|
FILGRASTIM 480 MCG/0.8 ML INJ SYRG
|
Facility
|
OP
|
$2,070.52
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
108076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1,925.59 |
| Rate for Payer: Aetna Commercial |
$1,747.52
|
| Rate for Payer: Aetna Medicare |
$662.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$641.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,189.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$761.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$728.82
|
| Rate for Payer: Cash Price |
$1,242.31
|
| Rate for Payer: Cash Price |
$1,242.31
|
| Rate for Payer: Centivo All Commercial |
$1,126.36
|
| Rate for Payer: Cigna All Commercial |
$1,786.86
|
| Rate for Payer: CORVEL All Commercial |
$1,925.59
|
| Rate for Payer: Coventry All Commercial |
$1,822.06
|
| Rate for Payer: Encore All Commercial |
$1,905.92
|
| Rate for Payer: Frontpath All Commercial |
$1,904.88
|
| Rate for Payer: Humana ChoiceCare |
$1,788.31
|
| Rate for Payer: Humana Medicare |
$662.57
|
| Rate for Payer: Lucent All Commercial |
$1,126.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,863.47
|
| Rate for Payer: Managed Health Services Medicaid |
$1.10
|
| Rate for Payer: MDWise Medicaid |
$1.10
|
| Rate for Payer: PHCS All Commercial |
$1,552.89
|
| Rate for Payer: PHP All Commercial |
$1,570.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$807.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,598.44
|
| Rate for Payer: Signature Care EPO |
$1,718.53
|
| Rate for Payer: Signature Care PPO |
$1,822.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,759.94
|
| Rate for Payer: United Healthcare Commercial |
$1,631.57
|
| Rate for Payer: United Healthcare Medicare |
$662.57
|
|
|
FILGRASTIM 480 MCG/0.8 ML INJ SYRG
|
Facility
|
IP
|
$2,070.52
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
108076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,552.89 |
| Max. Negotiated Rate |
$1,925.59 |
| Rate for Payer: Aetna Commercial |
$1,788.93
|
| Rate for Payer: Cash Price |
$1,242.31
|
| Rate for Payer: Cigna All Commercial |
$1,786.86
|
| Rate for Payer: CORVEL All Commercial |
$1,925.59
|
| Rate for Payer: Coventry All Commercial |
$1,822.06
|
| Rate for Payer: Encore All Commercial |
$1,905.92
|
| Rate for Payer: Frontpath All Commercial |
$1,904.88
|
| Rate for Payer: Humana ChoiceCare |
$1,788.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,863.47
|
| Rate for Payer: PHCS All Commercial |
$1,552.89
|
| Rate for Payer: PHP All Commercial |
$1,570.28
|
| Rate for Payer: Sagamore Health Network All Products |
$1,598.44
|
| Rate for Payer: Signature Care EPO |
$1,718.53
|
| Rate for Payer: Signature Care PPO |
$1,822.06
|
| Rate for Payer: United Healthcare Commercial |
$1,631.57
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBQ SYRG
|
Facility
|
IP
|
$1,095.12
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
186099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$821.34 |
| Max. Negotiated Rate |
$1,018.46 |
| Rate for Payer: Aetna Commercial |
$946.18
|
| Rate for Payer: Aetna Commercial |
$946.17
|
| Rate for Payer: Cash Price |
$657.07
|
| Rate for Payer: Cash Price |
$657.06
|
| Rate for Payer: Cigna All Commercial |
$945.09
|
| Rate for Payer: Cigna All Commercial |
$945.07
|
| Rate for Payer: CORVEL All Commercial |
$1,018.44
|
| Rate for Payer: CORVEL All Commercial |
$1,018.46
|
| Rate for Payer: Coventry All Commercial |
$963.69
|
| Rate for Payer: Coventry All Commercial |
$963.71
|
| Rate for Payer: Encore All Commercial |
$1,008.06
|
| Rate for Payer: Encore All Commercial |
$1,008.04
|
| Rate for Payer: Frontpath All Commercial |
$1,007.49
|
| Rate for Payer: Frontpath All Commercial |
$1,007.51
|
| Rate for Payer: Humana ChoiceCare |
$945.86
|
| Rate for Payer: Humana ChoiceCare |
