|
PHMB 0.1% (PURAPLY AM) 4 X 4 WOUND MATRIX EXTRA FENESTRATED
|
Facility
|
IP
|
$6,912.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,184.00 |
| Max. Negotiated Rate |
$6,428.16 |
| Rate for Payer: Aetna Commercial |
$5,971.97
|
| Rate for Payer: Cash Price |
$4,147.20
|
| Rate for Payer: Cigna All Commercial |
$5,965.06
|
| Rate for Payer: CORVEL All Commercial |
$6,428.16
|
| Rate for Payer: Coventry All Commercial |
$6,082.56
|
| Rate for Payer: Encore All Commercial |
$6,362.50
|
| Rate for Payer: Frontpath All Commercial |
$6,359.04
|
| Rate for Payer: Humana ChoiceCare |
$5,969.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,220.80
|
| Rate for Payer: PHCS All Commercial |
$5,184.00
|
| Rate for Payer: PHP All Commercial |
$5,242.06
|
| Rate for Payer: Sagamore Health Network All Products |
$5,336.06
|
| Rate for Payer: Signature Care EPO |
$5,736.96
|
| Rate for Payer: Signature Care PPO |
$6,082.56
|
| Rate for Payer: United Healthcare Commercial |
$5,446.66
|
|
|
PHMB 0.1% (PURAPLY AM) 4 X 4 WOUND MATRIX EXTRA FENESTRATED
|
Facility
|
OP
|
$6,912.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$6,428.16 |
| Rate for Payer: Aetna Commercial |
$5,833.73
|
| Rate for Payer: Aetna Medicare |
$2,211.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,142.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,969.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,320.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,543.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,433.02
|
| Rate for Payer: Cash Price |
$4,147.20
|
| Rate for Payer: Cash Price |
$4,147.20
|
| Rate for Payer: Centivo All Commercial |
$3,760.13
|
| Rate for Payer: Cigna All Commercial |
$5,965.06
|
| Rate for Payer: CORVEL All Commercial |
$6,428.16
|
| Rate for Payer: Coventry All Commercial |
$6,082.56
|
| Rate for Payer: Encore All Commercial |
$6,362.50
|
| Rate for Payer: Frontpath All Commercial |
$6,359.04
|
| Rate for Payer: Humana ChoiceCare |
$5,969.89
|
| Rate for Payer: Humana Medicare |
$2,211.84
|
| Rate for Payer: Lucent All Commercial |
$3,760.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,220.80
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$5,184.00
|
| Rate for Payer: PHP All Commercial |
$5,242.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,695.68
|
| Rate for Payer: Sagamore Health Network All Products |
$5,336.06
|
| Rate for Payer: Signature Care EPO |
$5,736.96
|
| Rate for Payer: Signature Care PPO |
$6,082.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,875.20
|
| Rate for Payer: United Healthcare Commercial |
$5,446.66
|
| Rate for Payer: United Healthcare Medicare |
$2,211.84
|
|
|
PHMB 0.1% (PURAPLY AM) 5 X 5 WOUND MATRIX
|
Facility
|
IP
|
$10,400.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,800.00 |
| Max. Negotiated Rate |
$9,672.00 |
| Rate for Payer: Aetna Commercial |
$8,985.60
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cigna All Commercial |
$8,975.20
|
| Rate for Payer: CORVEL All Commercial |
$9,672.00
|
| Rate for Payer: Coventry All Commercial |
$9,152.00
|
| Rate for Payer: Encore All Commercial |
$9,573.20
|
| Rate for Payer: Frontpath All Commercial |
$9,568.00
|
| Rate for Payer: Humana ChoiceCare |
$8,982.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,360.00
|
| Rate for Payer: PHCS All Commercial |
$7,800.00
|
| Rate for Payer: PHP All Commercial |
$7,887.36
|
| Rate for Payer: Sagamore Health Network All Products |
$8,028.80
|
| Rate for Payer: Signature Care EPO |
$8,632.00
|
| Rate for Payer: Signature Care PPO |
$9,152.00
|
| Rate for Payer: United Healthcare Commercial |
$8,195.20
|
|
|
PHMB 0.1% (PURAPLY AM) 5 X 5 WOUND MATRIX
|
Facility
|
OP
|
$10,400.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$9,672.00 |
| Rate for Payer: Aetna Commercial |
$8,777.60
|
| Rate for Payer: Aetna Medicare |
$3,328.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,224.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,972.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,501.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,827.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,660.80
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Centivo All Commercial |
$5,657.60
|
