|
INFLIXIMAB-DYYB 100 MG IV SOLR
|
Facility
|
OP
|
$3,690.48
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
179180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$3,432.15 |
| Rate for Payer: Aetna Commercial |
$3,114.77
|
| Rate for Payer: Aetna Medicare |
$1,180.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$99.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,144.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,119.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,306.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$99.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,358.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,299.05
|
| Rate for Payer: Cash Price |
$2,214.29
|
| Rate for Payer: Cash Price |
$2,214.29
|
| Rate for Payer: Centivo All Commercial |
$2,007.62
|
| Rate for Payer: Cigna All Commercial |
$3,184.88
|
| Rate for Payer: CORVEL All Commercial |
$3,432.15
|
| Rate for Payer: Coventry All Commercial |
$3,247.62
|
| Rate for Payer: Encore All Commercial |
$3,397.09
|
| Rate for Payer: Frontpath All Commercial |
$3,395.24
|
| Rate for Payer: Humana ChoiceCare |
$3,187.47
|
| Rate for Payer: Humana Medicare |
$1,180.95
|
| Rate for Payer: Lucent All Commercial |
$2,007.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,321.43
|
| Rate for Payer: Managed Health Services Medicaid |
$99.36
|
| Rate for Payer: MDWise Medicaid |
$99.36
|
| Rate for Payer: PHCS All Commercial |
$2,767.86
|
| Rate for Payer: PHP All Commercial |
$2,798.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,439.29
|
| Rate for Payer: Sagamore Health Network All Products |
$2,849.05
|
| Rate for Payer: Signature Care EPO |
$3,063.10
|
| Rate for Payer: Signature Care PPO |
$3,247.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,136.91
|
| Rate for Payer: United Healthcare Commercial |
$2,908.10
|
| Rate for Payer: United Healthcare Medicare |
$1,180.95
|
|
|
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
114723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.88 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$94.95
|
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Centivo All Commercial |
$61.20
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Lucent All Commercial |
$61.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.88
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.62
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
| Rate for Payer: United Healthcare Medicare |
$36.00
|
|
|
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
114723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna All Commercial |
$97.09
|
| Rate for Payer: CORVEL All Commercial |
$104.62
|
| Rate for Payer: Coventry All Commercial |
$99.00
|
| Rate for Payer: Encore All Commercial |
$103.56
|
| Rate for Payer: Frontpath All Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$97.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.25
|
| Rate for Payer: PHCS All Commercial |
$84.38
|
| Rate for Payer: PHP All Commercial |
$85.32
|
| Rate for Payer: Sagamore Health Network All Products |
$86.85
|
| Rate for Payer: Signature Care EPO |
$93.38
|
| Rate for Payer: Signature Care PPO |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$88.65
|
|
|
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
118974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$54.65
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cigna All Commercial |
$54.59
|
| Rate for Payer: CORVEL All Commercial |
$58.82
|
| Rate for Payer: Coventry All Commercial |
$55.66
|
| Rate for Payer: Encore All Commercial |
$58.22
|
| Rate for Payer: Frontpath All Commercial |
$58.19
|
| Rate for Payer: Humana ChoiceCare |
$54.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.93
|
| Rate for Payer: PHCS All Commercial |
$47.44
|
| Rate for Payer: PHP All Commercial |
$47.97
|
| Rate for Payer: Sagamore Health Network All Products |
$48.83
|
| Rate for Payer: Signature Care EPO |
$52.50
|
| Rate for Payer: Signature Care PPO |
$55.66
|
