|
LACTULOSE 10 GRAM/15 ML RETENTION ENEMA (CAMERON)
|
Facility
|
IP
|
$13.02
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
1.401E+12
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cigna All Commercial |
$11.24
|
| Rate for Payer: CORVEL All Commercial |
$12.11
|
| Rate for Payer: Coventry All Commercial |
$11.46
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.98
|
| Rate for Payer: Humana ChoiceCare |
$11.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.72
|
| Rate for Payer: PHCS All Commercial |
$9.77
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Sagamore Health Network All Products |
$10.05
|
| Rate for Payer: Signature Care EPO |
$10.81
|
| Rate for Payer: Signature Care PPO |
$11.46
|
| Rate for Payer: United Healthcare Commercial |
$10.26
|
|
|
LACTULOSE 10 GRAM/15 ML RETENTION ENEMA (CAMERON)
|
Facility
|
OP
|
$13.02
|
|
|
Service Code
|
NDC 00121115440
|
| Hospital Charge Code |
1.401E+12
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.58
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Centivo All Commercial |
$7.08
|
| Rate for Payer: Cigna All Commercial |
$11.24
|
| Rate for Payer: CORVEL All Commercial |
$12.11
|
| Rate for Payer: Coventry All Commercial |
$11.46
|
| Rate for Payer: Encore All Commercial |
$11.98
|
| Rate for Payer: Frontpath All Commercial |
$11.98
|
| Rate for Payer: Humana ChoiceCare |
$11.25
|
| Rate for Payer: Humana Medicare |
$4.17
|
| Rate for Payer: Lucent All Commercial |
$7.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.72
|
| Rate for Payer: PHCS All Commercial |
$9.77
|
| Rate for Payer: PHP All Commercial |
$9.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.08
|
| Rate for Payer: Sagamore Health Network All Products |
$10.05
|
| Rate for Payer: Signature Care EPO |
$10.81
|
| Rate for Payer: Signature Care PPO |
$11.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.07
|
| Rate for Payer: United Healthcare Commercial |
$10.26
|
| Rate for Payer: United Healthcare Medicare |
$4.17
|
|
|
LAMOTRIGINE 100 MG ORAL TAB
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna All Commercial |
$1.07
|
| Rate for Payer: CORVEL All Commercial |
$1.15
|
| Rate for Payer: Coventry All Commercial |
$1.09
|
| Rate for Payer: Encore All Commercial |
$1.14
|
| Rate for Payer: Frontpath All Commercial |
$1.14
|
| Rate for Payer: Humana ChoiceCare |
$1.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.12
|
| Rate for Payer: PHCS All Commercial |
$0.93
|
| Rate for Payer: PHP All Commercial |
$0.94
|
| Rate for Payer: Sagamore Health Network All Products |
$0.96
|
| Rate for Payer: Signature Care EPO |
$1.03
|
| Rate for Payer: Signature Care PPO |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
|
|
LAMOTRIGINE 100 MG ORAL TAB
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 68084031901
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna Commercial |
$1.05
|
| Rate for Payer: Aetna Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.44
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Centivo All Commercial |
$0.67
|
| Rate for Payer: Cigna All Commercial |
$1.07
|
| Rate for Payer: CORVEL All Commercial |
$1.15
|
| Rate for Payer: Coventry All Commercial |
$1.09
|
| Rate for Payer: Encore All Commercial |
$1.14
|
| Rate for Payer: Frontpath All Commercial |
$1.14
|
| Rate for Payer: Humana ChoiceCare |
$1.07
|
| Rate for Payer: Humana Medicare |
$0.40
|
| Rate for Payer: Lucent All Commercial |
$0.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.12
|
| Rate for Payer: PHCS All Commercial |
$0.93
|
| Rate for Payer: PHP All Commercial |
$0.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.48
|
| Rate for Payer: Sagamore Health Network All Products |
$0.96
|
| Rate for Payer: Signature Care EPO |
$1.03
|
| Rate for Payer: Signature Care PPO |
$1.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
|
|
LATANOPROST 0.005 % OPHT DROP
|
Facility
|
OP
|