| Rate for Payer: Cigna All Commercial |
$8,975.20
|
| Rate for Payer: CORVEL All Commercial |
$9,672.00
|
| Rate for Payer: Coventry All Commercial |
$9,152.00
|
| Rate for Payer: Encore All Commercial |
$9,573.20
|
| Rate for Payer: Frontpath All Commercial |
$9,568.00
|
| Rate for Payer: Humana ChoiceCare |
$8,982.48
|
| Rate for Payer: Humana Medicare |
$3,328.00
|
| Rate for Payer: Lucent All Commercial |
$5,657.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,360.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$7,800.00
|
| Rate for Payer: PHP All Commercial |
$7,887.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,056.00
|
| Rate for Payer: Sagamore Health Network All Products |
$8,028.80
|
| Rate for Payer: Signature Care EPO |
$8,632.00
|
| Rate for Payer: Signature Care PPO |
$9,152.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,840.00
|
| Rate for Payer: United Healthcare Commercial |
$8,195.20
|
| Rate for Payer: United Healthcare Medicare |
$3,328.00
|
|
|
PHMB 0.1% (PURAPLY AM) 6 X 9 WOUND MATRIX
|
Facility
|
IP
|
$20,520.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,390.00 |
| Max. Negotiated Rate |
$19,083.60 |
| Rate for Payer: Aetna Commercial |
$17,729.28
|
| Rate for Payer: Cash Price |
$12,312.00
|
| Rate for Payer: Cigna All Commercial |
$17,708.76
|
| Rate for Payer: CORVEL All Commercial |
$19,083.60
|
| Rate for Payer: Coventry All Commercial |
$18,057.60
|
| Rate for Payer: Encore All Commercial |
$18,888.66
|
| Rate for Payer: Frontpath All Commercial |
$18,878.40
|
| Rate for Payer: Humana ChoiceCare |
$17,723.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18,468.00
|
| Rate for Payer: PHCS All Commercial |
$15,390.00
|
| Rate for Payer: PHP All Commercial |
$15,562.37
|
| Rate for Payer: Sagamore Health Network All Products |
$15,841.44
|
| Rate for Payer: Signature Care EPO |
$17,031.60
|
| Rate for Payer: Signature Care PPO |
$18,057.60
|
| Rate for Payer: United Healthcare Commercial |
$16,169.76
|
|
|
PHMB 0.1% (PURAPLY AM) 6 X 9 WOUND MATRIX
|
Facility
|
OP
|
$20,520.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$19,083.60 |
| Rate for Payer: Aetna Commercial |
$17,318.88
|
| Rate for Payer: Aetna Medicare |
$6,566.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,361.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11,784.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,827.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,551.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,223.04
|
| Rate for Payer: Cash Price |
$12,312.00
|
| Rate for Payer: Cash Price |
$12,312.00
|
| Rate for Payer: Centivo All Commercial |
$11,162.88
|
| Rate for Payer: Cigna All Commercial |
$17,708.76
|
| Rate for Payer: CORVEL All Commercial |
$19,083.60
|
| Rate for Payer: Coventry All Commercial |
$18,057.60
|
| Rate for Payer: Encore All Commercial |
$18,888.66
|
| Rate for Payer: Frontpath All Commercial |
$18,878.40
|
| Rate for Payer: Humana ChoiceCare |
$17,723.12
|
| Rate for Payer: Humana Medicare |
$6,566.40
|
| Rate for Payer: Lucent All Commercial |
$11,162.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18,468.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$15,390.00
|
| Rate for Payer: PHP All Commercial |
$15,562.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,002.80
|
| Rate for Payer: Sagamore Health Network All Products |
$15,841.44
|
| Rate for Payer: Signature Care EPO |
$17,031.60
|
| Rate for Payer: Signature Care PPO |
$18,057.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,442.00
|
| Rate for Payer: United Healthcare Commercial |
$16,169.76
|
| Rate for Payer: United Healthcare Medicare |
$6,566.40
|
|
|
PHMB 0.1% (PURAPLY AM XT EF) 4.91 X 4.91 WOUND MATRIX
|
Facility
|
IP
|
$11,300.01
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800596
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8,475.01 |
| Max. Negotiated Rate |
$10,509.01 |
| Rate for Payer: Aetna Commercial |
$9,763.21
|
| Rate for Payer: Cash Price |
$6,780.00
|
| Rate for Payer: Cigna All Commercial |
$9,751.91
|
| Rate for Payer: CORVEL All Commercial |
$10,509.01
|
| Rate for Payer: Coventry All Commercial |
$9,944.01
|
| Rate for Payer: Encore All Commercial |
$10,401.66
|
| Rate for Payer: Frontpath All Commercial |
