|
PIPERACILLIN-TAZOBACTAM 2.25 G IV SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| 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: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| 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: Plain Church Group Ministry All Commercial |
$7.02
|
| 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: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 G IV SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| 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: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| 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: Plain Church Group Ministry All Commercial |
$7.02
|
| 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: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 G IV SOLR
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18303
|
|
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
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 G IV SOLR
|
Facility
|
OP
|
$31.42
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna Commercial |
$26.52
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.06
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Centivo All Commercial |
$17.09
|
| Rate for Payer: Cigna All Commercial |
$27.11
|
| Rate for Payer: CORVEL All Commercial |
$29.22
|
| Rate for Payer: Coventry All Commercial |
$27.65
|
| Rate for Payer: Encore All Commercial |
$28.92
|
| Rate for Payer: Frontpath All Commercial |
$28.90
|
| Rate for Payer: Humana ChoiceCare |
$27.13
|
| Rate for Payer: Humana Medicare |
$10.05
|
| Rate for Payer: Lucent All Commercial |
$17.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.27
|
| Rate for Payer: PHCS All Commercial |
$23.56
|
| Rate for Payer: PHP All Commercial |
$23.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.25
|
| Rate for Payer: Sagamore Health Network All Products |
$24.25
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$27.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.70
|
| Rate for Payer: United Healthcare Commercial |
$24.76
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 G IV SOLR
|
Facility
|
IP
|
$31.42
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Cigna All Commercial |
$27.11
|
| Rate for Payer: CORVEL All Commercial |
$29.22
|
| Rate for Payer: Coventry All Commercial |
$27.65
|
| Rate for Payer: Encore All Commercial |
$28.92
|
| Rate for Payer: Frontpath All Commercial |
$28.90
|
| Rate for Payer: Humana ChoiceCare |
$27.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.27
|
| Rate for Payer: PHCS All Commercial |
$23.56
|
| Rate for Payer: PHP All Commercial |
$23.83
|
| Rate for Payer: Sagamore Health Network All Products |
$24.25
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$27.65
|
| Rate for Payer: United Healthcare Commercial |
$24.76
|
|
|
PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG
|
Facility
|
IP
|
$1,236.08
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
195321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$927.06 |
| Max. Negotiated Rate |
$1,149.55 |
| Rate for Payer: Aetna Commercial |
$1,067.97
|
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Cash Price |
$741.65
|
| Rate for Payer: Cash Price |
$611.90
|
| Rate for Payer: Cigna All Commercial |
$1,066.74
|
| Rate for Payer: Cigna All Commercial |
$880.12
|
| Rate for Payer: CORVEL All Commercial |
$948.45
|
| Rate for Payer: CORVEL All Commercial |
$1,149.55
|
| Rate for Payer: Coventry All Commercial |
$897.46
|
| Rate for Payer: Coventry All Commercial |
$1,087.75
|
| Rate for Payer: Encore All Commercial |
$1,137.81
|
| Rate for Payer: Encore All Commercial |
$938.76
|
| Rate for Payer: Frontpath All Commercial |
$938.25
|
| Rate for Payer: Frontpath All Commercial |
$1,137.19
|
| Rate for Payer: Humana ChoiceCare |
$1,067.60
|
| Rate for Payer: Humana ChoiceCare |
$880.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,112.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$917.86
|
| Rate for Payer: PHCS All Commercial |
$764.88
|
| Rate for Payer: PHCS All Commercial |
$927.06
|
| Rate for Payer: PHP All Commercial |
$773.45
|
| Rate for Payer: PHP All Commercial |
$937.44
|
| Rate for Payer: Sagamore Health Network All Products |
$787.32
|
| Rate for Payer: Sagamore Health Network All Products |
$954.25
|
| Rate for Payer: Signature Care EPO |
$846.47