$41.02
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Aetna Commercial |
$34.62
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.44
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Centivo All Commercial |
$22.31
|
| Rate for Payer: Cigna All Commercial |
$35.40
|
| Rate for Payer: CORVEL All Commercial |
$38.15
|
| Rate for Payer: Coventry All Commercial |
$36.10
|
| Rate for Payer: Encore All Commercial |
$37.76
|
| Rate for Payer: Frontpath All Commercial |
$37.74
|
| Rate for Payer: Humana ChoiceCare |
$35.43
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Lucent All Commercial |
$22.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.92
|
| Rate for Payer: PHCS All Commercial |
$30.77
|
| Rate for Payer: PHP All Commercial |
$31.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.00
|
| Rate for Payer: Sagamore Health Network All Products |
$31.67
|
| Rate for Payer: Signature Care EPO |
$34.05
|
| Rate for Payer: Signature Care PPO |
$36.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.87
|
| Rate for Payer: United Healthcare Commercial |
$32.32
|
| Rate for Payer: United Healthcare Medicare |
$13.13
|
|
|
LATANOPROST 0.005 % OPHT DROP
|
Facility
|
IP
|
$41.02
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Aetna Commercial |
$35.44
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Cigna All Commercial |
$35.40
|
| Rate for Payer: CORVEL All Commercial |
$38.15
|
| Rate for Payer: Coventry All Commercial |
$36.10
|
| Rate for Payer: Encore All Commercial |
$37.76
|
| Rate for Payer: Frontpath All Commercial |
$37.74
|
| Rate for Payer: Humana ChoiceCare |
$35.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.92
|
| Rate for Payer: PHCS All Commercial |
$30.77
|
| Rate for Payer: PHP All Commercial |
$31.11
|
| Rate for Payer: Sagamore Health Network All Products |
$31.67
|
| Rate for Payer: Signature Care EPO |
$34.05
|
| Rate for Payer: Signature Care PPO |
$36.10
|
| Rate for Payer: United Healthcare Commercial |
$32.32
|
|
|
LEUPROLIDE 3.75 MG IM SYKT
|
Facility
|
OP
|
$5,909.89
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,126.81 |
| Max. Negotiated Rate |
$5,496.20 |
| Rate for Payer: Aetna Commercial |
$4,987.95
|
| Rate for Payer: Aetna Medicare |
$1,891.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,126.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,832.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,394.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,694.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,126.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,174.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,080.28
|
| Rate for Payer: Cash Price |
$3,545.93
|
| Rate for Payer: Cash Price |
$3,545.93
|
| Rate for Payer: Centivo All Commercial |
$3,214.98
|
| Rate for Payer: Cigna All Commercial |
$5,100.24
|
| Rate for Payer: CORVEL All Commercial |
$5,496.20
|
| Rate for Payer: Coventry All Commercial |
$5,200.70
|
| Rate for Payer: Encore All Commercial |
$5,440.05
|
| Rate for Payer: Frontpath All Commercial |
$5,437.10
|
| Rate for Payer: Humana ChoiceCare |
$5,104.37
|
| Rate for Payer: Humana Medicare |
$1,891.16
|
| Rate for Payer: Lucent All Commercial |
$3,214.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,318.90
|
| Rate for Payer: Managed Health Services Medicaid |
$1,126.81
|
| Rate for Payer: MDWise Medicaid |
$1,126.81
|
| Rate for Payer: PHCS All Commercial |
$4,432.42
|
| Rate for Payer: PHP All Commercial |
$4,482.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,304.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,562.44
|
| Rate for Payer: Signature Care EPO |
$4,905.21
|
| Rate for Payer: Signature Care PPO |
$5,200.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,023.41
|
| Rate for Payer: United Healthcare Commercial |
$4,656.99
|
| Rate for Payer: United Healthcare Medicare |
$1,891.16
|
|
|
LEUPROLIDE 3.75 MG IM SYKT