| Rate for Payer: United Healthcare Commercial |
$49.84
|
|
|
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN
|
Facility
|
OP
|
$63.25
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
118974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$53.38
|
| Rate for Payer: Aetna Medicare |
$20.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.26
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Centivo All Commercial |
$34.41
|
| Rate for Payer: Cigna All Commercial |
$54.59
|
| Rate for Payer: CORVEL All Commercial |
$58.82
|
| Rate for Payer: Coventry All Commercial |
$55.66
|
| Rate for Payer: Encore All Commercial |
$58.22
|
| Rate for Payer: Frontpath All Commercial |
$58.19
|
| Rate for Payer: Humana ChoiceCare |
$54.63
|
| Rate for Payer: Humana Medicare |
$20.24
|
| Rate for Payer: Lucent All Commercial |
$34.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.93
|
| Rate for Payer: PHCS All Commercial |
$47.44
|
| Rate for Payer: PHP All Commercial |
$47.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.67
|
| Rate for Payer: Sagamore Health Network All Products |
$48.83
|
| Rate for Payer: Signature Care EPO |
$52.50
|
| Rate for Payer: Signature Care PPO |
$55.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.76
|
| Rate for Payer: United Healthcare Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare |
$20.24
|
|
|
INSULIN LISPRO 100 UNITS/ML SUBQ SOLN
|
Facility
|
IP
|
$110.34
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$102.62 |
| Rate for Payer: Aetna Commercial |
$95.33
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cigna All Commercial |
$95.22
|
| Rate for Payer: CORVEL All Commercial |
$102.62
|
| Rate for Payer: Coventry All Commercial |
$97.10
|
| Rate for Payer: Encore All Commercial |
$101.57
|
| Rate for Payer: Frontpath All Commercial |
$101.51
|
| Rate for Payer: Humana ChoiceCare |
$95.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.31
|
| Rate for Payer: PHCS All Commercial |
$82.75
|
| Rate for Payer: PHP All Commercial |
$83.68
|
| Rate for Payer: Sagamore Health Network All Products |
$85.18
|
| Rate for Payer: Signature Care EPO |
$91.58
|
| Rate for Payer: Signature Care PPO |
$97.10
|
| Rate for Payer: United Healthcare Commercial |
$86.95
|
|
|
INSULIN LISPRO 100 UNITS/ML SUBQ SOLN
|
Facility
|
OP
|
$110.34
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$102.62 |
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna Medicare |
$35.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$63.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.84
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Centivo All Commercial |
$60.02
|
| Rate for Payer: Cigna All Commercial |
$95.22
|
| Rate for Payer: CORVEL All Commercial |
$102.62
|
| Rate for Payer: Coventry All Commercial |
$97.10
|
| Rate for Payer: Encore All Commercial |
$101.57
|
| Rate for Payer: Frontpath All Commercial |
$101.51
|
| Rate for Payer: Humana ChoiceCare |
$95.30
|
| Rate for Payer: Humana Medicare |
$35.31
|
| Rate for Payer: Lucent All Commercial |
$60.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.31
|
| Rate for Payer: PHCS All Commercial |
$82.75
|
| Rate for Payer: PHP All Commercial |
$83.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.03
|
| Rate for Payer: Sagamore Health Network All Products |
$85.18
|
| Rate for Payer: Signature Care EPO |
$91.58
|
| Rate for Payer: Signature Care PPO |
$97.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.79
|
| Rate for Payer: United Healthcare Commercial |
$86.95
|
| Rate for Payer: United Healthcare Medicare |
$35.31
|
|
|
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP
|
Facility
|
IP
|
$144.87
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
70693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$134.73 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: Cash Price |
$86.92
|
| Rate for Payer: Cigna All Commercial |
$125.02
|
| Rate for Payer: CORVEL All Commercial |
$134.73
|
| Rate for Payer: Coventry All Commercial |
$127.49
|
