|
FENTANYL CITRATE (PF) 50 MCG/ML PEDIATRIC INTRANASAL SOLN (CAMERON)
|
Facility
OP
|
$12.22
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
140160205301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: Aetna Medicare |
$4.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.43
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: Centivo All Commercial |
$6.23
|
| Rate for Payer: Cigna All Commercial |
$10.54
|
| Rate for Payer: CORVEL All Commercial |
$11.36
|
| Rate for Payer: Coventry All Commercial |
$10.75
|
| Rate for Payer: Encore All Commercial |
$11.24
|
| Rate for Payer: Frontpath All Commercial |
$11.24
|
| Rate for Payer: Humana ChoiceCare |
$10.55
|
| Rate for Payer: Humana Medicare |
$6.23
|
| Rate for Payer: Lucent All Commercial |
$6.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.99
|
| Rate for Payer: PHCS All Commercial |
$9.16
|
| Rate for Payer: PHP All Commercial |
$9.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.76
|
| Rate for Payer: Sagamore Health Network All Products |
$9.43
|
| Rate for Payer: Signature Care EPO |
$10.14
|
| Rate for Payer: Signature Care PPO |
$10.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.38
|
| Rate for Payer: United Healthcare Commercial |
$9.63
|
| Rate for Payer: United Healthcare Medicare |
$4.03
|
|
|
FENTANYL (PF)-BUPIVACAINE-NACL 2 MCG/ML- 0.125 % INJ SOLN
|
Facility
IP
|
$160.30
|
|
|
Service Code
|
NDC 70092110436
|
| Hospital Charge Code |
30862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Aetna Commercial |
$138.50
|
| Rate for Payer: Cash Price |
$99.39
|
| Rate for Payer: Cigna All Commercial |
$138.34
|
| Rate for Payer: CORVEL All Commercial |
$149.08
|
| Rate for Payer: Coventry All Commercial |
$141.06
|
| Rate for Payer: Encore All Commercial |
$147.56
|
| Rate for Payer: Frontpath All Commercial |
$147.48
|
| Rate for Payer: Humana ChoiceCare |
$138.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.27
|
| Rate for Payer: PHCS All Commercial |
$120.22
|
| Rate for Payer: PHP All Commercial |
$121.57
|
| Rate for Payer: Sagamore Health Network All Products |
$123.75
|
| Rate for Payer: Signature Care EPO |
$133.05
|
| Rate for Payer: Signature Care PPO |
$141.06
|
| Rate for Payer: United Healthcare Commercial |
$126.32
|
|
|
FENTANYL (PF)-BUPIVACAINE-NACL 2 MCG/ML- 0.125 % INJ SOLN
|
Facility
OP
|
$160.30
|
|
|
Service Code
|
NDC 70092110436
|
| Hospital Charge Code |
30862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Aetna Commercial |
$135.29
|
| Rate for Payer: Aetna Medicare |
$52.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.19
|
| Rate for Payer: Cash Price |
$99.39
|
| Rate for Payer: Centivo All Commercial |
$81.75
|
| Rate for Payer: Cigna All Commercial |
$138.34
|
| Rate for Payer: CORVEL All Commercial |
$149.08
|
| Rate for Payer: Coventry All Commercial |
$141.06
|
| Rate for Payer: Encore All Commercial |
$147.56
|
| Rate for Payer: Frontpath All Commercial |
$147.48
|
| Rate for Payer: Humana ChoiceCare |
$138.45
|
| Rate for Payer: Humana Medicare |
$81.75
|
| Rate for Payer: Lucent All Commercial |
$81.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.27
|
| Rate for Payer: PHCS All Commercial |
$120.22
|
| Rate for Payer: PHP All Commercial |
$121.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.52
|
| Rate for Payer: Sagamore Health Network All Products |
$123.75
|
| Rate for Payer: Signature Care EPO |
$133.05
|
| Rate for Payer: Signature Care PPO |
$141.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.26
|
| Rate for Payer: United Healthcare Commercial |
$126.32
|
| Rate for Payer: United Healthcare Medicare |
$52.90
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN
|
Facility
IP
|
$3,760.74
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
165287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,820.56 |
| Max. Negotiated Rate |
$3,497.49 |
| Rate for Payer: Aetna Commercial |
$3,249.28
|
| Rate for Payer: Cash Price |
$2,331.66
|
| Rate for Payer: Cigna All Commercial |
$3,245.52
|
| Rate for Payer: CORVEL All Commercial |
$3,497.49
|
| Rate for Payer: Coventry All Commercial |
$3,309.45
|
| Rate for Payer: Encore All Commercial |
$3,461.76
|
| Rate for Payer: Frontpath All Commercial |
$3,459.88
|
| Rate for Payer: Humana ChoiceCare |
$3,248.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,384.67
|
| Rate for Payer: PHCS All Commercial |
$2,820.56
|
| Rate for Payer: PHP All Commercial |
$2,852.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,903.29
|
| Rate for Payer: Signature Care EPO |
$3,121.41
|
| Rate for Payer: Signature Care PPO |
$3,309.45
|