|
Facility
|
IP
|
$5,909.89
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,432.42 |
| Max. Negotiated Rate |
$5,496.20 |
| Rate for Payer: Aetna Commercial |
$5,106.14
|
| Rate for Payer: Cash Price |
$3,545.93
|
| Rate for Payer: Cigna All Commercial |
$5,100.24
|
| Rate for Payer: CORVEL All Commercial |
$5,496.20
|
| Rate for Payer: Coventry All Commercial |
$5,200.70
|
| Rate for Payer: Encore All Commercial |
$5,440.05
|
| Rate for Payer: Frontpath All Commercial |
$5,437.10
|
| Rate for Payer: Humana ChoiceCare |
$5,104.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,318.90
|
| Rate for Payer: PHCS All Commercial |
$4,432.42
|
| Rate for Payer: PHP All Commercial |
$4,482.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,562.44
|
| Rate for Payer: Signature Care EPO |
$4,905.21
|
| Rate for Payer: Signature Care PPO |
$5,200.70
|
| Rate for Payer: United Healthcare Commercial |
$4,656.99
|
|
|
LEUPROLIDE (3 MONTH) 11.25 MG IM SYKT
|
Facility
|
IP
|
$17,729.81
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
21044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13,297.36 |
| Max. Negotiated Rate |
$16,488.72 |
| Rate for Payer: Aetna Commercial |
$15,318.56
|
| Rate for Payer: Cash Price |
$10,637.89
|
| Rate for Payer: Cigna All Commercial |
$15,300.83
|
| Rate for Payer: CORVEL All Commercial |
$16,488.72
|
| Rate for Payer: Coventry All Commercial |
$15,602.23
|
| Rate for Payer: Encore All Commercial |
$16,320.29
|
| Rate for Payer: Frontpath All Commercial |
$16,311.43
|
| Rate for Payer: Humana ChoiceCare |
$15,313.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,956.83
|
| Rate for Payer: PHCS All Commercial |
$13,297.36
|
| Rate for Payer: PHP All Commercial |
$13,446.29
|
| Rate for Payer: Sagamore Health Network All Products |
$13,687.41
|
| Rate for Payer: Signature Care EPO |
$14,715.74
|
| Rate for Payer: Signature Care PPO |
$15,602.23
|
| Rate for Payer: United Healthcare Commercial |
$13,971.09
|
|
|
LEUPROLIDE (3 MONTH) 11.25 MG IM SYKT
|
Facility
|
OP
|
$17,729.81
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
21044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,126.81 |
| Max. Negotiated Rate |
$16,488.72 |
| Rate for Payer: Aetna Commercial |
$14,963.96
|
| Rate for Payer: Aetna Medicare |
$5,673.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,126.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,496.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10,182.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,082.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,126.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,524.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,240.89
|
| Rate for Payer: Cash Price |
$10,637.89
|
| Rate for Payer: Cash Price |
$10,637.89
|
| Rate for Payer: Centivo All Commercial |
$9,645.02
|
| Rate for Payer: Cigna All Commercial |
$15,300.83
|
| Rate for Payer: CORVEL All Commercial |
$16,488.72
|
| Rate for Payer: Coventry All Commercial |
$15,602.23
|
| Rate for Payer: Encore All Commercial |
$16,320.29
|
| Rate for Payer: Frontpath All Commercial |
$16,311.43
|
| Rate for Payer: Humana ChoiceCare |
$15,313.24
|
| Rate for Payer: Humana Medicare |
$5,673.54
|
| Rate for Payer: Lucent All Commercial |
$9,645.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,956.83
|
| Rate for Payer: Managed Health Services Medicaid |
$1,126.81
|
| Rate for Payer: MDWise Medicaid |
$1,126.81
|
| Rate for Payer: PHCS All Commercial |
$13,297.36
|
| Rate for Payer: PHP All Commercial |
$13,446.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,914.63
|
| Rate for Payer: Sagamore Health Network All Products |
$13,687.41
|
| Rate for Payer: Signature Care EPO |
$14,715.74
|
| Rate for Payer: Signature Care PPO |
$15,602.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,070.34
|
| Rate for Payer: United Healthcare Commercial |
$13,971.09
|