$945.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.59
|
| Rate for Payer: PHCS All Commercial |
$821.33
|
| Rate for Payer: PHCS All Commercial |
$821.34
|
| Rate for Payer: PHP All Commercial |
$830.52
|
| Rate for Payer: PHP All Commercial |
$830.54
|
| Rate for Payer: Sagamore Health Network All Products |
$845.42
|
| Rate for Payer: Sagamore Health Network All Products |
$845.43
|
| Rate for Payer: Signature Care EPO |
$908.93
|
| Rate for Payer: Signature Care EPO |
$908.95
|
| Rate for Payer: Signature Care PPO |
$963.71
|
| Rate for Payer: Signature Care PPO |
$963.69
|
| Rate for Payer: United Healthcare Commercial |
$862.94
|
| Rate for Payer: United Healthcare Commercial |
$862.95
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBQ SYRG
|
Facility
|
OP
|
$1,095.12
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
186099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1,018.46 |
| Rate for Payer: Aetna Commercial |
$924.28
|
| Rate for Payer: Aetna Commercial |
$924.26
|
| Rate for Payer: Aetna Medicare |
$350.44
|
| Rate for Payer: Aetna Medicare |
$350.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$339.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$339.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$628.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$628.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$403.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$403.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.48
|
| Rate for Payer: Cash Price |
$657.07
|
| Rate for Payer: Cash Price |
$657.06
|
| Rate for Payer: Cash Price |
$657.06
|
| Rate for Payer: Cash Price |
$657.07
|
| Rate for Payer: Centivo All Commercial |
$595.73
|
| Rate for Payer: Centivo All Commercial |
$595.75
|
| Rate for Payer: Cigna All Commercial |
$945.09
|
| Rate for Payer: Cigna All Commercial |
$945.07
|
| Rate for Payer: CORVEL All Commercial |
$1,018.46
|
| Rate for Payer: CORVEL All Commercial |
$1,018.44
|
| Rate for Payer: Coventry All Commercial |
$963.71
|
| Rate for Payer: Coventry All Commercial |
$963.69
|
| Rate for Payer: Encore All Commercial |
$1,008.06
|
| Rate for Payer: Encore All Commercial |
$1,008.04
|
| Rate for Payer: Frontpath All Commercial |
$1,007.49
|
| Rate for Payer: Frontpath All Commercial |
$1,007.51
|
| Rate for Payer: Humana ChoiceCare |
$945.86
|
| Rate for Payer: Humana ChoiceCare |
$945.84
|
| Rate for Payer: Humana Medicare |
$350.43
|
| Rate for Payer: Humana Medicare |
$350.44
|
| Rate for Payer: Lucent All Commercial |
$595.75
|
| Rate for Payer: Lucent All Commercial |
$595.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.59
|
| Rate for Payer: Managed Health Services Medicaid |
$0.77
|
| Rate for Payer: Managed Health Services Medicaid |
$0.77
|
| Rate for Payer: MDWise Medicaid |
$0.77
|
| Rate for Payer: MDWise Medicaid |
$0.77
|
| Rate for Payer: PHCS All Commercial |
$821.33
|
| Rate for Payer: PHCS All Commercial |
$821.34
|
| Rate for Payer: PHP All Commercial |
$830.54
|
| Rate for Payer: PHP All Commercial |
$830.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.10
|
| Rate for Payer: Sagamore Health Network All Products |
$845.42
|
| Rate for Payer: Sagamore Health Network All Products |
$845.43
|
| Rate for Payer: Signature Care EPO |
$908.95
|
| Rate for Payer: Signature Care EPO |
$908.93
|
| Rate for Payer: Signature Care PPO |
$963.69
|
| Rate for Payer: Signature Care PPO |
$963.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.84
|
| Rate for Payer: United Healthcare Commercial |
$862.94
|
| Rate for Payer: United Healthcare Commercial |
$862.95
|
| Rate for Payer: United Healthcare Medicare |
$350.43
|
| Rate for Payer: United Healthcare Medicare |
$350.44
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJ SYRG