| Rate for Payer: United Healthcare Commercial |
$2,963.46
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN
|
Facility
OP
|
$3,760.74
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
165287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3,497.49 |
| Rate for Payer: Aetna Commercial |
$3,174.06
|
| Rate for Payer: Aetna Medicare |
$1,241.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,241.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,159.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,350.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,427.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,365.15
|
| Rate for Payer: Cash Price |
$2,331.66
|
| Rate for Payer: Cash Price |
$2,331.66
|
| Rate for Payer: Centivo All Commercial |
$1,917.98
|
| Rate for Payer: Cigna All Commercial |
$3,245.52
|
| Rate for Payer: CORVEL All Commercial |
$3,497.49
|
| Rate for Payer: Coventry All Commercial |
$3,309.45
|
| Rate for Payer: Encore All Commercial |
$3,461.76
|
| Rate for Payer: Frontpath All Commercial |
$3,459.88
|
| Rate for Payer: Humana ChoiceCare |
$3,248.15
|
| Rate for Payer: Humana Medicare |
$1,917.98
|
| Rate for Payer: Lucent All Commercial |
$1,917.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,384.67
|
| Rate for Payer: Managed Health Services Medicaid |
$1.89
|
| Rate for Payer: MDWise Medicaid |
$1.89
|
| Rate for Payer: PHCS All Commercial |
$2,820.56
|
| Rate for Payer: PHP All Commercial |
$2,852.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,466.69
|
| Rate for Payer: Sagamore Health Network All Products |
$2,903.29
|
| Rate for Payer: Signature Care EPO |
$3,121.41
|
| Rate for Payer: Signature Care PPO |
$3,309.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,196.63
|
| Rate for Payer: United Healthcare Commercial |
$2,963.46
|
| Rate for Payer: United Healthcare Medicare |
$1,241.04
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML IV SOLN
|
Facility
IP
|
$11,931.89
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
192376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8,948.91 |
| Max. Negotiated Rate |
$11,096.65 |
| Rate for Payer: Aetna Commercial |
$10,309.15
|
| Rate for Payer: Cash Price |
$7,397.77
|
| Rate for Payer: Cigna All Commercial |
$10,297.22
|
| Rate for Payer: CORVEL All Commercial |
$11,096.65
|
| Rate for Payer: Coventry All Commercial |
$10,500.06
|
| Rate for Payer: Encore All Commercial |
$10,983.30
|
| Rate for Payer: Frontpath All Commercial |
$10,977.33
|
| Rate for Payer: Humana ChoiceCare |
$10,305.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,738.70
|
| Rate for Payer: PHCS All Commercial |
$8,948.91
|
| Rate for Payer: PHP All Commercial |
$9,049.14
|
| Rate for Payer: Sagamore Health Network All Products |
$9,211.42
|
| Rate for Payer: Signature Care EPO |
$9,903.46
|
| Rate for Payer: Signature Care PPO |
$10,500.06
|
| Rate for Payer: United Healthcare Commercial |
$9,402.33
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML IV SOLN
|
Facility
OP
|
$11,931.89
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
192376
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$11,096.65 |
| Rate for Payer: Aetna Commercial |
$10,070.51
|
| Rate for Payer: Aetna Medicare |
$3,937.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,937.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,852.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,458.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$26.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,528.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,331.27
|
| Rate for Payer: Cash Price |
$7,397.77
|
| Rate for Payer: Cash Price |
$7,397.77
|
| Rate for Payer: Centivo All Commercial |
$6,085.26
|
| Rate for Payer: Cigna All Commercial |
$10,297.22
|
| Rate for Payer: CORVEL All Commercial |
$11,096.65
|
| Rate for Payer: Coventry All Commercial |
$10,500.06
|
| Rate for Payer: Encore All Commercial |
$10,983.30
|
| Rate for Payer: Frontpath All Commercial |
$10,977.33
|
| Rate for Payer: Humana ChoiceCare |
$10,305.57
|
| Rate for Payer: Humana Medicare |
$6,085.26
|
| Rate for Payer: Lucent All Commercial |
$6,085.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,738.70
|
| Rate for Payer: Managed Health Services Medicaid |
$26.65
|
| Rate for Payer: MDWise Medicaid |
$26.65
|
| Rate for Payer: PHCS All Commercial |
$8,948.91
|
| Rate for Payer: PHP All Commercial |
$9,049.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,653.44
|
| Rate for Payer: Sagamore Health Network All Products |
$9,211.42
|
| Rate for Payer: Signature Care EPO |
$9,903.46
|