|
| Rate for Payer: Signature Care EPO |
$1,025.95
|
| Rate for Payer: Signature Care PPO |
$1,087.75
|
| Rate for Payer: Signature Care PPO |
$897.46
|
| Rate for Payer: United Healthcare Commercial |
$803.63
|
| Rate for Payer: United Healthcare Commercial |
$974.03
|
|
|
PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG
|
Facility
|
OP
|
$1,236.08
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
195321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$287.54 |
| Max. Negotiated Rate |
$1,149.55 |
| Rate for Payer: Aetna Commercial |
$1,043.25
|
| Rate for Payer: Aetna Commercial |
$860.74
|
| Rate for Payer: Aetna Medicare |
$395.55
|
| Rate for Payer: Aetna Medicare |
$326.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$287.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$287.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$383.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$316.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$585.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$709.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$772.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$287.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$287.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$454.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.98
|
| Rate for Payer: Cash Price |
$741.65
|
| Rate for Payer: Cash Price |
$611.90
|
| Rate for Payer: Cash Price |
$611.90
|
| Rate for Payer: Cash Price |
$741.65
|
| Rate for Payer: Centivo All Commercial |
$554.79
|
| Rate for Payer: Centivo All Commercial |
$672.43
|
| Rate for Payer: Cigna All Commercial |
$1,066.74
|
| Rate for Payer: Cigna All Commercial |
$880.12
|
| Rate for Payer: CORVEL All Commercial |
$1,149.55
|
| Rate for Payer: CORVEL All Commercial |
$948.45
|
| Rate for Payer: Coventry All Commercial |
$1,087.75
|
| Rate for Payer: Coventry All Commercial |
$897.46
|
| Rate for Payer: Encore All Commercial |
$1,137.81
|
| Rate for Payer: Encore All Commercial |
$938.76
|
| Rate for Payer: Frontpath All Commercial |
$938.25
|
| Rate for Payer: Frontpath All Commercial |
$1,137.19
|
| Rate for Payer: Humana ChoiceCare |
$1,067.60
|
| Rate for Payer: Humana ChoiceCare |
$880.84
|
| Rate for Payer: Humana Medicare |
$326.35
|
| Rate for Payer: Humana Medicare |
$395.55
|
| Rate for Payer: Lucent All Commercial |
$672.43
|
| Rate for Payer: Lucent All Commercial |
$554.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,112.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$917.86
|
| Rate for Payer: Managed Health Services Medicaid |
$287.54
|
| Rate for Payer: Managed Health Services Medicaid |
$287.54
|
| Rate for Payer: MDWise Medicaid |
$287.54
|
| Rate for Payer: MDWise Medicaid |
$287.54
|
| Rate for Payer: PHCS All Commercial |
$764.88
|
| Rate for Payer: PHCS All Commercial |
$927.06
|
| Rate for Payer: PHP All Commercial |
$937.44
|
| Rate for Payer: PHP All Commercial |
$773.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$482.07
|
| Rate for Payer: Sagamore Health Network All Products |
$787.32
|
| Rate for Payer: Sagamore Health Network All Products |
$954.25
|
| Rate for Payer: Signature Care EPO |
$1,025.95
|
| Rate for Payer: Signature Care EPO |
$846.47
|
| Rate for Payer: Signature Care PPO |
$897.46
|
| Rate for Payer: Signature Care PPO |
$1,087.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,050.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$866.86
|
| Rate for Payer: United Healthcare Commercial |
$803.63
|
| Rate for Payer: United Healthcare Commercial |
$974.03
|
| Rate for Payer: United Healthcare Medicare |
$326.35
|
| Rate for Payer: United Healthcare Medicare |
$395.55
|
|
|
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG
|
Facility
|
OP
|
$241.47
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
113995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.86 |
| Max. Negotiated Rate |
$224.57 |
| Rate for Payer: Aetna Commercial |
$203.80
|
| Rate for Payer: Aetna Medicare |
$77.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$138.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.00
|
| Rate for Payer: Cash Price |
$144.88
|
| Rate for Payer: Cash Price |
$144.88
|
| Rate for Payer: Centivo All Commercial |
$131.36
|
| Rate for Payer: Cigna All Commercial |
$208.39
|
| Rate for Payer: CORVEL All Commercial |
$224.57