$10,396.01
|
| Rate for Payer: Humana ChoiceCare |
$9,759.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,170.01
|
| Rate for Payer: PHCS All Commercial |
$8,475.01
|
| Rate for Payer: PHP All Commercial |
$8,569.93
|
| Rate for Payer: Sagamore Health Network All Products |
$8,723.61
|
| Rate for Payer: Signature Care EPO |
$9,379.01
|
| Rate for Payer: Signature Care PPO |
$9,944.01
|
| Rate for Payer: United Healthcare Commercial |
$8,904.41
|
|
|
PHMB 0.1% (PURAPLY AM XT EF) 4.91 X 4.91 WOUND MATRIX
|
Facility
|
OP
|
$11,300.01
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$10,509.01 |
| Rate for Payer: Aetna Commercial |
$9,537.21
|
| Rate for Payer: Aetna Medicare |
$3,616.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,503.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,489.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,063.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,158.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,977.60
|
| Rate for Payer: Cash Price |
$6,780.00
|
| Rate for Payer: Cash Price |
$6,780.00
|
| Rate for Payer: Centivo All Commercial |
$6,147.20
|
| Rate for Payer: Cigna All Commercial |
$9,751.91
|
| Rate for Payer: CORVEL All Commercial |
$10,509.01
|
| Rate for Payer: Coventry All Commercial |
$9,944.01
|
| Rate for Payer: Encore All Commercial |
$10,401.66
|
| Rate for Payer: Frontpath All Commercial |
$10,396.01
|
| Rate for Payer: Humana ChoiceCare |
$9,759.82
|
| Rate for Payer: Humana Medicare |
$3,616.00
|
| Rate for Payer: Lucent All Commercial |
$6,147.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,170.01
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$8,475.01
|
| Rate for Payer: PHP All Commercial |
$8,569.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,407.00
|
| Rate for Payer: Sagamore Health Network All Products |
$8,723.61
|
| Rate for Payer: Signature Care EPO |
$9,379.01
|
| Rate for Payer: Signature Care PPO |
$9,944.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,605.01
|
| Rate for Payer: United Healthcare Commercial |
$8,904.41
|
| Rate for Payer: United Healthcare Medicare |
$3,616.00
|
|
|
PHMB 0.1% (PURAPLY MZ) 1000 MG WOUND MATRIX
|
Facility
|
IP
|
$9,260.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,945.00 |
| Max. Negotiated Rate |
$8,611.80 |
| Rate for Payer: Aetna Commercial |
$8,000.64
|
| Rate for Payer: Cash Price |
$5,556.00
|
| Rate for Payer: Cigna All Commercial |
$7,991.38
|
| Rate for Payer: CORVEL All Commercial |
$8,611.80
|
| Rate for Payer: Coventry All Commercial |
$8,148.80
|
| Rate for Payer: Encore All Commercial |
$8,523.83
|
| Rate for Payer: Frontpath All Commercial |
$8,519.20
|
| Rate for Payer: Humana ChoiceCare |
$7,997.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,334.00
|
| Rate for Payer: PHCS All Commercial |
$6,945.00
|
| Rate for Payer: PHP All Commercial |
$7,022.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7,148.72
|
| Rate for Payer: Signature Care EPO |
$7,685.80
|
| Rate for Payer: Signature Care PPO |
$8,148.80
|
| Rate for Payer: United Healthcare Commercial |
$7,296.88
|
|
|
PHMB 0.1% (PURAPLY MZ) 1000 MG WOUND MATRIX
|
Facility
|
OP
|
$9,260.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$8,611.80 |
| Rate for Payer: Aetna Commercial |
$7,815.44
|
| Rate for Payer: Aetna Medicare |
$2,963.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,870.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,318.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,788.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,407.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,259.52
|
| Rate for Payer: Cash Price |
$5,556.00
|
| Rate for Payer: Cash Price |
$5,556.00
|
| Rate for Payer: Centivo All Commercial |
$5,037.44
|
| Rate for Payer: Cigna All Commercial |
$7,991.38
|
| Rate for Payer: CORVEL All Commercial |
$8,611.80
|
| Rate for Payer: Coventry All Commercial |
$8,148.80
|
| Rate for Payer: Encore All Commercial |
$8,523.83
|
| Rate for Payer: Frontpath All Commercial |
$8,519.20
|
| Rate for Payer: Humana ChoiceCare |
$7,997.86
|
| Rate for Payer: Humana Medicare |
$2,963.20
|
| Rate for Payer: Lucent All Commercial |
