature Care EPO |
$3,642.88
|
| Rate for Payer: Signature Care PPO |
$3,862.33
|
| Rate for Payer: United Healthcare Commercial |
$3,458.54
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML IV SOLN
|
Facility
|
OP
|
$190.05
|
|
|
Service Code
|
NDC 00409409201
|
| Hospital Charge Code |
110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$176.75 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$60.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$109.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.90
|
| Rate for Payer: Cash Price |
$114.03
|
| Rate for Payer: Cash Price |
$114.03
|
| Rate for Payer: Centivo All Commercial |
$103.39
|
| Rate for Payer: Cigna All Commercial |
$164.01
|
| Rate for Payer: CORVEL All Commercial |
$176.75
|
| Rate for Payer: Coventry All Commercial |
$167.24
|
| Rate for Payer: Encore All Commercial |
$174.94
|
| Rate for Payer: Frontpath All Commercial |
$174.85
|
| Rate for Payer: Humana ChoiceCare |
$164.15
|
| Rate for Payer: Humana Medicare |
$60.82
|
| Rate for Payer: Lucent All Commercial |
$103.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.04
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$142.54
|
| Rate for Payer: PHP All Commercial |
$144.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.12
|
| Rate for Payer: Sagamore Health Network All Products |
$146.72
|
| Rate for Payer: Signature Care EPO |
$157.74
|
| Rate for Payer: Signature Care PPO |
$167.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$161.54
|
| Rate for Payer: United Healthcare Commercial |
$149.76
|
| Rate for Payer: United Healthcare Medicare |
$60.82
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML IV SOLN
|
Facility
|
IP
|
$190.05
|
|
|
Service Code
|
NDC 00409409201
|
| Hospital Charge Code |
110358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$176.75 |
| Rate for Payer: Aetna Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$114.03
|
| Rate for Payer: Cigna All Commercial |
$164.01
|
| Rate for Payer: CORVEL All Commercial |
$176.75
|
| Rate for Payer: Coventry All Commercial |
$167.24
|
| Rate for Payer: Encore All Commercial |
$174.94
|
| Rate for Payer: Frontpath All Commercial |
$174.85
|
| Rate for Payer: Humana ChoiceCare |
$164.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.04
|
| Rate for Payer: PHCS All Commercial |
$142.54
|
| Rate for Payer: PHP All Commercial |
$144.13
|
| Rate for Payer: Sagamore Health Network All Products |
$146.72
|
| Rate for Payer: Signature Care EPO |
$157.74
|
| Rate for Payer: Signature Care PPO |
$167.24
|
| Rate for Payer: United Healthcare Commercial |
$149.76
|
|
|
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG ORAL TAB
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna Commercial |
$1.00
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Centivo All Commercial |
$0.65
|
| Rate for Payer: Cigna All Commercial |
$1.03
|
| Rate for Payer: CORVEL All Commercial |
$1.11
|
| Rate for Payer: Coventry All Commercial |
$1.05
|
| Rate for Payer: Encore All Commercial |
$1.10
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.03
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Lucent All Commercial |
$0.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.07
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.46
|
| Rate for Payer: Sagamore Health Network All Products |
$0.92
|
| Rate for Payer: Signature Care EPO |
$0.99
|
| Rate for Payer: Signature Care PPO |
$1.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
|
|
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG ORAL TAB
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna All Commercial |
$1.03
|
| Rate for Payer: CORVEL All Commercial |
$1.11
|
| Rate for Payer: Coventry All Commercial |
$1.05
|
| Rate for Payer: Encore All Commercial |
$1.10
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.07
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Sagamore Health Network All Products |
$0.92
|
| Rate for Payer: Signature Care EPO |
$0.99
|
| Rate for Payer: Signature Care PPO |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
|
|
CYCLOBENZAPRINE 10 MG ORAL TAB
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 60687055811
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.10
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.46
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centivo All Commercial |
$0.71
|
| Rate for Payer: Cigna All Commercial |
$1.12
|
| Rate for Payer: CORVEL All Commercial |
$1.21
|
| Rate for Payer: Coventry All Commercial |
$1.15
|
| Rate for Payer: Encore All Commercial |
$1.20
|
| Rate for Payer: Frontpath All Commercial |
$1.20
|
| Rate for Payer: Humana ChoiceCare |
$1.12
|
| Rate for Payer: Humana Medicare |
$0.42
|
| Rate for Payer: Lucent All Commercial |
$0.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.17
|
| Rate for Payer: PHCS All Commercial |
$0.98
|
| Rate for Payer: PHP All Commercial |
$0.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1.01
|
| Rate for Payer: Signature Care EPO |
$1.08
|
| Rate for Payer: Signature Care PPO |
$1.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
|
|
CYCLOBENZAPRINE 10 MG ORAL TAB
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 60687055801
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.10
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.46
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centivo All Commercial |
$0.71
|
| Rate for Payer: Cigna All Commercial |
$1.12
|
| Rate for Payer: CORVEL All Commercial |
$1.21
|
| Rate for Payer: Coventry All Commercial |
$1.15
|
| Rate for Payer: Encore All Commercial |
$1.20
|
| Rate for Payer: Frontpath All Commercial |
$1.20
|
| Rate for Payer: Humana ChoiceCare |
$1.12
|
| Rate for Payer: Humana Medicare |
$0.42
|
| Rate for Payer: Lucent All Commercial |
$0.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.17
|
| Rate for Payer: PHCS All Commercial |
$0.98
|
| Rate for Payer: PHP All Commercial |
$0.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1.01
|
| Rate for Payer: Signature Care EPO |
$1.08
|
| Rate for Payer: Signature Care PPO |
$1.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
|