|
| Rate for Payer: Coventry All Commercial |
$212.49
|
| Rate for Payer: Encore All Commercial |
$222.27
|
| Rate for Payer: Frontpath All Commercial |
$222.15
|
| Rate for Payer: Humana ChoiceCare |
$208.56
|
| Rate for Payer: Humana Medicare |
$77.27
|
| Rate for Payer: Lucent All Commercial |
$131.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.32
|
| Rate for Payer: Managed Health Services Medicaid |
$122.94
|
| Rate for Payer: MDWise Medicaid |
$122.94
|
| Rate for Payer: PHCS All Commercial |
$181.10
|
| Rate for Payer: PHP All Commercial |
$183.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.17
|
| Rate for Payer: Sagamore Health Network All Products |
$186.41
|
| Rate for Payer: Signature Care EPO |
$200.42
|
| Rate for Payer: Signature Care PPO |
$212.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$205.25
|
| Rate for Payer: United Healthcare Commercial |
$190.28
|
| Rate for Payer: United Healthcare Medicare |
$77.27
|
|
|
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG
|
Facility
|
IP
|
$241.47
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
113995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$181.10 |
| Max. Negotiated Rate |
$224.57 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: Cash Price |
$144.88
|
| Rate for Payer: Cigna All Commercial |
$208.39
|
| Rate for Payer: CORVEL All Commercial |
$224.57
|
| Rate for Payer: Coventry All Commercial |
$212.49
|
| Rate for Payer: Encore All Commercial |
$222.27
|
| Rate for Payer: Frontpath All Commercial |
$222.15
|
| Rate for Payer: Humana ChoiceCare |
$208.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.32
|
| Rate for Payer: PHCS All Commercial |
$181.10
|
| Rate for Payer: PHP All Commercial |
$183.13
|
| Rate for Payer: Sagamore Health Network All Products |
$186.41
|
| Rate for Payer: Signature Care EPO |
$200.42
|
| Rate for Payer: Signature Care PPO |
$212.49
|
| Rate for Payer: United Healthcare Commercial |
$190.28
|
|
|
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP
|
Facility
|
IP
|
$1,594.72
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
108127
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,196.04 |
| Max. Negotiated Rate |
$1,483.09 |
| Rate for Payer: Aetna Commercial |
$1,377.84
|
| Rate for Payer: Cash Price |
$956.83
|
| Rate for Payer: Cigna All Commercial |
$1,376.24
|
| Rate for Payer: CORVEL All Commercial |
$1,483.09
|
| Rate for Payer: Coventry All Commercial |
$1,403.35
|
| Rate for Payer: Encore All Commercial |
$1,467.94
|
| Rate for Payer: Frontpath All Commercial |
$1,467.14
|
| Rate for Payer: Humana ChoiceCare |
$1,377.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,435.25
|
| Rate for Payer: PHCS All Commercial |
$1,196.04
|
| Rate for Payer: PHP All Commercial |
$1,209.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,231.12
|
| Rate for Payer: Signature Care EPO |
$1,323.62
|
| Rate for Payer: Signature Care PPO |
$1,403.35
|
| Rate for Payer: United Healthcare Commercial |
$1,256.64
|
|
|
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP
|
Facility
|
OP
|
$1,594.72
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
108127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$494.36 |
| Max. Negotiated Rate |
$1,483.09 |
| Rate for Payer: Aetna Commercial |
$1,345.94
|
| Rate for Payer: Aetna Medicare |
$510.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$494.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$915.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$996.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$586.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$561.34
|
| Rate for Payer: Cash Price |
$956.83
|
| Rate for Payer: Centivo All Commercial |
$867.53
|
| Rate for Payer: Cigna All Commercial |
$1,376.24
|
| Rate for Payer: CORVEL All Commercial |
$1,483.09
|
| Rate for Payer: Coventry All Commercial |
$1,403.35
|
| Rate for Payer: Encore All Commercial |
$1,467.94
|
| Rate for Payer: Frontpath All Commercial |
$1,467.14
|
| Rate for Payer: Humana ChoiceCare |
$1,377.36
|
| Rate for Payer: Humana Medicare |
$510.31
|
| Rate for Payer: Lucent All Commercial |
$867.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,435.25
|
| Rate for Payer: PHCS All Commercial |
$1,196.04
|
| Rate for Payer: PHP All Commercial |
$1,209.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$621.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,231.12