$5,037.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,334.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$6,945.00
|
| Rate for Payer: PHP All Commercial |
$7,022.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,611.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,148.72
|
| Rate for Payer: Signature Care EPO |
$7,685.80
|
| Rate for Payer: Signature Care PPO |
$8,148.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,871.00
|
| Rate for Payer: United Healthcare Commercial |
$7,296.88
|
| Rate for Payer: United Healthcare Medicare |
$2,963.20
|
|
|
PHMB 0.1% (PURAPLY MZ) 100 MG WOUND MATRIX
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$860.88
|
| Rate for Payer: Aetna Medicare |
$326.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$316.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$585.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.04
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Centivo All Commercial |
$554.88
|
| Rate for Payer: Cigna All Commercial |
$880.26
|
| Rate for Payer: CORVEL All Commercial |
$948.60
|
| Rate for Payer: Coventry All Commercial |
$897.60
|
| Rate for Payer: Encore All Commercial |
$938.91
|
| Rate for Payer: Frontpath All Commercial |
$938.40
|
| Rate for Payer: Humana ChoiceCare |
$880.97
|
| Rate for Payer: Humana Medicare |
$326.40
|
| Rate for Payer: Lucent All Commercial |
$554.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$765.00
|
| Rate for Payer: PHP All Commercial |
$773.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.80
|
| Rate for Payer: Sagamore Health Network All Products |
$787.44
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$897.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$867.00
|
| Rate for Payer: United Healthcare Commercial |
$803.76
|
| Rate for Payer: United Healthcare Medicare |
$326.40
|
|
|
PHMB 0.1% (PURAPLY MZ) 100 MG WOUND MATRIX
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800597
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$881.28
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna All Commercial |
$880.26
|
| Rate for Payer: CORVEL All Commercial |
$948.60
|
| Rate for Payer: Coventry All Commercial |
$897.60
|
| Rate for Payer: Encore All Commercial |
$938.91
|
| Rate for Payer: Frontpath All Commercial |
$938.40
|
| Rate for Payer: Humana ChoiceCare |
$880.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: PHCS All Commercial |
$765.00
|
| Rate for Payer: PHP All Commercial |
$773.57
|
| Rate for Payer: Sagamore Health Network All Products |
$787.44
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$897.60
|
| Rate for Payer: United Healthcare Commercial |
$803.76
|
|
|
PHMB 0.1% (PURAPLY MZ) 500 MG WOUND MATRIX
|
Facility
|
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800598
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,480.00 |
| Max. Negotiated Rate |
$4,315.20 |
| Rate for Payer: Aetna Commercial |
$4,008.96
|
| Rate for Payer: Cash Price |
$2,784.00
|
| Rate for Payer: Cigna All Commercial |
$4,004.32
|
| Rate for Payer: CORVEL All Commercial |
$4,315.20
|
| Rate for Payer: Coventry All Commercial |
$4,083.20
|
| Rate for Payer: Encore All Commercial |
$4,271.12
|
| Rate for Payer: Frontpath All Commercial |
$4,268.80
|
| Rate for Payer: Humana ChoiceCare |
$4,007.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,176.00
|
| Rate for Payer: PHCS All Commercial |
$3,480.00
|
| Rate for Payer: PHP All Commercial |
$3,518.98
|
| Rate for Payer: Sagamore Health Network All Products |
$3,582.08
|
| Rate for Payer: Signature Care EPO |
$3,851.20
|
| Rate for Payer: Signature Care PPO |
$4,083.20
|
| Rate for Payer: United Healthcare Commercial |
$3,656.32
|
|
|
PHMB 0.1% (PURAPLY MZ) 500 MG WOUND MATRIX
|
Facility
|
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
800598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$4,315.20 |
| Rate for Payer: Aetna Commercial |
$3,916.16
|
| Rate for Payer: Aetna Medicare |
$1,484.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,438.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,664.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,900.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,707.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,633.28
|
| Rate for Payer: Cash Price |
$2,784.00