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
174011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$903.08
|
| Rate for Payer: Aetna Medicare |
$342.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$614.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$0.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$393.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$376.64
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Centivo All Commercial |
$582.08
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.93
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Humana Medicare |
$342.40
|
| Rate for Payer: Lucent All Commercial |
$582.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: Managed Health Services Medicaid |
$0.96
|
| Rate for Payer: MDWise Medicaid |
$0.96
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.30
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
| Rate for Payer: United Healthcare Medicare |
$342.40
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJ SYRG
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
174011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$995.10 |
| Rate for Payer: Aetna Commercial |
$924.48
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna All Commercial |
$923.41
|
| Rate for Payer: CORVEL All Commercial |
$995.10
|
| Rate for Payer: Coventry All Commercial |
$941.60
|
| Rate for Payer: Encore All Commercial |
$984.93
|
| Rate for Payer: Frontpath All Commercial |
$984.40
|
| Rate for Payer: Humana ChoiceCare |
$924.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$802.50
|
| Rate for Payer: PHP All Commercial |
$811.49
|
| Rate for Payer: Sagamore Health Network All Products |
$826.04
|
| Rate for Payer: Signature Care EPO |
$888.10
|
| Rate for Payer: Signature Care PPO |
$941.60
|
| Rate for Payer: United Healthcare Commercial |
$843.16
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJ SYRG
|
Facility
|
IP
|
$1,712.04
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
174010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,284.03 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna Commercial |
$1,479.20
|
| Rate for Payer: Cash Price |
$1,027.23
|
| Rate for Payer: Cigna All Commercial |
$1,477.49
|
| Rate for Payer: CORVEL All Commercial |
$1,592.20
|
| Rate for Payer: Coventry All Commercial |
$1,506.60
|
| Rate for Payer: Encore All Commercial |
$1,575.93
|
| Rate for Payer: Frontpath All Commercial |
$1,575.08
|
| Rate for Payer: Humana ChoiceCare |
$1,478.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,540.84
|
| Rate for Payer: PHCS All Commercial |
$1,284.03
|
| Rate for Payer: PHP All Commercial |
$1,298.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,321.70
|
| Rate for Payer: Signature Care EPO |
$1,420.99
|
| Rate for Payer: Signature Care PPO |
$1,506.60
|
| Rate for Payer: United Healthcare Commercial |
$1,349.09
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJ SYRG
|
Facility
|
OP
|
$1,712.04
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
174010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna Commercial |
$1,444.96
|
| Rate for Payer: Aetna Medicare |
$547.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$530.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$983.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,070.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$0.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$630.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$602.64
|
| Rate for Payer: Cash Price |
$1,027.23
|
| Rate for Payer: Cash Price |
$1,027.23
|
| Rate for Payer: Centivo All Commercial |
$931.35
|
| Rate for Payer: Cigna All Commercial |
$1,477.49
|
| Rate for Payer: CORVEL All Commercial |
$1,592.20
|
| Rate for Payer: Coventry All Commercial |
$1,506.60