|
| Rate for Payer: Signature Care EPO |
$1,323.62
|
| Rate for Payer: Signature Care PPO |
$1,403.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,355.51
|
| Rate for Payer: United Healthcare Commercial |
$1,256.64
|
| Rate for Payer: United Healthcare Medicare |
$510.31
|
|
|
POLYETHYLENE GLYCOL 3350 17 G ORAL PWPK
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
NDC 11523726808
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: Aetna Commercial |
$7.75
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.23
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Centivo All Commercial |
$5.00
|
| Rate for Payer: Cigna All Commercial |
$7.93
|
| Rate for Payer: CORVEL All Commercial |
$8.54
|
| Rate for Payer: Coventry All Commercial |
$8.08
|
| Rate for Payer: Encore All Commercial |
$8.45
|
| Rate for Payer: Frontpath All Commercial |
$8.45
|
| Rate for Payer: Humana ChoiceCare |
$7.93
|
| Rate for Payer: Humana Medicare |
$2.94
|
| Rate for Payer: Lucent All Commercial |
$5.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.27
|
| Rate for Payer: PHCS All Commercial |
$6.89
|
| Rate for Payer: PHP All Commercial |
$6.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.58
|
| Rate for Payer: Sagamore Health Network All Products |
$7.09
|
| Rate for Payer: Signature Care EPO |
$7.62
|
| Rate for Payer: Signature Care PPO |
$8.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.81
|
| Rate for Payer: United Healthcare Commercial |
$7.24
|
| Rate for Payer: United Healthcare Medicare |
$2.94
|
|
|
POLYETHYLENE GLYCOL 3350 17 G ORAL PWPK
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
NDC 11523726808
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna All Commercial |
$7.93
|
| Rate for Payer: CORVEL All Commercial |
$8.54
|
| Rate for Payer: Coventry All Commercial |
$8.08
|
| Rate for Payer: Encore All Commercial |
$8.45
|
| Rate for Payer: Frontpath All Commercial |
$8.45
|
| Rate for Payer: Humana ChoiceCare |
$7.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.27
|
| Rate for Payer: PHCS All Commercial |
$6.89
|
| Rate for Payer: PHP All Commercial |
$6.97
|
| Rate for Payer: Sagamore Health Network All Products |
$7.09
|
| Rate for Payer: Signature Care EPO |
$7.62
|
| Rate for Payer: Signature Care PPO |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$7.24
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD
|
Facility
|
IP
|
$41.65
|
|
|
Service Code
|
NDC 00536105224
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna Commercial |
$35.99
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cigna All Commercial |
$35.94
|
| Rate for Payer: CORVEL All Commercial |
$38.73
|
| Rate for Payer: Coventry All Commercial |
$36.65
|
| Rate for Payer: Encore All Commercial |
$38.34
|
| Rate for Payer: Frontpath All Commercial |
$38.32
|
| Rate for Payer: Humana ChoiceCare |
$35.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$31.24
|
| Rate for Payer: PHP All Commercial |
$31.59
|
| Rate for Payer: Sagamore Health Network All Products |
$32.15
|
| Rate for Payer: Signature Care EPO |
$34.57
|
| Rate for Payer: Signature Care PPO |
$36.65
|
| Rate for Payer: United Healthcare Commercial |
$32.82
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD
|
Facility
|
OP
|
$41.65
|
|
|
Service Code
|
NDC 00536105224
|
| Hospital Charge Code |
24984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Medicare |
$13.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.66
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Centivo All Commercial |
$22.66
|
| Rate for Payer: Cigna All Commercial |
$35.94
|
| Rate for Payer: CORVEL All Commercial |
$38.73
|
| Rate for Payer: Coventry All Commercial |
$36.65
|
| Rate for Payer: Encore All Commercial |
$38.34
|
| Rate for Payer: Frontpath All Commercial |
$38.32
|
| Rate for Payer: Humana ChoiceCare |
$35.97
|
| Rate for Payer: Humana Medicare |
$13.33
|
| Rate for Payer: Lucent All Commercial |
$22.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$31.24
|
| Rate for Payer: PHP All Commercial |
$31.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.24
|
| Rate for Payer: Sagamore Health Network All Products |
$32.15
|
| Rate for Payer: Signature Care EPO |
$34.57
|
| Rate for Payer: Signature Care PPO |
$36.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.40
|