|
| Rate for Payer: Cash Price |
$2,784.00
|
| Rate for Payer: Centivo All Commercial |
$2,524.16
|
| Rate for Payer: Cigna All Commercial |
$4,004.32
|
| Rate for Payer: CORVEL All Commercial |
$4,315.20
|
| Rate for Payer: Coventry All Commercial |
$4,083.20
|
| Rate for Payer: Encore All Commercial |
$4,271.12
|
| Rate for Payer: Frontpath All Commercial |
$4,268.80
|
| Rate for Payer: Humana ChoiceCare |
$4,007.57
|
| Rate for Payer: Humana Medicare |
$1,484.80
|
| Rate for Payer: Lucent All Commercial |
$2,524.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,176.00
|
| Rate for Payer: Managed Health Services Medicaid |
$47.71
|
| Rate for Payer: MDWise Medicaid |
$47.71
|
| Rate for Payer: PHCS All Commercial |
$3,480.00
|
| Rate for Payer: PHP All Commercial |
$3,518.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,809.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,582.08
|
| Rate for Payer: Signature Care EPO |
$3,851.20
|
| Rate for Payer: Signature Care PPO |
$4,083.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,944.00
|
| Rate for Payer: United Healthcare Commercial |
$3,656.32
|
| Rate for Payer: United Healthcare Medicare |
$1,484.80
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN
|
Facility
|
OP
|
$299.36
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$252.66
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$171.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.38
|
| Rate for Payer: Cash Price |
$179.62
|
| Rate for Payer: Centivo All Commercial |
$162.85
|
| Rate for Payer: Cigna All Commercial |
$258.35
|
| Rate for Payer: CORVEL All Commercial |
$278.41
|
| Rate for Payer: Coventry All Commercial |
$263.44
|
| Rate for Payer: Encore All Commercial |
$275.56
|
| Rate for Payer: Frontpath All Commercial |
$275.41
|
| Rate for Payer: Humana ChoiceCare |
$258.56
|
| Rate for Payer: Humana Medicare |
$95.80
|
| Rate for Payer: Lucent All Commercial |
$162.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.43
|
| Rate for Payer: PHCS All Commercial |
$224.52
|
| Rate for Payer: PHP All Commercial |
$227.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.75
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.47
|
| Rate for Payer: Signature Care PPO |
$263.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.46
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
| Rate for Payer: United Healthcare Medicare |
$95.80
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN
|
Facility
|
IP
|
$299.36
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$224.52 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$258.65
|
| Rate for Payer: Cash Price |
$179.62
|
| Rate for Payer: Cigna All Commercial |
$258.35
|
| Rate for Payer: CORVEL All Commercial |
$278.41
|
| Rate for Payer: Coventry All Commercial |
$263.44
|
| Rate for Payer: Encore All Commercial |
$275.56
|
| Rate for Payer: Frontpath All Commercial |
$275.41
|
| Rate for Payer: Humana ChoiceCare |
$258.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.43
|
| Rate for Payer: PHCS All Commercial |
$224.52
|
| Rate for Payer: PHP All Commercial |
$227.04
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.47
|
| Rate for Payer: Signature Care PPO |
$263.44
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG
|
Facility
|
IP
|
$157.04
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.78 |
| Max. Negotiated Rate |
$146.05 |
| Rate for Payer: Aetna Commercial |
$135.68
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cigna All Commercial |
$135.52
|
| Rate for Payer: CORVEL All Commercial |
$146.05
|
| Rate for Payer: Coventry All Commercial |
$138.19
|
| Rate for Payer: Encore All Commercial |
$144.55
|
| Rate for Payer: Frontpath All Commercial |
$144.47
|
| Rate for Payer: Humana ChoiceCare |
$135.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.33
|
| Rate for Payer: PHCS All Commercial |
$117.78
|
| Rate for Payer: PHP All Commercial |
$119.10
|
| Rate for Payer: Sagamore Health Network All Products |
$121.23
|
| Rate for Payer: Signature Care EPO |
$130.34
|
| Rate for Payer: Signature Care PPO |
$138.19
|
| Rate for Payer: United Healthcare Commercial |
$123.75
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG
|
Facility
|
OP
|
$157.04