|
| Rate for Payer: Encore All Commercial |
$1,575.93
|
| Rate for Payer: Frontpath All Commercial |
$1,575.08
|
| Rate for Payer: Humana ChoiceCare |
$1,478.69
|
| Rate for Payer: Humana Medicare |
$547.85
|
| Rate for Payer: Lucent All Commercial |
$931.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,540.84
|
| Rate for Payer: Managed Health Services Medicaid |
$0.96
|
| Rate for Payer: MDWise Medicaid |
$0.96
|
| Rate for Payer: PHCS All Commercial |
$1,284.03
|
| Rate for Payer: PHP All Commercial |
$1,298.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$667.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,321.70
|
| Rate for Payer: Signature Care EPO |
$1,420.99
|
| Rate for Payer: Signature Care PPO |
$1,506.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,455.24
|
| Rate for Payer: United Healthcare Commercial |
$1,349.09
|
| Rate for Payer: United Healthcare Medicare |
$547.85
|
|
|
FINASTERIDE 5 MG ORAL TAB
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna All Commercial |
$2.56
|
| Rate for Payer: CORVEL All Commercial |
$2.76
|
| Rate for Payer: Coventry All Commercial |
$2.61
|
| Rate for Payer: Encore All Commercial |
$2.73
|
| Rate for Payer: Frontpath All Commercial |
$2.73
|
| Rate for Payer: Humana ChoiceCare |
$2.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.67
|
| Rate for Payer: PHCS All Commercial |
$2.23
|
| Rate for Payer: PHP All Commercial |
$2.25
|
| Rate for Payer: Sagamore Health Network All Products |
$2.29
|
| Rate for Payer: Signature Care EPO |
$2.46
|
| Rate for Payer: Signature Care PPO |
$2.61
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
|
|
FINASTERIDE 5 MG ORAL TAB
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
10037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.04
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Centivo All Commercial |
$1.61
|
| Rate for Payer: Cigna All Commercial |
$2.56
|
| Rate for Payer: CORVEL All Commercial |
$2.76
|
| Rate for Payer: Coventry All Commercial |
$2.61
|
| Rate for Payer: Encore All Commercial |
$2.73
|
| Rate for Payer: Frontpath All Commercial |
$2.73
|
| Rate for Payer: Humana ChoiceCare |
$2.56
|
| Rate for Payer: Humana Medicare |
$0.95
|
| Rate for Payer: Lucent All Commercial |
$1.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.67
|
| Rate for Payer: PHCS All Commercial |
$2.23
|
| Rate for Payer: PHP All Commercial |
$2.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2.29
|
| Rate for Payer: Signature Care EPO |
$2.46
|
| Rate for Payer: Signature Care PPO |
$2.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.52
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
| Rate for Payer: United Healthcare Medicare |
$0.95
|
|
|
FLECAINIDE 50 MG ORAL TAB
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna All Commercial |
$3.25
|
| Rate for Payer: CORVEL All Commercial |
$3.50
|
| Rate for Payer: Coventry All Commercial |
$3.31
|
| Rate for Payer: Encore All Commercial |
$3.47
|
| Rate for Payer: Frontpath All Commercial |
$3.46
|
| Rate for Payer: Humana ChoiceCare |
$3.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.39
|
| Rate for Payer: PHCS All Commercial |
$2.82
|
| Rate for Payer: PHP All Commercial |
$2.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2.91
|
| Rate for Payer: Signature Care EPO |
$3.13
|
| Rate for Payer: Signature Care PPO |
$3.31
|
| Rate for Payer: United Healthcare Commercial |
$2.97
|
|
|
FLECAINIDE 50 MG ORAL TAB
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Centivo All Commercial |
$2.05
|
| Rate for Payer: Cigna All Commercial |
$3.25
|
| Rate for Payer: CORVEL All Commercial |
$3.50
|
| Rate for Payer: Coventry All Commercial |
$3.31
|
| Rate for Payer: Encore All Commercial |
$3.47
|
| Rate for Payer: Frontpath All Commercial |
$3.46
|