| Rate for Payer: Encore All Commercial |
$133.35
|
| Rate for Payer: Frontpath All Commercial |
$133.28
|
| Rate for Payer: Humana ChoiceCare |
$125.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.38
|
| Rate for Payer: PHCS All Commercial |
$108.65
|
| Rate for Payer: PHP All Commercial |
$109.87
|
| Rate for Payer: Sagamore Health Network All Products |
$111.84
|
| Rate for Payer: Signature Care EPO |
$120.24
|
| Rate for Payer: Signature Care PPO |
$127.49
|
| Rate for Payer: United Healthcare Commercial |
$114.16
|
|
|
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP
|
Facility
|
OP
|
$144.87
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
70693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$134.73 |
| Rate for Payer: Aetna Commercial |
$122.27
|
| Rate for Payer: Aetna Medicare |
$46.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$44.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$83.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.99
|
| Rate for Payer: Cash Price |
$86.92
|
| Rate for Payer: Centivo All Commercial |
$78.81
|
| Rate for Payer: Cigna All Commercial |
$125.02
|
| Rate for Payer: CORVEL All Commercial |
$134.73
|
| Rate for Payer: Coventry All Commercial |
$127.49
|
| Rate for Payer: Encore All Commercial |
$133.35
|
| Rate for Payer: Frontpath All Commercial |
$133.28
|
| Rate for Payer: Humana ChoiceCare |
$125.12
|
| Rate for Payer: Humana Medicare |
$46.36
|
| Rate for Payer: Lucent All Commercial |
$78.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.38
|
| Rate for Payer: PHCS All Commercial |
$108.65
|
| Rate for Payer: PHP All Commercial |
$109.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.50
|
| Rate for Payer: Sagamore Health Network All Products |
$111.84
|
| Rate for Payer: Signature Care EPO |
$120.24
|
| Rate for Payer: Signature Care PPO |
$127.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.14
|
| Rate for Payer: United Healthcare Commercial |
$114.16
|
| Rate for Payer: United Healthcare Medicare |
$46.36
|
|
|
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP
|
Facility
|
IP
|
$66.50
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10286
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$57.46
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
|
|
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP
|
Facility
|
OP
|
$66.50
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$56.13
|
| Rate for Payer: Aetna Medicare |
$21.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.41
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Centivo All Commercial |
$36.18
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Humana Medicare |
$21.28
|
| Rate for Payer: Lucent All Commercial |
$36.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.93
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
| Rate for Payer: United Healthcare Medicare |
$21.28
|
|
|
INSULIN NPH ISOPH U-100 HUMAN 100 UNITS/ML SUBQ SUSP
|
Facility
|
IP
|
$66.50
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$57.46
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
|
|
INSULIN NPH ISOPH U-100 HUMAN 100 UNITS/ML SUBQ SUSP
|
Facility
|
OP
|
$66.50
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$56.13
|
| Rate for Payer: Aetna Medicare |
$21.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.41
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Centivo All Commercial |
$36.18
|
| Rate for Payer: Cigna All Commercial |
$57.39
|
| Rate for Payer: CORVEL All Commercial |
$61.84
|
| Rate for Payer: Coventry All Commercial |
$58.52
|
| Rate for Payer: Encore All Commercial |
$61.21
|
| Rate for Payer: Frontpath All Commercial |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$57.44
|
| Rate for Payer: Humana Medicare |
$21.28
|
| Rate for Payer: Lucent All Commercial |
$36.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.85
|
| Rate for Payer: PHCS All Commercial |
$49.88
|
| Rate for Payer: PHP All Commercial |
$50.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.93
|