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
6271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$146.05 |
| Rate for Payer: Aetna Commercial |
$132.54
|
| Rate for Payer: Aetna Medicare |
$50.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.28
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Centivo All Commercial |
$85.43
|
| Rate for Payer: Cigna All Commercial |
$135.52
|
| Rate for Payer: CORVEL All Commercial |
$146.05
|
| Rate for Payer: Coventry All Commercial |
$138.19
|
| Rate for Payer: Encore All Commercial |
$144.55
|
| Rate for Payer: Frontpath All Commercial |
$144.47
|
| Rate for Payer: Humana ChoiceCare |
$135.63
|
| Rate for Payer: Humana Medicare |
$50.25
|
| Rate for Payer: Lucent All Commercial |
$85.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.33
|
| Rate for Payer: PHCS All Commercial |
$117.78
|
| Rate for Payer: PHP All Commercial |
$119.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.24
|
| Rate for Payer: Sagamore Health Network All Products |
$121.23
|
| Rate for Payer: Signature Care EPO |
$130.34
|
| Rate for Payer: Signature Care PPO |
$138.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.48
|
| Rate for Payer: United Healthcare Commercial |
$123.75
|
| Rate for Payer: United Healthcare Medicare |
$50.25
|
|
|
PIFLUFOLASTAT F 18 37 MBQ/ML TO 2,960 MBQ/ML IV SOLN
|
Facility
|
OP
|
$19,374.32
|
|
|
Service Code
|
HCPCS A9595
|
| Hospital Charge Code |
195262
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$645.81 |
| Max. Negotiated Rate |
$18,018.12 |
| Rate for Payer: Aetna Commercial |
$16,351.93
|
| Rate for Payer: Aetna Medicare |
$6,199.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$645.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,006.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11,126.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,110.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$645.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,129.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,819.76
|
| Rate for Payer: Cash Price |
$11,624.59
|
| Rate for Payer: Cash Price |
$11,624.59
|
| Rate for Payer: Centivo All Commercial |
$10,539.63
|
| Rate for Payer: Cigna All Commercial |
$16,720.04
|
| Rate for Payer: CORVEL All Commercial |
$18,018.12
|
| Rate for Payer: Coventry All Commercial |
$17,049.40
|
| Rate for Payer: Encore All Commercial |
$17,834.06
|
| Rate for Payer: Frontpath All Commercial |
$17,824.37
|
| Rate for Payer: Humana ChoiceCare |
$16,733.60
|
| Rate for Payer: Humana Medicare |
$6,199.78
|
| Rate for Payer: Lucent All Commercial |
$10,539.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,436.89
|
| Rate for Payer: Managed Health Services Medicaid |
$645.81
|
| Rate for Payer: MDWise Medicaid |
$645.81
|
| Rate for Payer: PHCS All Commercial |
$14,530.74
|
| Rate for Payer: PHP All Commercial |
$14,693.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,555.98
|
| Rate for Payer: Sagamore Health Network All Products |
$14,956.98
|
| Rate for Payer: Signature Care EPO |
$16,080.69
|
| Rate for Payer: Signature Care PPO |
$17,049.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,468.17
|
| Rate for Payer: United Healthcare Commercial |
$15,266.96
|
| Rate for Payer: United Healthcare Medicare |
$6,199.78
|
|
|
PIFLUFOLASTAT F 18 37 MBQ/ML TO 2,960 MBQ/ML IV SOLN
|
Facility
|
IP
|
$19,374.32
|
|
|
Service Code
|
HCPCS A9595
|
| Hospital Charge Code |
195262
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$14,530.74 |
| Max. Negotiated Rate |
$18,018.12 |
| Rate for Payer: Aetna Commercial |
$16,739.41
|
| Rate for Payer: Cash Price |
$11,624.59
|
| Rate for Payer: Cigna All Commercial |
$16,720.04
|
| Rate for Payer: CORVEL All Commercial |
$18,018.12
|
| Rate for Payer: Coventry All Commercial |
$17,049.40
|
| Rate for Payer: Encore All Commercial |
$17,834.06
|
| Rate for Payer: Frontpath All Commercial |
$17,824.37
|
| Rate for Payer: Humana ChoiceCare |
$16,733.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,436.89
|
| Rate for Payer: PHCS All Commercial |
$14,530.74
|
| Rate for Payer: PHP All Commercial |
$14,693.48
|
| Rate for Payer: Sagamore Health Network All Products |
$14,956.98
|
| Rate for Payer: Signature Care EPO |