| Rate for Payer: United Healthcare Medicare |
$5,673.54
|
|
|
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT
|
Facility
|
OP
|
$21,127.58
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.27 |
| Max. Negotiated Rate |
$19,648.64 |
| Rate for Payer: Aetna Commercial |
$17,831.67
|
| Rate for Payer: Aetna Medicare |
$6,760.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$474.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,549.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12,133.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13,206.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$474.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,774.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,436.91
|
| Rate for Payer: Cash Price |
$12,676.55
|
| Rate for Payer: Cash Price |
$12,676.55
|
| Rate for Payer: Centivo All Commercial |
$11,493.40
|
| Rate for Payer: Cigna All Commercial |
$18,233.10
|
| Rate for Payer: CORVEL All Commercial |
$19,648.64
|
| Rate for Payer: Coventry All Commercial |
$18,592.27
|
| Rate for Payer: Encore All Commercial |
$19,447.93
|
| Rate for Payer: Frontpath All Commercial |
$19,437.37
|
| Rate for Payer: Humana ChoiceCare |
$18,247.89
|
| Rate for Payer: Humana Medicare |
$6,760.82
|
| Rate for Payer: Lucent All Commercial |
$11,493.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19,014.82
|
| Rate for Payer: Managed Health Services Medicaid |
$474.27
|
| Rate for Payer: MDWise Medicaid |
$474.27
|
| Rate for Payer: PHCS All Commercial |
$15,845.68
|
| Rate for Payer: PHP All Commercial |
$16,023.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,239.75
|
| Rate for Payer: Sagamore Health Network All Products |
$16,310.49
|
| Rate for Payer: Signature Care EPO |
$17,535.89
|
| Rate for Payer: Signature Care PPO |
$18,592.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,958.44
|
| Rate for Payer: United Healthcare Commercial |
$16,648.53
|
| Rate for Payer: United Healthcare Medicare |
$6,760.82
|
|
|
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT
|
Facility
|
IP
|
$21,127.58
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,845.68 |
| Max. Negotiated Rate |
$19,648.64 |
| Rate for Payer: Aetna Commercial |
$18,254.22
|
| Rate for Payer: Cash Price |
$12,676.55
|
| Rate for Payer: Cigna All Commercial |
$18,233.10
|
| Rate for Payer: CORVEL All Commercial |
$19,648.64
|
| Rate for Payer: Coventry All Commercial |
$18,592.27
|
| Rate for Payer: Encore All Commercial |
$19,447.93
|
| Rate for Payer: Frontpath All Commercial |
$19,437.37
|
| Rate for Payer: Humana ChoiceCare |
$18,247.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19,014.82
|
| Rate for Payer: PHCS All Commercial |
$15,845.68
|
| Rate for Payer: PHP All Commercial |
$16,023.15
|
| Rate for Payer: Sagamore Health Network All Products |
$16,310.49
|
| Rate for Payer: Signature Care EPO |
$17,535.89
|
| Rate for Payer: Signature Care PPO |
$18,592.27
|
| Rate for Payer: United Healthcare Commercial |
$16,648.53
|
|
|
LEUPROLIDE (4 MONTH) 30 MG IM SYKT
|
Facility
|
IP
|
$28,170.21
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21,127.65 |
| Max. Negotiated Rate |
$26,198.29 |
| Rate for Payer: Aetna Commercial |
$24,339.06
|
| Rate for Payer: Cash Price |
$16,902.12
|
| Rate for Payer: Cigna All Commercial |
$24,310.89
|
| Rate for Payer: CORVEL All Commercial |
$26,198.29
|
| Rate for Payer: Coventry All Commercial |
$24,789.78
|
| Rate for Payer: Encore All Commercial |
$25,930.67
|
| Rate for Payer: Frontpath All Commercial |
$25,916.59
|
| Rate for Payer: Humana ChoiceCare |
$24,330.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25,353.18
|
| Rate for Payer: PHCS All Commercial |
$21,127.65
|
| Rate for Payer: PHP All Commercial |
$21,364.28
|
| Rate for Payer: Sagamore Health Network All Products |
$21,747.40
|
| Rate for Payer: Signature Care EPO |
$23,381.27
|
| Rate for Payer: Signature Care PPO |