| Rate for Payer: Signature Care PPO |
$10,500.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,142.10
|
| Rate for Payer: United Healthcare Commercial |
$9,402.33
|
| Rate for Payer: United Healthcare Medicare |
$3,937.52
|
|
|
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA
|
Facility
OP
|
$114.41
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
165668
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna Commercial |
$96.56
|
| Rate for Payer: Aetna Medicare |
$37.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.53
|
| Rate for Payer: Cash Price |
$70.93
|
| Rate for Payer: Cash Price |
$70.93
|
| Rate for Payer: Centivo All Commercial |
$58.35
|
| Rate for Payer: Cigna All Commercial |
$98.73
|
| Rate for Payer: CORVEL All Commercial |
$106.40
|
| Rate for Payer: Coventry All Commercial |
$100.68
|
| Rate for Payer: Encore All Commercial |
$105.31
|
| Rate for Payer: Frontpath All Commercial |
$105.26
|
| Rate for Payer: Humana ChoiceCare |
$98.81
|
| Rate for Payer: Humana Medicare |
$58.35
|
| Rate for Payer: Lucent All Commercial |
$58.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.97
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$85.81
|
| Rate for Payer: PHP All Commercial |
$86.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.62
|
| Rate for Payer: Sagamore Health Network All Products |
$88.32
|
| Rate for Payer: Signature Care EPO |
$94.96
|
| Rate for Payer: Signature Care PPO |
$100.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.25
|
| Rate for Payer: United Healthcare Commercial |
$90.15
|
| Rate for Payer: United Healthcare Medicare |
$37.75
|
|
|
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA
|
Facility
IP
|
$114.41
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
165668
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.81 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$70.93
|
| Rate for Payer: Cigna All Commercial |
$98.73
|
| Rate for Payer: CORVEL All Commercial |
$106.40
|
| Rate for Payer: Coventry All Commercial |
$100.68
|
| Rate for Payer: Encore All Commercial |
$105.31
|
| Rate for Payer: Frontpath All Commercial |
$105.26
|
| Rate for Payer: Humana ChoiceCare |
$98.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.97
|
| Rate for Payer: PHCS All Commercial |
$85.81
|
| Rate for Payer: PHP All Commercial |
$86.77
|
| Rate for Payer: Sagamore Health Network All Products |
$88.32
|
| Rate for Payer: Signature Care EPO |
$94.96
|
| Rate for Payer: Signature Care PPO |
$100.68
|
| Rate for Payer: United Healthcare Commercial |
$90.15
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIX
|
Facility
IP
|
$0.53
|
|
|
Service Code
|
NDC 50383778
|
| Hospital Charge Code |
178290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna All Commercial |
$0.45
|
| Rate for Payer: CORVEL All Commercial |
$0.49
|
| Rate for Payer: Coventry All Commercial |
$0.46
|
| Rate for Payer: Encore All Commercial |
$0.48
|
| Rate for Payer: Frontpath All Commercial |
$0.48
|
| Rate for Payer: Humana ChoiceCare |
$0.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.47
|
| Rate for Payer: PHCS All Commercial |
$0.39
|
| Rate for Payer: PHP All Commercial |
$0.40
|
| Rate for Payer: Sagamore Health Network All Products |
$0.41
|
| Rate for Payer: Signature Care EPO |
$0.44
|
| Rate for Payer: Signature Care PPO |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.41
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIX
|
Facility
IP
|
$49.67
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
178290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Aetna Commercial |
$42.91
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cigna All Commercial |
$42.86
|
| Rate for Payer: CORVEL All Commercial |
$46.19
|
| Rate for Payer: Coventry All Commercial |
$43.71
|
| Rate for Payer: Encore All Commercial |
$45.72
|
| Rate for Payer: Frontpath All Commercial |
$45.69
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.70
|
| Rate for Payer: PHCS All Commercial |
$37.25
|
| Rate for Payer: PHP All Commercial |
$37.67
|
| Rate for Payer: Sagamore Health Network All Products |
$38.34
|
| Rate for Payer: Signature Care EPO |
$41.22
|
| Rate for Payer: Signature Care PPO |
$43.71
|
| Rate for Payer: United Healthcare Commercial |
$39.14
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIX
|
Facility
OP
|
$49.67
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
178290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: Aetna Medicare |
$16.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.03
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Centivo All Commercial |
$25.33
|