$16,080.69
|
| Rate for Payer: Signature Care PPO |
$17,049.40
|
| Rate for Payer: United Healthcare Commercial |
$15,266.96
|
|
|
PILOCARPINE HCL 2 % OPHT DROP
|
Facility
|
IP
|
$276.05
|
|
|
Service Code
|
NDC 61314020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$207.03 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Cigna All Commercial |
$238.23
|
| Rate for Payer: CORVEL All Commercial |
$256.72
|
| Rate for Payer: Coventry All Commercial |
$242.92
|
| Rate for Payer: Encore All Commercial |
$254.10
|
| Rate for Payer: Frontpath All Commercial |
$253.96
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.44
|
| Rate for Payer: PHCS All Commercial |
$207.03
|
| Rate for Payer: PHP All Commercial |
$209.35
|
| Rate for Payer: Sagamore Health Network All Products |
$213.11
|
| Rate for Payer: Signature Care EPO |
$229.12
|
| Rate for Payer: Signature Care PPO |
$242.92
|
| Rate for Payer: United Healthcare Commercial |
$217.52
|
|
|
PILOCARPINE HCL 2 % OPHT DROP
|
Facility
|
OP
|
$276.05
|
|
|
Service Code
|
NDC 61314020415
|
| Hospital Charge Code |
6280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Aetna Commercial |
$232.98
|
| Rate for Payer: Aetna Medicare |
$88.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$158.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.17
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Centivo All Commercial |
$150.17
|
| Rate for Payer: Cigna All Commercial |
$238.23
|
| Rate for Payer: CORVEL All Commercial |
$256.72
|
| Rate for Payer: Coventry All Commercial |
$242.92
|
| Rate for Payer: Encore All Commercial |
$254.10
|
| Rate for Payer: Frontpath All Commercial |
$253.96
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Humana Medicare |
$88.33
|
| Rate for Payer: Lucent All Commercial |
$150.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$248.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$207.03
|
| Rate for Payer: PHP All Commercial |
$209.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.66
|
| Rate for Payer: Sagamore Health Network All Products |
$213.11
|
| Rate for Payer: Signature Care EPO |
$229.12
|
| Rate for Payer: Signature Care PPO |
$242.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$234.64
|
| Rate for Payer: United Healthcare Commercial |
$217.52
|
| Rate for Payer: United Healthcare Medicare |
$88.33
|
|
|
PIOGLITAZONE 15 MG ORAL TAB
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.54
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Centivo All Commercial |
$3.93
|
| Rate for Payer: Cigna All Commercial |
$6.23
|
| Rate for Payer: CORVEL All Commercial |
$6.72
|
| Rate for Payer: Coventry All Commercial |
$6.36
|
| Rate for Payer: Encore All Commercial |
$6.65
|
| Rate for Payer: Frontpath All Commercial |
$6.65
|
| Rate for Payer: Humana ChoiceCare |
$6.24
|
| Rate for Payer: Humana Medicare |
$2.31
|
| Rate for Payer: Lucent All Commercial |
$3.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.50
|
| Rate for Payer: PHCS All Commercial |
$5.42
|
| Rate for Payer: PHP All Commercial |
$5.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.82
|
| Rate for Payer: Sagamore Health Network All Products |
$5.58
|
| Rate for Payer: Signature Care EPO |
$6.00
|
| Rate for Payer: Signature Care PPO |
$6.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$5.69
|
| Rate for Payer: United Healthcare Medicare |
$2.31
|
|
|
PIOGLITAZONE 15 MG ORAL TAB
|
Facility
|
IP
|
$7.22
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna All Commercial |
$6.23
|
| Rate for Payer: CORVEL All Commercial |
$6.72
|
| Rate for Payer: Coventry All Commercial |
$6.36
|
| Rate for Payer: Encore All Commercial |
$6.65
|
| Rate for Payer: Frontpath All Commercial |
$6.65
|
| Rate for Payer: Humana ChoiceCare |
$6.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.50
|
| Rate for Payer: PHCS All Commercial |
$5.42
|
| Rate for Payer: PHP All Commercial |
$5.48
|
| Rate for Payer: Sagamore Health Network All Products |
$5.58
|
| Rate for Payer: Signature Care EPO |
$6.00
|
| Rate for Payer: Signature Care PPO |
$6.36
|
| Rate for Payer: United Healthcare Commercial |
$5.69
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 G IV SOLR
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