$24,789.78
|
| Rate for Payer: United Healthcare Commercial |
$22,198.12
|
|
|
LEUPROLIDE (4 MONTH) 30 MG IM SYKT
|
Facility
|
OP
|
$28,170.21
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.27 |
| Max. Negotiated Rate |
$26,198.29 |
| Rate for Payer: Aetna Commercial |
$23,775.65
|
| Rate for Payer: Aetna Medicare |
$9,014.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$474.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,732.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16,178.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17,609.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$474.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,366.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,915.91
|
| Rate for Payer: Cash Price |
$16,902.12
|
| Rate for Payer: Cash Price |
$16,902.12
|
| Rate for Payer: Centivo All Commercial |
$15,324.59
|
| Rate for Payer: Cigna All Commercial |
$24,310.89
|
| Rate for Payer: CORVEL All Commercial |
$26,198.29
|
| Rate for Payer: Coventry All Commercial |
$24,789.78
|
| Rate for Payer: Encore All Commercial |
$25,930.67
|
| Rate for Payer: Frontpath All Commercial |
$25,916.59
|
| Rate for Payer: Humana ChoiceCare |
$24,330.61
|
| Rate for Payer: Humana Medicare |
$9,014.47
|
| Rate for Payer: Lucent All Commercial |
$15,324.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25,353.18
|
| Rate for Payer: Managed Health Services Medicaid |
$474.27
|
| Rate for Payer: MDWise Medicaid |
$474.27
|
| Rate for Payer: PHCS All Commercial |
$21,127.65
|
| Rate for Payer: PHP All Commercial |
$21,364.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10,986.38
|
| Rate for Payer: Sagamore Health Network All Products |
$21,747.40
|
| Rate for Payer: Signature Care EPO |
$23,381.27
|
| Rate for Payer: Signature Care PPO |
$24,789.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,944.67
|
| Rate for Payer: United Healthcare Commercial |
$22,198.12
|
| Rate for Payer: United Healthcare Medicare |
$9,014.47
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT
|
Facility
|
OP
|
$42,255.92
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.27 |
| Max. Negotiated Rate |
$39,298.01 |
| Rate for Payer: Aetna Commercial |
$35,664.00
|
| Rate for Payer: Aetna Medicare |
$13,521.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$474.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13,099.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24,267.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26,414.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$474.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15,550.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14,874.08
|
| Rate for Payer: Cash Price |
$25,353.55
|
| Rate for Payer: Cash Price |
$25,353.55
|
| Rate for Payer: Centivo All Commercial |
$22,987.22
|
| Rate for Payer: Cigna All Commercial |
$36,466.86
|
| Rate for Payer: CORVEL All Commercial |
$39,298.01
|
| Rate for Payer: Coventry All Commercial |
$37,185.21
|
| Rate for Payer: Encore All Commercial |
$38,896.57
|
| Rate for Payer: Frontpath All Commercial |
$38,875.45
|
| Rate for Payer: Humana ChoiceCare |
$36,496.44
|
| Rate for Payer: Humana Medicare |
$13,521.89
|
| Rate for Payer: Lucent All Commercial |
$22,987.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38,030.33
|
| Rate for Payer: Managed Health Services Medicaid |
$474.27
|
| Rate for Payer: MDWise Medicaid |
$474.27
|
| Rate for Payer: PHCS All Commercial |
$31,691.94
|
| Rate for Payer: PHP All Commercial |
$32,046.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16,479.81
|
| Rate for Payer: Sagamore Health Network All Products |
$32,621.57
|
| Rate for Payer: Signature Care EPO |
$35,072.41
|
| Rate for Payer: Signature Care PPO |
$37,185.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35,917.53
|
| Rate for Payer: United Healthcare Commercial |
$33,297.66
|