| Rate for Payer: Sagamore Health Network All Products |
$51.34
|
| Rate for Payer: Signature Care EPO |
$55.20
|
| Rate for Payer: Signature Care PPO |
$58.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.52
|
| Rate for Payer: United Healthcare Commercial |
$52.40
|
| Rate for Payer: United Healthcare Medicare |
$21.28
|
|
|
INSULIN REGULAR HUMAN 100 UNITS/ML INJ SOLN
|
Facility
|
IP
|
$98.43
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$91.54 |
| Rate for Payer: Aetna Commercial |
$85.04
|
| Rate for Payer: Aetna Commercial |
$13.85
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cash Price |
$59.06
|
| Rate for Payer: Cigna All Commercial |
$13.84
|
| Rate for Payer: Cigna All Commercial |
$84.95
|
| Rate for Payer: CORVEL All Commercial |
$14.91
|
| Rate for Payer: CORVEL All Commercial |
$91.54
|
| Rate for Payer: Coventry All Commercial |
$86.62
|
| Rate for Payer: Coventry All Commercial |
$14.11
|
| Rate for Payer: Encore All Commercial |
$90.60
|
| Rate for Payer: Encore All Commercial |
$14.76
|
| Rate for Payer: Frontpath All Commercial |
$14.75
|
| Rate for Payer: Frontpath All Commercial |
$90.56
|
| Rate for Payer: Humana ChoiceCare |
$13.85
|
| Rate for Payer: Humana ChoiceCare |
$85.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.59
|
| Rate for Payer: PHCS All Commercial |
$73.82
|
| Rate for Payer: PHCS All Commercial |
$12.03
|
| Rate for Payer: PHP All Commercial |
$12.16
|
| Rate for Payer: PHP All Commercial |
$74.65
|
| Rate for Payer: Sagamore Health Network All Products |
$75.99
|
| Rate for Payer: Sagamore Health Network All Products |
$12.38
|
| Rate for Payer: Signature Care EPO |
$81.70
|
| Rate for Payer: Signature Care EPO |
$13.31
|
| Rate for Payer: Signature Care PPO |
$14.11
|
| Rate for Payer: Signature Care PPO |
$86.62
|
| Rate for Payer: United Healthcare Commercial |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
|
|
INSULIN REGULAR HUMAN 100 UNITS/ML INJ SOLN
|
Facility
|
OP
|
$98.43
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$91.54 |
| Rate for Payer: Aetna Commercial |
$83.07
|
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.65
|
| Rate for Payer: Cash Price |
$59.06
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Centivo All Commercial |
$53.55
|
| Rate for Payer: Centivo All Commercial |
$8.72
|
| Rate for Payer: Cigna All Commercial |
$13.84
|
| Rate for Payer: Cigna All Commercial |
$84.95
|
| Rate for Payer: CORVEL All Commercial |
$14.91
|
| Rate for Payer: CORVEL All Commercial |
$91.54
|
| Rate for Payer: Coventry All Commercial |
$14.11
|
| Rate for Payer: Coventry All Commercial |
$86.62
|
| Rate for Payer: Encore All Commercial |
$14.76
|
| Rate for Payer: Encore All Commercial |
$90.60
|
| Rate for Payer: Frontpath All Commercial |
$90.56
|
| Rate for Payer: Frontpath All Commercial |
$14.75
|
| Rate for Payer: Humana ChoiceCare |
$85.01
|
| Rate for Payer: Humana ChoiceCare |
$13.85
|
| Rate for Payer: Humana Medicare |
$31.50
|
| Rate for Payer: Humana Medicare |
$5.13
|
| Rate for Payer: Lucent All Commercial |
$8.72
|
| Rate for Payer: Lucent All Commercial |
$53.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.43
|
| Rate for Payer: PHCS All Commercial |
$73.82
|
| Rate for Payer: PHCS All Commercial |
$12.03
|
| Rate for Payer: PHP All Commercial |
$12.16
|
| Rate for Payer: PHP All Commercial |
$74.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.39
|
| Rate for Payer: Sagamore Health Network All Products |
$12.38
|
| Rate for Payer: Sagamore Health Network All Products |
$75.99
|
| Rate for Payer: Signature Care EPO |
$81.70
|
| Rate for Payer: Signature Care EPO |
$13.31
|
| Rate for Payer: Signature Care PPO |
$14.11
|
| Rate for Payer: Signature Care PPO |
$86.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.63
|
| Rate for Payer: United Healthcare Commercial |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
| Rate for Payer: United Healthcare Medicare |
$5.13
|
| Rate for Payer: United Healthcare Medicare |
$31.50
|
|
|
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