| Rate for Payer: United Healthcare Commercial |
$32.82
|
| Rate for Payer: United Healthcare Medicare |
$13.33
|
|
|
POLYMYXIN B SULFATE 500000 UNITS INJ SOLR
|
Facility
|
IP
|
$32.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$28.35
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cigna All Commercial |
$28.32
|
| Rate for Payer: CORVEL All Commercial |
$30.52
|
| Rate for Payer: Coventry All Commercial |
$28.88
|
| Rate for Payer: Encore All Commercial |
$30.21
|
| Rate for Payer: Frontpath All Commercial |
$30.19
|
| Rate for Payer: Humana ChoiceCare |
$28.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.53
|
| Rate for Payer: PHCS All Commercial |
$24.61
|
| Rate for Payer: PHP All Commercial |
$24.89
|
| Rate for Payer: Sagamore Health Network All Products |
$25.33
|
| Rate for Payer: Signature Care EPO |
$27.24
|
| Rate for Payer: Signature Care PPO |
$28.88
|
| Rate for Payer: United Healthcare Commercial |
$25.86
|
|
|
POLYMYXIN B SULFATE 500000 UNITS INJ SOLR
|
Facility
|
OP
|
$32.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$27.70
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.55
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Centivo All Commercial |
$17.85
|
| Rate for Payer: Cigna All Commercial |
$28.32
|
| Rate for Payer: CORVEL All Commercial |
$30.52
|
| Rate for Payer: Coventry All Commercial |
$28.88
|
| Rate for Payer: Encore All Commercial |
$30.21
|
| Rate for Payer: Frontpath All Commercial |
$30.19
|
| Rate for Payer: Humana ChoiceCare |
$28.34
|
| Rate for Payer: Humana Medicare |
$10.50
|
| Rate for Payer: Lucent All Commercial |
$17.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.53
|
| Rate for Payer: PHCS All Commercial |
$24.61
|
| Rate for Payer: PHP All Commercial |
$24.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.80
|
| Rate for Payer: Sagamore Health Network All Products |
$25.33
|
| Rate for Payer: Signature Care EPO |
$27.24
|
| Rate for Payer: Signature Care PPO |
$28.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.89
|
| Rate for Payer: United Healthcare Commercial |
$25.86
|
| Rate for Payer: United Healthcare Medicare |
$10.50
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN
|
Facility
|
IP
|
$32.06
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$29.82 |
| Rate for Payer: Aetna Commercial |
$27.70
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cigna All Commercial |
$27.67
|
| Rate for Payer: CORVEL All Commercial |
$29.82
|
| Rate for Payer: Coventry All Commercial |
$28.21
|
| Rate for Payer: Encore All Commercial |
$29.51
|
| Rate for Payer: Frontpath All Commercial |
$29.50
|
| Rate for Payer: Humana ChoiceCare |
$27.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.85
|
| Rate for Payer: PHCS All Commercial |
$24.05
|
| Rate for Payer: PHP All Commercial |
$24.31
|
| Rate for Payer: Sagamore Health Network All Products |
$24.75
|
| Rate for Payer: Signature Care EPO |
$26.61
|
| Rate for Payer: Signature Care PPO |
$28.21
|
| Rate for Payer: United Healthcare Commercial |
$25.26
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN
|
Facility
|
OP
|
$32.06
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$29.82 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$10.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.29
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Centivo All Commercial |
$17.44
|
| Rate for Payer: Cigna All Commercial |
$27.67
|
| Rate for Payer: CORVEL All Commercial |
$29.82
|
| Rate for Payer: Coventry All Commercial |
$28.21
|
| Rate for Payer: Encore All Commercial |
$29.51
|
| Rate for Payer: Frontpath All Commercial |
$29.50
|
| Rate for Payer: Humana ChoiceCare |
$27.69
|
| Rate for Payer: Humana Medicare |
$10.26
|
| Rate for Payer: Lucent All Commercial |
$17.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.85
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$24.05
|
| Rate for Payer: PHP All Commercial |
$24.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.50
|
| Rate for Payer: Sagamore Health Network All Products |
$24.75
|
| Rate for Payer: Signature Care EPO |
$26.61
|
| Rate for Payer: Signature Care PPO |
$28.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.25
|
| Rate for Payer: United Healthcare Commercial |
$25.26
|
| Rate for Payer: United Healthcare Medicare |
$10.26
|
|
|
POTASSIUM CHLORID-D5-0.45%NACL 20 MEQ/L IV SOLP