| Rate for Payer: United Healthcare Medicare |
$13,521.89
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT
|
Facility
|
IP
|
$42,255.92
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31,691.94 |
| Max. Negotiated Rate |
$39,298.01 |
| Rate for Payer: Aetna Commercial |
$36,509.11
|
| Rate for Payer: Cash Price |
$25,353.55
|
| Rate for Payer: Cigna All Commercial |
$36,466.86
|
| Rate for Payer: CORVEL All Commercial |
$39,298.01
|
| Rate for Payer: Coventry All Commercial |
$37,185.21
|
| Rate for Payer: Encore All Commercial |
$38,896.57
|
| Rate for Payer: Frontpath All Commercial |
$38,875.45
|
| Rate for Payer: Humana ChoiceCare |
$36,496.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38,030.33
|
| Rate for Payer: PHCS All Commercial |
$31,691.94
|
| Rate for Payer: PHP All Commercial |
$32,046.89
|
| Rate for Payer: Sagamore Health Network All Products |
$32,621.57
|
| Rate for Payer: Signature Care EPO |
$35,072.41
|
| Rate for Payer: Signature Care PPO |
$37,185.21
|
| Rate for Payer: United Healthcare Commercial |
$33,297.66
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG SUBQ SYRG
|
Facility
|
OP
|
$9,485.46
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
40801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.27 |
| Max. Negotiated Rate |
$8,821.47 |
| Rate for Payer: Aetna Commercial |
$8,005.72
|
| Rate for Payer: Aetna Medicare |
$3,035.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$474.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,940.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,447.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,929.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$474.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,490.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,338.88
|
| Rate for Payer: Cash Price |
$5,691.27
|
| Rate for Payer: Cash Price |
$5,691.27
|
| Rate for Payer: Centivo All Commercial |
$5,160.09
|
| Rate for Payer: Cigna All Commercial |
$8,185.95
|
| Rate for Payer: CORVEL All Commercial |
$8,821.47
|
| Rate for Payer: Coventry All Commercial |
$8,347.20
|
| Rate for Payer: Encore All Commercial |
$8,731.36
|
| Rate for Payer: Frontpath All Commercial |
$8,726.62
|
| Rate for Payer: Humana ChoiceCare |
$8,192.59
|
| Rate for Payer: Humana Medicare |
$3,035.35
|
| Rate for Payer: Lucent All Commercial |
$5,160.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,536.91
|
| Rate for Payer: Managed Health Services Medicaid |
$474.27
|
| Rate for Payer: MDWise Medicaid |
$474.27
|
| Rate for Payer: PHCS All Commercial |
$7,114.09
|
| Rate for Payer: PHP All Commercial |
$7,193.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,699.33
|
| Rate for Payer: Sagamore Health Network All Products |
$7,322.77
|
| Rate for Payer: Signature Care EPO |
$7,872.93
|
| Rate for Payer: Signature Care PPO |
$8,347.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,062.64
|
| Rate for Payer: United Healthcare Commercial |
$7,474.54
|
| Rate for Payer: United Healthcare Medicare |
$3,035.35
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG SUBQ SYRG
|
Facility
|
IP
|
$9,485.46
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
40801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,114.09 |
| Max. Negotiated Rate |
$8,821.47 |
| Rate for Payer: Aetna Commercial |
$8,195.43
|
| Rate for Payer: Cash Price |
$5,691.27
|
| Rate for Payer: Cigna All Commercial |
$8,185.95
|
| Rate for Payer: CORVEL All Commercial |
$8,821.47
|
| Rate for Payer: Coventry All Commercial |
$8,347.20
|
| Rate for Payer: Encore All Commercial |
$8,731.36
|
| Rate for Payer: Frontpath All Commercial |
$8,726.62
|
| Rate for Payer: Humana ChoiceCare |
$8,192.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,536.91
|
| Rate for Payer: PHCS All Commercial |
$7,114.09
|
| Rate for Payer: PHP All Commercial |
$7,193.77
|
| Rate for Payer: Sagamore Health Network All Products |