| Rate for Payer: Humana ChoiceCare |
$3.25
|
| Rate for Payer: Humana Medicare |
$1.21
|
| Rate for Payer: Lucent All Commercial |
$2.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.39
|
| Rate for Payer: PHCS All Commercial |
$2.82
|
| Rate for Payer: PHP All Commercial |
$2.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.47
|
| Rate for Payer: Sagamore Health Network All Products |
$2.91
|
| Rate for Payer: Signature Care EPO |
$3.13
|
| Rate for Payer: Signature Care PPO |
$3.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$2.97
|
| Rate for Payer: United Healthcare Medicare |
$1.21
|
|
|
FLUCICLOVINE F18 10 MCI (370 MBQ) IV SOLN
|
Facility
|
IP
|
$17,304.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
182304
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$12,978.00 |
| Max. Negotiated Rate |
$16,092.72 |
| Rate for Payer: Aetna Commercial |
$14,950.66
|
| Rate for Payer: Cash Price |
$10,382.40
|
| Rate for Payer: Cigna All Commercial |
$14,933.35
|
| Rate for Payer: CORVEL All Commercial |
$16,092.72
|
| Rate for Payer: Coventry All Commercial |
$15,227.52
|
| Rate for Payer: Encore All Commercial |
$15,928.33
|
| Rate for Payer: Frontpath All Commercial |
$15,919.68
|
| Rate for Payer: Humana ChoiceCare |
$14,945.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,573.60
|
| Rate for Payer: PHCS All Commercial |
$12,978.00
|
| Rate for Payer: PHP All Commercial |
$13,123.35
|
| Rate for Payer: Sagamore Health Network All Products |
$13,358.69
|
| Rate for Payer: Signature Care EPO |
$14,362.32
|
| Rate for Payer: Signature Care PPO |
$15,227.52
|
| Rate for Payer: United Healthcare Commercial |
$13,635.55
|
|
|
FLUCICLOVINE F18 10 MCI (370 MBQ) IV SOLN
|
Facility
|
OP
|
$17,304.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
182304
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,364.24 |
| Max. Negotiated Rate |
$16,092.72 |
| Rate for Payer: Aetna Commercial |
$14,604.58
|
| Rate for Payer: Aetna Medicare |
$5,537.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,364.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,937.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,816.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,367.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,091.01
|
| Rate for Payer: Cash Price |
$10,382.40
|
| Rate for Payer: Centivo All Commercial |
$9,413.38
|
| Rate for Payer: Cigna All Commercial |
$14,933.35
|
| Rate for Payer: CORVEL All Commercial |
$16,092.72
|
| Rate for Payer: Coventry All Commercial |
$15,227.52
|
| Rate for Payer: Encore All Commercial |
$15,928.33
|
| Rate for Payer: Frontpath All Commercial |
$15,919.68
|
| Rate for Payer: Humana ChoiceCare |
$14,945.46
|
| Rate for Payer: Humana Medicare |
$5,537.28
|
| Rate for Payer: Lucent All Commercial |
$9,413.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,573.60
|
| Rate for Payer: PHCS All Commercial |
$12,978.00
|
| Rate for Payer: PHP All Commercial |
$13,123.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,748.56
|
| Rate for Payer: Sagamore Health Network All Products |
$13,358.69
|
| Rate for Payer: Signature Care EPO |
$14,362.32
|
| Rate for Payer: Signature Care PPO |
$15,227.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,708.40
|
| Rate for Payer: United Healthcare Commercial |
$13,635.55
|
| Rate for Payer: United Healthcare Medicare |
$5,537.28
|
|
|
FLUCONAZOLE 100 MG ORAL TAB
|
Facility
|
OP
|
$8.34
|
|
|
Service Code
|
NDC 50268033715
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.94
|
| Rate for Payer: Cash Price |
$5.01
|
| Rate for Payer: Centivo All Commercial |
$4.54
|
| Rate for Payer: Cigna All Commercial |
$7.20
|
| Rate for Payer: CORVEL All Commercial |
$7.76
|
| Rate for Payer: Coventry All Commercial |
$7.34
|
| Rate for Payer: Encore All Commercial |