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$35.45
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Centivo All Commercial |
$22.85
|
| Rate for Payer: Cigna All Commercial |
$36.25
|
| Rate for Payer: CORVEL All Commercial |
$39.06
|
| Rate for Payer: Coventry All Commercial |
$36.96
|
| Rate for Payer: Encore All Commercial |
$38.66
|
| Rate for Payer: Frontpath All Commercial |
$38.64
|
| Rate for Payer: Humana ChoiceCare |
$36.28
|
| Rate for Payer: Humana Medicare |
$13.44
|
| Rate for Payer: Lucent All Commercial |
$22.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.80
|
| Rate for Payer: PHCS All Commercial |
$31.50
|
| Rate for Payer: PHP All Commercial |
$31.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.38
|
| Rate for Payer: Sagamore Health Network All Products |
$32.42
|
| Rate for Payer: Signature Care EPO |
$34.86
|
| Rate for Payer: Signature Care PPO |
$36.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.70
|
| Rate for Payer: United Healthcare Commercial |
$33.10
|
| Rate for Payer: United Healthcare Medicare |
$13.44
|
|
|
POTASSIUM CHLORID-D5-0.45%NACL 20 MEQ/L IV SOLP
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
9801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$36.29
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna All Commercial |
$36.25
|
| Rate for Payer: CORVEL All Commercial |
$39.06
|
| Rate for Payer: Coventry All Commercial |
$36.96
|
| Rate for Payer: Encore All Commercial |
$38.66
|
| Rate for Payer: Frontpath All Commercial |
$38.64
|
| Rate for Payer: Humana ChoiceCare |
$36.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.80
|
| Rate for Payer: PHCS All Commercial |
$31.50
|
| Rate for Payer: PHP All Commercial |
$31.85
|
| Rate for Payer: Sagamore Health Network All Products |
$32.42
|
| Rate for Payer: Signature Care EPO |
$34.86
|
| Rate for Payer: Signature Care PPO |
$36.96
|
| Rate for Payer: United Healthcare Commercial |
$33.10
|
|
|
POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
9807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$59.08
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.64
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Centivo All Commercial |
$38.08
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Humana Medicare |
$22.40
|
| Rate for Payer: Lucent All Commercial |
$38.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.30
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
| Rate for Payer: United Healthcare Medicare |
$22.40
|
|
|
POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
9807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
|
|
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 00245531701
|
| Hospital Charge Code |
35942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna All Commercial |
$1.81
|
| Rate for Payer: CORVEL All Commercial |
$1.95
|
| Rate for Payer: Coventry All Commercial |
$1.85
|
| Rate for Payer: Encore All Commercial |
$1.93
|
| Rate for Payer: Frontpath All Commercial |
$1.93
|
| Rate for Payer: Humana ChoiceCare |
$1.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.89
|
| Rate for Payer: PHCS All Commercial |
$1.57
|
| Rate for Payer: PHP All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1.62
|
| Rate for Payer: Signature Care EPO |
$1.74
|
| Rate for Payer: Signature Care PPO |
$1.85
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
|
|
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 00245531701
|
| Hospital Charge Code |
35942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Centivo All Commercial |
$1.14
|
| Rate for Payer: Cigna All Commercial |
$1.81
|
| Rate for Payer: CORVEL All Commercial |
$1.95
|
| Rate for Payer: Coventry All Commercial |
$1.85
|
| Rate for Payer: Encore All Commercial |
$1.93
|
| Rate for Payer: Frontpath All Commercial |
$1.93
|
| Rate for Payer: Humana ChoiceCare |
$1.81
|
| Rate for Payer: Humana Medicare |
$0.67
|
| Rate for Payer: Lucent All Commercial |
$1.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.89
|
| Rate for Payer: PHCS All Commercial |
$1.57
|
| Rate for Payer: PHP All Commercial |
$1.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1.62
|
| Rate for Payer: Signature Care EPO |
$1.74
|
| Rate for Payer: Signature Care PPO |
$1.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.78
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
|