$7,322.77
|
| Rate for Payer: Signature Care EPO |
$7,872.93
|
| Rate for Payer: Signature Care PPO |
$8,347.20
|
| Rate for Payer: United Healthcare Commercial |
$7,474.54
|
|
|
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU
|
Facility
|
IP
|
$7.37
|
|
|
Service Code
|
NDC 00093414656
|
| Hospital Charge Code |
24915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna All Commercial |
$6.36
|
| Rate for Payer: CORVEL All Commercial |
$6.86
|
| Rate for Payer: Coventry All Commercial |
$6.49
|
| Rate for Payer: Encore All Commercial |
$6.79
|
| Rate for Payer: Frontpath All Commercial |
$6.78
|
| Rate for Payer: Humana ChoiceCare |
$6.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.63
|
| Rate for Payer: PHCS All Commercial |
$5.53
|
| Rate for Payer: PHP All Commercial |
$5.59
|
| Rate for Payer: Sagamore Health Network All Products |
$5.69
|
| Rate for Payer: Signature Care EPO |
$6.12
|
| Rate for Payer: Signature Care PPO |
$6.49
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
|
|
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU
|
Facility
|
OP
|
$7.37
|
|
|
Service Code
|
NDC 00093414656
|
| Hospital Charge Code |
24915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna Commercial |
$6.22
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.59
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Centivo All Commercial |
$4.01
|
| Rate for Payer: Cigna All Commercial |
$6.36
|
| Rate for Payer: CORVEL All Commercial |
$6.86
|
| Rate for Payer: Coventry All Commercial |
$6.49
|
| Rate for Payer: Encore All Commercial |
$6.79
|
| Rate for Payer: Frontpath All Commercial |
$6.78
|
| Rate for Payer: Humana ChoiceCare |
$6.37
|
| Rate for Payer: Humana Medicare |
$2.36
|
| Rate for Payer: Lucent All Commercial |
$4.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.63
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$5.53
|
| Rate for Payer: PHP All Commercial |
$5.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.87
|
| Rate for Payer: Sagamore Health Network All Products |
$5.69
|
| Rate for Payer: Signature Care EPO |
$6.12
|
| Rate for Payer: Signature Care PPO |
$6.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.27
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
| Rate for Payer: United Healthcare Medicare |
$2.36
|
|
|
LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBU
|
Facility
|
IP
|
$33.16
|
|
|
Service Code
|
NDC 00378699393
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$30.84 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cigna All Commercial |
$28.62
|
| Rate for Payer: CORVEL All Commercial |
$30.84
|
| Rate for Payer: Coventry All Commercial |
$29.18
|
| Rate for Payer: Encore All Commercial |
$30.52
|
| Rate for Payer: Frontpath All Commercial |
$30.51
|
| Rate for Payer: Humana ChoiceCare |
$28.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.84
|
| Rate for Payer: PHCS All Commercial |
$24.87
|
| Rate for Payer: PHP All Commercial |
$25.15
|
| Rate for Payer: Sagamore Health Network All Products |
$25.60
|
| Rate for Payer: Signature Care EPO |
$27.52
|
| Rate for Payer: Signature Care PPO |
$29.18
|
| Rate for Payer: United Healthcare Commercial |
$26.13
|
|
|
LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBU
|
Facility
|
OP
|
$33.16
|
|
|
Service Code
|
NDC 00378699393
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$30.84 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.67
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Centivo All Commercial |
$18.04
|
| Rate for Payer: Cigna All Commercial |
$28.62
|
| Rate for Payer: CORVEL All Commercial |
$30.84
|
| Rate for Payer: Coventry All Commercial |
$29.18
|
| Rate for Payer: Encore All Commercial |
$30.52
|
| Rate for Payer: Frontpath All Commercial |
$30.51
|
| Rate for Payer: Humana ChoiceCare |
$28.64
|
| Rate for Payer: Humana Medicare |
$10.61
|
| Rate for Payer: Lucent All Commercial |