| Rate for Payer: Cigna All Commercial |
$42.86
|
| Rate for Payer: CORVEL All Commercial |
$46.19
|
| Rate for Payer: Coventry All Commercial |
$43.71
|
| Rate for Payer: Encore All Commercial |
$45.72
|
| Rate for Payer: Frontpath All Commercial |
$45.69
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Humana Medicare |
$25.33
|
| Rate for Payer: Lucent All Commercial |
$25.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.70
|
| Rate for Payer: PHCS All Commercial |
$37.25
|
| Rate for Payer: PHP All Commercial |
$37.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.37
|
| Rate for Payer: Sagamore Health Network All Products |
$38.34
|
| Rate for Payer: Signature Care EPO |
$41.22
|
| Rate for Payer: Signature Care PPO |
$43.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.22
|
| Rate for Payer: United Healthcare Commercial |
$39.14
|
| Rate for Payer: United Healthcare Medicare |
$16.39
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIX
|
Facility
OP
|
$0.53
|
|
|
Service Code
|
NDC 50383778
|
| Hospital Charge Code |
178290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna Commercial |
$0.44
|
| Rate for Payer: Aetna Medicare |
$0.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.19
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Centivo All Commercial |
$0.27
|
| Rate for Payer: Cigna All Commercial |
$0.45
|
| Rate for Payer: CORVEL All Commercial |
$0.49
|
| Rate for Payer: Coventry All Commercial |
$0.46
|
| Rate for Payer: Encore All Commercial |
$0.48
|
| Rate for Payer: Frontpath All Commercial |
$0.48
|
| Rate for Payer: Humana ChoiceCare |
$0.45
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Lucent All Commercial |
$0.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.47
|
| Rate for Payer: PHCS All Commercial |
$0.39
|
| Rate for Payer: PHP All Commercial |
$0.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.20
|
| Rate for Payer: Sagamore Health Network All Products |
$0.41
|
| Rate for Payer: Signature Care EPO |
$0.44
|
| Rate for Payer: Signature Care PPO |
$0.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.41
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
|
|
FERROUS SULFATE 325 MG ORAL TAB
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Aetna Medicare |
$0.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.08
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Centivo All Commercial |
$0.11
|
| Rate for Payer: Cigna All Commercial |
$0.19
|
| Rate for Payer: CORVEL All Commercial |
$0.21
|
| Rate for Payer: Coventry All Commercial |
$0.20
|
| Rate for Payer: Encore All Commercial |
$0.21
|
| Rate for Payer: Frontpath All Commercial |
$0.21
|
| Rate for Payer: Humana ChoiceCare |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.11
|
| Rate for Payer: Lucent All Commercial |
$0.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.20
|
| Rate for Payer: PHCS All Commercial |
$0.17
|
| Rate for Payer: PHP All Commercial |
$0.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.09
|
| Rate for Payer: Sagamore Health Network All Products |
$0.17
|
| Rate for Payer: Signature Care EPO |
$0.19
|
| Rate for Payer: Signature Care PPO |
$0.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
|
|
FERROUS SULFATE 325 MG ORAL TAB
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna All Commercial |
$0.19
|
| Rate for Payer: CORVEL All Commercial |
$0.21
|
| Rate for Payer: Coventry All Commercial |
$0.20
|
| Rate for Payer: Encore All Commercial |
$0.21
|
| Rate for Payer: Frontpath All Commercial |
$0.21
|
| Rate for Payer: Humana ChoiceCare |
$0.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.20
|
| Rate for Payer: PHCS All Commercial |
$0.17
|
| Rate for Payer: PHP All Commercial |
$0.17
|
| Rate for Payer: Sagamore Health Network All Products |
$0.17
|
| Rate for Payer: Signature Care EPO |
$0.19
|
| Rate for Payer: Signature Care PPO |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN
|
Facility
OP
|
$1,574.54
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1,464.32 |
| Rate for Payer: Aetna Commercial |
$1,328.91
|
| Rate for Payer: Aetna Medicare |
$519.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$519.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$904.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$984.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$597.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$571.56
|
| Rate for Payer: Cash Price |
$976.21
|
| Rate for Payer: Cash Price |
$976.21
|
| Rate for Payer: Centivo All Commercial |
$803.02
|
| Rate for Payer: Cigna All Commercial |
$1,358.83
|
| Rate for Payer: CORVEL All Commercial |