188890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$227.85 |
| Rate for Payer: Aetna Commercial |
$211.68
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna All Commercial |
$211.44
|
| Rate for Payer: CORVEL All Commercial |
$227.85
|
| Rate for Payer: Coventry All Commercial |
$215.60
|
| Rate for Payer: Encore All Commercial |
$225.52
|
| Rate for Payer: Frontpath All Commercial |
$225.40
|
| Rate for Payer: Humana ChoiceCare |
$211.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.50
|
| Rate for Payer: PHCS All Commercial |
$183.75
|
| Rate for Payer: PHP All Commercial |
$185.81
|
| Rate for Payer: Sagamore Health Network All Products |
$189.14
|
| Rate for Payer: Signature Care EPO |
$203.35
|
| Rate for Payer: Signature Care PPO |
$215.60
|
| Rate for Payer: United Healthcare Commercial |
$193.06
|
|
|
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
NDC 00338012612
|
| Hospital Charge Code |
188890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$227.85 |
| Rate for Payer: Aetna Commercial |
$206.78
|
| Rate for Payer: Aetna Medicare |
$78.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.24
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Centivo All Commercial |
$133.28
|
| Rate for Payer: Cigna All Commercial |
$211.44
|
| Rate for Payer: CORVEL All Commercial |
$227.85
|
| Rate for Payer: Coventry All Commercial |
$215.60
|
| Rate for Payer: Encore All Commercial |
$225.52
|
| Rate for Payer: Frontpath All Commercial |
$225.40
|
| Rate for Payer: Humana ChoiceCare |
$211.61
|
| Rate for Payer: Humana Medicare |
$78.40
|
| Rate for Payer: Lucent All Commercial |
$133.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.50
|
| Rate for Payer: PHCS All Commercial |
$183.75
|
| Rate for Payer: PHP All Commercial |
$185.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.55
|
| Rate for Payer: Sagamore Health Network All Products |
$189.14
|
| Rate for Payer: Signature Care EPO |
$203.35
|
| Rate for Payer: Signature Care PPO |
$215.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$193.06
|
| Rate for Payer: United Healthcare Medicare |
$78.40
|
|
|
IODINE-POTASSIUM IODIDE 5-10 % TOP SOLN
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
NDC 10481011108
|
| Hospital Charge Code |
3961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Aetna Commercial |
$48.21
|
| Rate for Payer: Aetna Medicare |
$18.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$32.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Centivo All Commercial |
$31.07
|
| Rate for Payer: Cigna All Commercial |
$49.29
|
| Rate for Payer: CORVEL All Commercial |
$53.12
|
| Rate for Payer: Coventry All Commercial |
$50.27
|
| Rate for Payer: Encore All Commercial |
$52.58
|
| Rate for Payer: Frontpath All Commercial |
$52.55
|
| Rate for Payer: Humana ChoiceCare |
$49.33
|
| Rate for Payer: Humana Medicare |
$18.28
|
| Rate for Payer: Lucent All Commercial |
$31.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.41
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$42.84
|
| Rate for Payer: PHP All Commercial |
$43.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.28
|
| Rate for Payer: Sagamore Health Network All Products |
$44.10
|
| Rate for Payer: Signature Care EPO |
$47.41
|
| Rate for Payer: Signature Care PPO |
$50.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.55
|
| Rate for Payer: United Healthcare Commercial |
$45.01
|
| Rate for Payer: United Healthcare Medicare |
$18.28
|
|
|
IODINE-POTASSIUM IODIDE 5-10 % TOP SOLN
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
NDC 10481011108
|
| Hospital Charge Code |
3961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Aetna Commercial |
$49.35
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cigna All Commercial |
$49.29
|
| Rate for Payer: CORVEL All Commercial |
$53.12
|
| Rate for Payer: Coventry All Commercial |
$50.27
|
| Rate for Payer: Encore All Commercial |
$52.58
|
| Rate for Payer: Frontpath All Commercial |
$52.55
|
| Rate for Payer: Humana ChoiceCare |