$18.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.84
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$24.87
|
| Rate for Payer: PHP All Commercial |
$25.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.93
|
| Rate for Payer: Sagamore Health Network All Products |
$25.60
|
| Rate for Payer: Signature Care EPO |
$27.52
|
| Rate for Payer: Signature Care PPO |
$29.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.19
|
| Rate for Payer: United Healthcare Commercial |
$26.13
|
| Rate for Payer: United Healthcare Medicare |
$10.61
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLN
|
Facility
|
IP
|
$79.46
|
|
|
Service Code
|
NDC 65862025047
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$73.90 |
| Rate for Payer: Aetna Commercial |
$68.66
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cigna All Commercial |
$68.58
|
| Rate for Payer: CORVEL All Commercial |
$73.90
|
| Rate for Payer: Coventry All Commercial |
$69.93
|
| Rate for Payer: Encore All Commercial |
$73.15
|
| Rate for Payer: Frontpath All Commercial |
$73.11
|
| Rate for Payer: Humana ChoiceCare |
$68.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.52
|
| Rate for Payer: PHCS All Commercial |
$59.60
|
| Rate for Payer: PHP All Commercial |
$60.27
|
| Rate for Payer: Sagamore Health Network All Products |
$61.35
|
| Rate for Payer: Signature Care EPO |
$65.96
|
| Rate for Payer: Signature Care PPO |
$69.93
|
| Rate for Payer: United Healthcare Commercial |
$62.62
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLN
|
Facility
|
OP
|
$79.46
|
|
|
Service Code
|
NDC 65862025047
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$73.90 |
| Rate for Payer: Aetna Commercial |
$67.07
|
| Rate for Payer: Aetna Medicare |
$25.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.97
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Centivo All Commercial |
$43.23
|
| Rate for Payer: Cigna All Commercial |
$68.58
|
| Rate for Payer: CORVEL All Commercial |
$73.90
|
| Rate for Payer: Coventry All Commercial |
$69.93
|
| Rate for Payer: Encore All Commercial |
$73.15
|
| Rate for Payer: Frontpath All Commercial |
$73.11
|
| Rate for Payer: Humana ChoiceCare |
$68.63
|
| Rate for Payer: Humana Medicare |
$25.43
|
| Rate for Payer: Lucent All Commercial |
$43.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.52
|
| Rate for Payer: PHCS All Commercial |
$59.60
|
| Rate for Payer: PHP All Commercial |
$60.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.99
|
| Rate for Payer: Sagamore Health Network All Products |
$61.35
|
| Rate for Payer: Signature Care EPO |
$65.96
|
| Rate for Payer: Signature Care PPO |
$69.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$62.62
|
| Rate for Payer: United Healthcare Medicare |
$25.43
|
|
|
LEVETIRACETAM 250 MG ORAL TAB
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 63739079510
|
| Hospital Charge Code |
26816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna Commercial |
$0.97
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.40
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Centivo All Commercial |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.99
|
| Rate for Payer: CORVEL All Commercial |
$1.07
|
| Rate for Payer: Coventry All Commercial |
$1.01
|
| Rate for Payer: Encore All Commercial |
$1.06
|
| Rate for Payer: Frontpath All Commercial |
$1.06
|
| Rate for Payer: Humana ChoiceCare |
$0.99
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Lucent All Commercial |
$0.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.03
|
| Rate for Payer: PHCS All Commercial |
$0.86
|
| Rate for Payer: PHP All Commercial |
$0.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.45
|
| Rate for Payer: Sagamore Health Network All Products |
$0.89
|
| Rate for Payer: Signature Care EPO |
$0.95
|
| Rate for Payer: Signature Care PPO |
$1.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
|