$1,464.32
|
| Rate for Payer: Coventry All Commercial |
$1,385.60
|
| Rate for Payer: Encore All Commercial |
$1,449.36
|
| Rate for Payer: Frontpath All Commercial |
$1,448.58
|
| Rate for Payer: Humana ChoiceCare |
$1,359.93
|
| Rate for Payer: Humana Medicare |
$803.02
|
| Rate for Payer: Lucent All Commercial |
$803.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,417.09
|
| Rate for Payer: Managed Health Services Medicaid |
$1.79
|
| Rate for Payer: MDWise Medicaid |
$1.79
|
| Rate for Payer: PHCS All Commercial |
$1,180.90
|
| Rate for Payer: PHP All Commercial |
$1,194.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$614.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,215.54
|
| Rate for Payer: Signature Care EPO |
$1,306.87
|
| Rate for Payer: Signature Care PPO |
$1,385.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,338.36
|
| Rate for Payer: United Healthcare Commercial |
$1,240.74
|
| Rate for Payer: United Healthcare Medicare |
$519.60
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN
|
Facility
IP
|
$1,574.54
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,180.90 |
| Max. Negotiated Rate |
$1,464.32 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Cash Price |
$976.21
|
| Rate for Payer: Cigna All Commercial |
$1,358.83
|
| Rate for Payer: CORVEL All Commercial |
$1,464.32
|
| Rate for Payer: Coventry All Commercial |
$1,385.60
|
| Rate for Payer: Encore All Commercial |
$1,449.36
|
| Rate for Payer: Frontpath All Commercial |
$1,448.58
|
| Rate for Payer: Humana ChoiceCare |
$1,359.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,417.09
|
| Rate for Payer: PHCS All Commercial |
$1,180.90
|
| Rate for Payer: PHP All Commercial |
$1,194.13
|
| Rate for Payer: Sagamore Health Network All Products |
$1,215.54
|
| Rate for Payer: Signature Care EPO |
$1,306.87
|
| Rate for Payer: Signature Care PPO |
$1,385.60
|
| Rate for Payer: United Healthcare Commercial |
$1,240.74
|
|
|
Fetal non-stress test
|
Facility
OP
|
$381.15
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
CPT-59025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$381.15
|
| Rate for Payer: Managed Health Services Medicaid |
$381.15
|
| Rate for Payer: MDWise Medicaid |
$381.15
|
|
|
FILGRASTIM 300 MCG/0.5 ML INJ SYRG
|
Facility
IP
|
$1,300.16
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
108075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$975.12 |
| Max. Negotiated Rate |
$1,209.15 |
| Rate for Payer: Aetna Commercial |
$1,123.34
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna All Commercial |
$1,122.04
|
| Rate for Payer: CORVEL All Commercial |
$1,209.15
|
| Rate for Payer: Coventry All Commercial |
$1,144.14
|
| Rate for Payer: Encore All Commercial |
$1,196.80
|
| Rate for Payer: Frontpath All Commercial |
$1,196.15
|
| Rate for Payer: Humana ChoiceCare |
$1,122.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,170.14
|
| Rate for Payer: PHCS All Commercial |
$975.12
|
| Rate for Payer: PHP All Commercial |
$986.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.72
|
| Rate for Payer: Signature Care EPO |
$1,079.13
|
| Rate for Payer: Signature Care PPO |
$1,144.14
|
| Rate for Payer: United Healthcare Commercial |
$1,024.53
|
|
|
FILGRASTIM 300 MCG/0.5 ML INJ SYRG
|
Facility
OP
|
$1,300.16
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
108075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1,209.15 |
| Rate for Payer: Aetna Commercial |
$1,097.34
|
| Rate for Payer: Aetna Medicare |
$429.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$746.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$812.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$493.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$471.96
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Centivo All Commercial |
$663.08
|
| Rate for Payer: Cigna All Commercial |
$1,122.04
|
| Rate for Payer: CORVEL All Commercial |
$1,209.15
|
| Rate for Payer: Coventry All Commercial |
$1,144.14
|
| Rate for Payer: Encore All Commercial |
$1,196.80
|
| Rate for Payer: Frontpath All Commercial |
$1,196.15
|
| Rate for Payer: Humana ChoiceCare |
$1,122.95
|
| Rate for Payer: Humana Medicare |
$663.08
|
| Rate for Payer: Lucent All Commercial |
$663.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,170.14
|
| Rate for Payer: Managed Health Services Medicaid |
$1.10
|
| Rate for Payer: MDWise Medicaid |
$1.10
|
| Rate for Payer: PHCS All Commercial |
$975.12
|
| Rate for Payer: PHP All Commercial |
$986.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$507.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,003.72