$7.68
|
| Rate for Payer: Frontpath All Commercial |
$7.68
|
| Rate for Payer: Humana ChoiceCare |
$7.21
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Lucent All Commercial |
$4.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.51
|
| Rate for Payer: PHCS All Commercial |
$6.26
|
| Rate for Payer: PHP All Commercial |
$6.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.25
|
| Rate for Payer: Sagamore Health Network All Products |
$6.44
|
| Rate for Payer: Signature Care EPO |
$6.93
|
| Rate for Payer: Signature Care PPO |
$7.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.09
|
| Rate for Payer: United Healthcare Commercial |
$6.58
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
|
|
FLUCONAZOLE 100 MG ORAL TAB
|
Facility
|
OP
|
$8.34
|
|
|
Service Code
|
NDC 50268033711
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.94
|
| Rate for Payer: Cash Price |
$5.01
|
| Rate for Payer: Centivo All Commercial |
$4.54
|
| Rate for Payer: Cigna All Commercial |
$7.20
|
| Rate for Payer: CORVEL All Commercial |
$7.76
|
| Rate for Payer: Coventry All Commercial |
$7.34
|
| Rate for Payer: Encore All Commercial |
$7.68
|
| Rate for Payer: Frontpath All Commercial |
$7.68
|
| Rate for Payer: Humana ChoiceCare |
$7.21
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Lucent All Commercial |
$4.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.51
|
| Rate for Payer: PHCS All Commercial |
$6.26
|
| Rate for Payer: PHP All Commercial |
$6.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.25
|
| Rate for Payer: Sagamore Health Network All Products |
$6.44
|
| Rate for Payer: Signature Care EPO |
$6.93
|
| Rate for Payer: Signature Care PPO |
$7.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.09
|
| Rate for Payer: United Healthcare Commercial |
$6.58
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
|
|
FLUCONAZOLE 100 MG ORAL TAB
|
Facility
|
IP
|
$8.34
|
|
|
Service Code
|
NDC 50268033711
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Cash Price |
$5.01
|
| Rate for Payer: Cigna All Commercial |
$7.20
|
| Rate for Payer: CORVEL All Commercial |
$7.76
|
| Rate for Payer: Coventry All Commercial |
$7.34
|
| Rate for Payer: Encore All Commercial |
$7.68
|
| Rate for Payer: Frontpath All Commercial |
$7.68
|
| Rate for Payer: Humana ChoiceCare |
$7.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.51
|
| Rate for Payer: PHCS All Commercial |
$6.26
|
| Rate for Payer: PHP All Commercial |
$6.33
|
| Rate for Payer: Sagamore Health Network All Products |
$6.44
|
| Rate for Payer: Signature Care EPO |
$6.93
|
| Rate for Payer: Signature Care PPO |
$7.34
|
| Rate for Payer: United Healthcare Commercial |
$6.58
|
|
|
FLUCONAZOLE 100 MG ORAL TAB
|
Facility
|
IP
|
$8.34
|
|
|
Service Code
|
NDC 50268033715
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Cash Price |
$5.01
|
| Rate for Payer: Cigna All Commercial |
$7.20
|
| Rate for Payer: CORVEL All Commercial |
$7.76
|
| Rate for Payer: Coventry All Commercial |
$7.34
|
| Rate for Payer: Encore All Commercial |
$7.68
|
| Rate for Payer: Frontpath All Commercial |
$7.68
|
| Rate for Payer: Humana ChoiceCare |
$7.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.51
|
| Rate for Payer: PHCS All Commercial |
$6.26
|
| Rate for Payer: PHP All Commercial |
$6.33
|
| Rate for Payer: Sagamore Health Network All Products |
$6.44
|
| Rate for Payer: Signature Care EPO |
$6.93
|
| Rate for Payer: Signature Care PPO |
$7.34
|
| Rate for Payer: United Healthcare Commercial |
$6.58
|
|
|
FLUCONAZOLE 150 MG ORAL TAB
|
Facility
|
IP
|
$17.94
|
|
|
Service Code
|
NDC 68462011944
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cigna All Commercial |
$15.48
|
| Rate for Payer: CORVEL All Commercial |
$16.69
|
| Rate for Payer: Coventry All Commercial |
$15.79