$49.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.41
|
| Rate for Payer: PHCS All Commercial |
$42.84
|
| Rate for Payer: PHP All Commercial |
$43.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.10
|
| Rate for Payer: Signature Care EPO |
$47.41
|
| Rate for Payer: Signature Care PPO |
$50.27
|
| Rate for Payer: United Healthcare Commercial |
$45.01
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLN
|
Facility
|
OP
|
$289.20
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
110362
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$268.95 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Aetna Medicare |
$92.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$166.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.80
|
| Rate for Payer: Cash Price |
$173.52
|
| Rate for Payer: Centivo All Commercial |
$157.32
|
| Rate for Payer: Cigna All Commercial |
$249.58
|
| Rate for Payer: CORVEL All Commercial |
$268.95
|
| Rate for Payer: Coventry All Commercial |
$254.49
|
| Rate for Payer: Encore All Commercial |
$266.21
|
| Rate for Payer: Frontpath All Commercial |
$266.06
|
| Rate for Payer: Humana ChoiceCare |
$249.78
|
| Rate for Payer: Humana Medicare |
$92.54
|
| Rate for Payer: Lucent All Commercial |
$157.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.28
|
| Rate for Payer: PHCS All Commercial |
$216.90
|
| Rate for Payer: PHP All Commercial |
$219.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.79
|
| Rate for Payer: Sagamore Health Network All Products |
$223.26
|
| Rate for Payer: Signature Care EPO |
$240.03
|
| Rate for Payer: Signature Care PPO |
$254.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$245.82
|
| Rate for Payer: United Healthcare Commercial |
$227.89
|
| Rate for Payer: United Healthcare Medicare |
$92.54
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLN
|
Facility
|
IP
|
$289.20
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
110362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$268.95 |
| Rate for Payer: Aetna Commercial |
$249.87
|
| Rate for Payer: Cash Price |
$173.52
|
| Rate for Payer: Cigna All Commercial |
$249.58
|
| Rate for Payer: CORVEL All Commercial |
$268.95
|
| Rate for Payer: Coventry All Commercial |
$254.49
|
| Rate for Payer: Encore All Commercial |
$266.21
|
| Rate for Payer: Frontpath All Commercial |
$266.06
|
| Rate for Payer: Humana ChoiceCare |
$249.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.28
|
| Rate for Payer: PHCS All Commercial |
$216.90
|
| Rate for Payer: PHP All Commercial |
$219.33
|
| Rate for Payer: Sagamore Health Network All Products |
$223.26
|
| Rate for Payer: Signature Care EPO |
$240.03
|
| Rate for Payer: Signature Care PPO |
$254.49
|
| Rate for Payer: United Healthcare Commercial |
$227.89
|
|
|
IODIXANOL 320 MG IODINE/ML IV SOLN 100 ML BTL
|
Facility
|
OP
|
$529.50
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
408175951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$492.44 |
| Rate for Payer: Aetna Commercial |
$446.90
|
| Rate for Payer: Aetna Medicare |
$169.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$304.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$330.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.38
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Centivo All Commercial |
$288.05
|
| Rate for Payer: Cigna All Commercial |
$456.96
|
| Rate for Payer: CORVEL All Commercial |
$492.44
|
| Rate for Payer: Coventry All Commercial |
$465.96
|
| Rate for Payer: Encore All Commercial |
$487.40
|
| Rate for Payer: Frontpath All Commercial |
$487.14
|
| Rate for Payer: Humana ChoiceCare |
$457.33
|
| Rate for Payer: Humana Medicare |
$169.44
|
| Rate for Payer: Lucent All Commercial |
$288.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.55
|
| Rate for Payer: PHCS All Commercial |
$397.12
|
| Rate for Payer: PHP All Commercial |
$401.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.50
|
| Rate for Payer: Sagamore Health Network All Products |
$408.77
|