|
| Rate for Payer: Signature Care EPO |
$1,079.13
|
| Rate for Payer: Signature Care PPO |
$1,144.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,105.14
|
| Rate for Payer: United Healthcare Commercial |
$1,024.53
|
| Rate for Payer: United Healthcare Medicare |
$429.05
|
|
|
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 |
$1,283.72
|
| 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 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 |
$683.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$683.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,189.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$785.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$751.60
|
| Rate for Payer: Cash Price |
$1,283.72
|
| Rate for Payer: Cash Price |
$1,283.72
|
| Rate for Payer: Centivo All Commercial |
$1,055.97
|
| 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 |
$1,055.97
|
| Rate for Payer: Lucent All Commercial |
$1,055.97
|
| 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 |
$683.27
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBQ SYRG
|
Facility
IP
|
$1,095.10
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
186099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$821.32 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$946.17
|
| Rate for Payer: Aetna Commercial |
$946.18
|
| Rate for Payer: Cash Price |
$678.97
|
| Rate for Payer: Cash Price |
$678.96
|
| 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 |
$1,008.04
|
| Rate for Payer: Encore All Commercial |
$1,008.06
|
| Rate for Payer: Frontpath All Commercial |
$1,007.51
|
| Rate for Payer: Frontpath All Commercial |
$1,007.49
|
| Rate for Payer: Humana ChoiceCare |
$945.86
|
| Rate for Payer: Humana ChoiceCare |
$945.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.61
|
| Rate for Payer: PHCS All Commercial |
$821.32
|
| 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 |
$845.43
|
| Rate for Payer: Sagamore Health Network All Products |
$845.42
|
| 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: United Healthcare Commercial |
$862.95
|
| Rate for Payer: United Healthcare Commercial |
$862.94
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBQ SYRG
|
Facility
OP
|
$1,095.10
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
186099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$924.26
|
| Rate for Payer: Aetna Commercial |
$924.28
|
| Rate for Payer: Aetna Medicare |
$361.39
|
| Rate for Payer: Aetna Medicare |
$361.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$628.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$628.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$684.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$415.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$415.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$397.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$397.53
|
| Rate for Payer: Cash Price |
$678.97
|
| Rate for Payer: Cash Price |
$678.96
|
| Rate for Payer: Cash Price |
$678.96
|
| Rate for Payer: Cash Price |
$678.97
|
| Rate for Payer: Centivo All Commercial |
$558.51
|
| Rate for Payer: Centivo All Commercial |
$558.50
|
| Rate for Payer: Cigna All Commercial |
$945.07
|
| Rate for Payer: Cigna All Commercial |
$945.09
|
| 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 |
$1,007.51
|
| Rate for Payer: Frontpath All Commercial |
$1,007.49
|
| Rate for Payer: Humana ChoiceCare |
$945.84
|
| Rate for Payer: Humana ChoiceCare |
$945.86
|
| Rate for Payer: Humana Medicare |
$558.50
|
| Rate for Payer: Humana Medicare |
$558.51
|
| Rate for Payer: Lucent All Commercial |
$558.51
|
| Rate for Payer: Lucent All Commercial |
$558.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.61
|
| 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 |
$821.34
|
| Rate for Payer: PHCS All Commercial |
$821.32
|
| Rate for Payer: PHP All Commercial |
$830.52
|
| Rate for Payer: PHP All Commercial |
$830.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.09
|
| 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: Three Rivers Preferred All Commercial |
$930.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.85
|
| Rate for Payer: United Healthcare Commercial |
$862.94
|
| Rate for Payer: United Healthcare Commercial |
$862.95
|
| Rate for Payer: United Healthcare Medicare |
$361.38
|
| Rate for Payer: United Healthcare Medicare |
$361.39
|
|
|
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 |
$663.40
|
| 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 |
$984.94
|
| 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
|
|