|
| Rate for Payer: Encore All Commercial |
$16.51
|
| Rate for Payer: Frontpath All Commercial |
$16.51
|
| Rate for Payer: Humana ChoiceCare |
$15.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.15
|
| Rate for Payer: PHCS All Commercial |
$13.46
|
| Rate for Payer: PHP All Commercial |
$13.61
|
| Rate for Payer: Sagamore Health Network All Products |
$13.85
|
| Rate for Payer: Signature Care EPO |
$14.89
|
| Rate for Payer: Signature Care PPO |
$15.79
|
| Rate for Payer: United Healthcare Commercial |
$14.14
|
|
|
FLUCONAZOLE 150 MG ORAL TAB
|
Facility
|
OP
|
$17.94
|
|
|
Service Code
|
NDC 68462011944
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna Commercial |
$15.14
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.32
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Centivo All Commercial |
$9.76
|
| Rate for Payer: Cigna All Commercial |
$15.48
|
| Rate for Payer: CORVEL All Commercial |
$16.69
|
| Rate for Payer: Coventry All Commercial |
$15.79
|
| Rate for Payer: Encore All Commercial |
$16.51
|
| Rate for Payer: Frontpath All Commercial |
$16.51
|
| Rate for Payer: Humana ChoiceCare |
$15.50
|
| Rate for Payer: Humana Medicare |
$5.74
|
| Rate for Payer: Lucent All Commercial |
$9.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.15
|
| Rate for Payer: PHCS All Commercial |
$13.46
|
| Rate for Payer: PHP All Commercial |
$13.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.00
|
| Rate for Payer: Sagamore Health Network All Products |
$13.85
|
| Rate for Payer: Signature Care EPO |
$14.89
|
| Rate for Payer: Signature Care PPO |
$15.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.25
|
| Rate for Payer: United Healthcare Commercial |
$14.14
|
| Rate for Payer: United Healthcare Medicare |
$5.74
|
|
|
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK
|
Facility
|
IP
|
$58.10
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$54.03 |
| Rate for Payer: Aetna Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$34.86
|
| Rate for Payer: Cigna All Commercial |
$50.14
|
| Rate for Payer: CORVEL All Commercial |
$54.03
|
| Rate for Payer: Coventry All Commercial |
$51.13
|
| Rate for Payer: Encore All Commercial |
$53.48
|
| Rate for Payer: Frontpath All Commercial |
$53.45
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.29
|
| Rate for Payer: PHCS All Commercial |
$43.58
|
| Rate for Payer: PHP All Commercial |
$44.06
|
| Rate for Payer: Sagamore Health Network All Products |
$44.85
|
| Rate for Payer: Signature Care EPO |
$48.22
|
| Rate for Payer: Signature Care PPO |
$51.13
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
|
|
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK
|
Facility
|
OP
|
$58.10
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
10049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$54.03 |
| Rate for Payer: Aetna Commercial |
$49.04
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.45
|
| Rate for Payer: Cash Price |
$34.86
|
| Rate for Payer: Centivo All Commercial |
$31.61
|
| Rate for Payer: Cigna All Commercial |
$50.14
|
| Rate for Payer: CORVEL All Commercial |
$54.03
|
| Rate for Payer: Coventry All Commercial |
$51.13
|
| Rate for Payer: Encore All Commercial |
$53.48
|
| Rate for Payer: Frontpath All Commercial |
$53.45
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Humana Medicare |
$18.59
|
| Rate for Payer: Lucent All Commercial |
$31.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.29
|
| Rate for Payer: PHCS All Commercial |
$43.58
|
| Rate for Payer: PHP All Commercial |
$44.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.66
|
| Rate for Payer: Sagamore Health Network All Products |
$44.85
|
| Rate for Payer: Signature Care EPO |
$48.22
|
| Rate for Payer: Signature Care PPO |
$51.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.38