| Rate for Payer: Signature Care EPO |
$439.49
|
| Rate for Payer: Signature Care PPO |
$465.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$450.07
|
| Rate for Payer: United Healthcare Commercial |
$417.25
|
| Rate for Payer: United Healthcare Medicare |
$169.44
|
|
|
IODIXANOL 320 MG IODINE/ML IV SOLN 100 ML BTL
|
Facility
|
IP
|
$529.50
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
408175951
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$397.12 |
| Max. Negotiated Rate |
$492.44 |
| Rate for Payer: Aetna Commercial |
$457.49
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna All Commercial |
$456.96
|
| Rate for Payer: CORVEL All Commercial |
$492.44
|
| Rate for Payer: Coventry All Commercial |
$465.96
|
| Rate for Payer: Encore All Commercial |
$487.40
|
| Rate for Payer: Frontpath All Commercial |
$487.14
|
| Rate for Payer: Humana ChoiceCare |
$457.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.55
|
| Rate for Payer: PHCS All Commercial |
$397.12
|
| Rate for Payer: PHP All Commercial |
$401.57
|
| Rate for Payer: Sagamore Health Network All Products |
$408.77
|
| Rate for Payer: Signature Care EPO |
$439.49
|
| Rate for Payer: Signature Care PPO |
$465.96
|
| Rate for Payer: United Healthcare Commercial |
$417.25
|
|
|
IOFLUPANE I 123 5 MCI/2.5 ML (185 MBQ/2.5ML) IV SOLN
|
Facility
|
IP
|
$6,230.00
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
108781
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4,672.50 |
| Max. Negotiated Rate |
$5,793.90 |
| Rate for Payer: Aetna Commercial |
$5,382.72
|
| Rate for Payer: Cash Price |
$3,738.00
|
| Rate for Payer: Cigna All Commercial |
$5,376.49
|
| Rate for Payer: CORVEL All Commercial |
$5,793.90
|
| Rate for Payer: Coventry All Commercial |
$5,482.40
|
| Rate for Payer: Encore All Commercial |
$5,734.72
|
| Rate for Payer: Frontpath All Commercial |
$5,731.60
|
| Rate for Payer: Humana ChoiceCare |
$5,380.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,607.00
|
| Rate for Payer: PHCS All Commercial |
$4,672.50
|
| Rate for Payer: PHP All Commercial |
$4,724.83
|
| Rate for Payer: Sagamore Health Network All Products |
$4,809.56
|
| Rate for Payer: Signature Care EPO |
$5,170.90
|
| Rate for Payer: Signature Care PPO |
$5,482.40
|
| Rate for Payer: United Healthcare Commercial |
$4,909.24
|
|
|
IOFLUPANE I 123 5 MCI/2.5 ML (185 MBQ/2.5ML) IV SOLN
|
Facility
|
OP
|
$6,230.00
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
108781
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,931.30 |
| Max. Negotiated Rate |
$5,793.90 |
| Rate for Payer: Aetna Commercial |
$5,258.12
|
| Rate for Payer: Aetna Medicare |
$1,993.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,931.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,577.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,894.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,292.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,192.96
|
| Rate for Payer: Cash Price |
$3,738.00
|
| Rate for Payer: Centivo All Commercial |
$3,389.12
|
| Rate for Payer: Cigna All Commercial |
$5,376.49
|
| Rate for Payer: CORVEL All Commercial |
$5,793.90
|
| Rate for Payer: Coventry All Commercial |
$5,482.40
|
| Rate for Payer: Encore All Commercial |
$5,734.72
|
| Rate for Payer: Frontpath All Commercial |
$5,731.60
|
| Rate for Payer: Humana ChoiceCare |
$5,380.85
|
| Rate for Payer: Humana Medicare |
$1,993.60
|
| Rate for Payer: Lucent All Commercial |
$3,389.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,607.00
|
| Rate for Payer: PHCS All Commercial |
$4,672.50
|
| Rate for Payer: PHP All Commercial |
$4,724.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,429.70
|
| Rate for Payer: Sagamore Health Network All Products |
$4,809.56
|
| Rate for Payer: Signature Care EPO |
$5,170.90
|
| Rate for Payer: Signature Care PPO |
$5,482.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,295.50
|
| Rate for Payer: United Healthcare Commercial |
$4,909.24
|
| Rate for Payer: United Healthcare Medicare |
$1,993.60
|
|