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
| Rate for Payer: United Healthcare Medicare |
$18.59
|
|
|
FLUDEOXYGLUCOSE F-18 20 MCI TO 500 MCI/ML IV SOLN
|
Facility
|
OP
|
$802.25
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
166388
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$746.09 |
| Rate for Payer: Aetna Commercial |
$677.10
|
| Rate for Payer: Aetna Medicare |
$256.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$248.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$460.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.39
|
| Rate for Payer: Cash Price |
$481.35
|
| Rate for Payer: Centivo All Commercial |
$436.42
|
| Rate for Payer: Cigna All Commercial |
$692.34
|
| Rate for Payer: CORVEL All Commercial |
$746.09
|
| Rate for Payer: Coventry All Commercial |
$705.98
|
| Rate for Payer: Encore All Commercial |
$738.47
|
| Rate for Payer: Frontpath All Commercial |
$738.07
|
| Rate for Payer: Humana ChoiceCare |
$692.90
|
| Rate for Payer: Humana Medicare |
$256.72
|
| Rate for Payer: Lucent All Commercial |
$436.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$722.02
|
| Rate for Payer: PHCS All Commercial |
$601.69
|
| Rate for Payer: PHP All Commercial |
$608.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.88
|
| Rate for Payer: Sagamore Health Network All Products |
$619.34
|
| Rate for Payer: Signature Care EPO |
$665.87
|
| Rate for Payer: Signature Care PPO |
$705.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$681.91
|
| Rate for Payer: United Healthcare Commercial |
$632.17
|
| Rate for Payer: United Healthcare Medicare |
$256.72
|
|
|
FLUDEOXYGLUCOSE F-18 20 MCI TO 500 MCI/ML IV SOLN
|
Facility
|
IP
|
$802.25
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
166388
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$601.69 |
| Max. Negotiated Rate |
$746.09 |
| Rate for Payer: Aetna Commercial |
$693.14
|
| Rate for Payer: Cash Price |
$481.35
|
| Rate for Payer: Cigna All Commercial |
$692.34
|
| Rate for Payer: CORVEL All Commercial |
$746.09
|
| Rate for Payer: Coventry All Commercial |
$705.98
|
| Rate for Payer: Encore All Commercial |
$738.47
|
| Rate for Payer: Frontpath All Commercial |
$738.07
|
| Rate for Payer: Humana ChoiceCare |
$692.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$722.02
|
| Rate for Payer: PHCS All Commercial |
$601.69
|
| Rate for Payer: PHP All Commercial |
$608.43
|
| Rate for Payer: Sagamore Health Network All Products |
$619.34
|
| Rate for Payer: Signature Care EPO |
$665.87
|
| Rate for Payer: Signature Care PPO |
$705.98
|
| Rate for Payer: United Healthcare Commercial |
$632.17
|
|
|
FLUDROCORTISONE 0.1 MG ORAL TAB
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 50268033015
|
| Hospital Charge Code |
10054
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.05
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Centivo All Commercial |
$1.63
|
| Rate for Payer: Cigna All Commercial |
$2.58
|
| Rate for Payer: CORVEL All Commercial |
$2.78
|
| Rate for Payer: Coventry All Commercial |
$2.63
|
| Rate for Payer: Encore All Commercial |
$2.75
|
| Rate for Payer: Frontpath All Commercial |
$2.75
|
| Rate for Payer: Humana ChoiceCare |
$2.58
|
| Rate for Payer: Humana Medicare |
$0.96
|
| Rate for Payer: Lucent All Commercial |
$1.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.69
|
| Rate for Payer: PHCS All Commercial |
$2.24
|
| Rate for Payer: PHP All Commercial |
$2.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.17
|
| Rate for Payer: Sagamore Health Network All Products |
$2.31
|
| Rate for Payer: Signature Care EPO |
$2.48
|
| Rate for Payer: Signature Care PPO |
$2.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$2.36
|
| Rate for Payer: United Healthcare Medicare |
$0.96
|
|
