|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$45.70
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
z93272
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$23.92
|
| Rate for Payer: Aetna Commercial |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.31
|
| Rate for Payer: Cash Price |
$28.33
|
| Rate for Payer: Cash Price |
$28.06
|
| Rate for Payer: Centivo All Commercial |
$37.08
|
| Rate for Payer: Centivo All Commercial |
$37.08
|
| Rate for Payer: Cigna All Commercial |
$23.92
|
| Rate for Payer: Cigna All Commercial |
$23.92
|
| Rate for Payer: CORVEL All Commercial |
$23.92
|
| Rate for Payer: CORVEL All Commercial |
$23.92
|
| Rate for Payer: Coventry All Commercial |
$28.70
|
| Rate for Payer: Coventry All Commercial |
$28.70
|
| Rate for Payer: Encore All Commercial |
$23.92
|
| Rate for Payer: Encore All Commercial |
$23.92
|
| Rate for Payer: Frontpath All Commercial |
$26.88
|
| Rate for Payer: Frontpath All Commercial |
$26.88
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$23.92
|
| Rate for Payer: Humana Medicare |
$23.92
|
| Rate for Payer: Lucent All Commercial |
$33.49
|
| Rate for Payer: Lucent All Commercial |
$33.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.48
|
| Rate for Payer: Managed Health Services Medicaid |
$22.48
|
| Rate for Payer: MDWise Medicaid |
$22.48
|
| Rate for Payer: MDWise Medicaid |
$22.48
|
| Rate for Payer: PHCS All Commercial |
$23.92
|
| Rate for Payer: PHCS All Commercial |
$23.92
|
| Rate for Payer: PHP All Commercial |
$33.26
|
| Rate for Payer: PHP All Commercial |
$33.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.92
|
| Rate for Payer: Sagamore Health Network All Products |
$23.92
|
| Rate for Payer: Sagamore Health Network All Products |
$23.92
|
| Rate for Payer: Signature Care EPO |
$40.66
|
| Rate for Payer: Signature Care EPO |
$40.66
|
| Rate for Payer: Signature Care PPO |
$40.66
|
| Rate for Payer: Signature Care PPO |
$40.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Medicare |
$22.63
|
| Rate for Payer: United Healthcare Medicare |
$22.63
|
|
|
PSEUDOEPHEDRINE HCL 30 MG ORAL TAB
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna All Commercial |
$0.14
|
| Rate for Payer: CORVEL All Commercial |
$0.15
|
| Rate for Payer: Coventry All Commercial |
$0.14
|
| Rate for Payer: Encore All Commercial |
$0.15
|
| Rate for Payer: Frontpath All Commercial |
$0.15
|
| Rate for Payer: Humana ChoiceCare |
$0.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.14
|
| Rate for Payer: PHCS All Commercial |
$0.12
|
| Rate for Payer: PHP All Commercial |
$0.12
|
| Rate for Payer: Sagamore Health Network All Products |
$0.12
|
| Rate for Payer: Signature Care EPO |
$0.13
|
| Rate for Payer: Signature Care PPO |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
|
|
PSEUDOEPHEDRINE HCL 30 MG ORAL TAB
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Centivo All Commercial |
$0.09
|
| Rate for Payer: Cigna All Commercial |
$0.14
|
| Rate for Payer: CORVEL All Commercial |
$0.15
|
| Rate for Payer: Coventry All Commercial |
$0.14
|
| Rate for Payer: Encore All Commercial |
$0.15
|
| Rate for Payer: Frontpath All Commercial |
$0.15
|
| Rate for Payer: Humana ChoiceCare |
$0.14
|
| Rate for Payer: Humana Medicare |
$0.05
|
| Rate for Payer: Lucent All Commercial |
$0.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.14
|
| Rate for Payer: PHCS All Commercial |
$0.12
|
| Rate for Payer: PHP All Commercial |
$0.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.06
|
| Rate for Payer: Sagamore Health Network All Products |
$0.12
|
| Rate for Payer: Signature Care EPO |
$0.13
|
| Rate for Payer: Signature Care PPO |
$0.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
|
|
PSYLLIUM HUSK 3.4 G ORAL PWPK
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Centivo All Commercial |
$2.21
|
| Rate for Payer: Cigna All Commercial |
$3.51
|
| Rate for Payer: CORVEL All Commercial |
$3.78
|
| Rate for Payer: Coventry All Commercial |
$3.58
|
| Rate for Payer: Encore All Commercial |
$3.74
|
| Rate for Payer: Frontpath All Commercial |
$3.74
|
| Rate for Payer: Humana ChoiceCare |
$3.51
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Lucent All Commercial |
$2.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.66
|
| Rate for Payer: PHCS All Commercial |
$3.05
|
| Rate for Payer: PHP All Commercial |
$3.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3.14
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
PSYLLIUM HUSK 3.4 G ORAL PWPK
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna All Commercial |
$3.51
|
| Rate for Payer: CORVEL All Commercial |
$3.78
|
| Rate for Payer: Coventry All Commercial |
$3.58
|
| Rate for Payer: Encore All Commercial |
$3.74
|
| Rate for Payer: Frontpath All Commercial |
$3.74
|
| Rate for Payer: Humana ChoiceCare |
$3.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.66
|
| Rate for Payer: PHCS All Commercial |
$3.05
|
| Rate for Payer: PHP All Commercial |
$3.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3.14
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.58
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 37000002310
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 37000002304
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 37000002304
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Centivo All Commercial |
$2.22
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Lucent All Commercial |
$2.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 37000002310
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Centivo All Commercial |
$2.22
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Lucent All Commercial |
$2.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$97.73
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.73
|
| Rate for Payer: Managed Health Services Medicaid |
$97.73
|
| Rate for Payer: MDWise Medicaid |
$97.73
|
|
|
PUNCTURE ASPIRATION OF CYST OF BREAST;
|
Facility
|
OP
|
$97.73
|
|
|
Service Code
|
CPT 19000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$97.73 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$97.73
|
| Rate for Payer: Managed Health Services Medicaid |
$97.73
|
| Rate for Payer: MDWise Medicaid |
$97.73
|
|
|
PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$73.30
|
|
|
Service Code
|
CPT 19001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$73.30 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$73.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.30
|
| Rate for Payer: Managed Health Services Medicaid |
$73.30
|
| Rate for Payer: MDWise Medicaid |
$73.30
|
|
|
QUETIAPINE 100 MG ORAL TAB
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$1.00
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Centivo All Commercial |
$0.64
|
| Rate for Payer: Cigna All Commercial |
$1.02
|
| Rate for Payer: CORVEL All Commercial |
$1.10
|
| Rate for Payer: Coventry All Commercial |
$1.04
|
| Rate for Payer: Encore All Commercial |
$1.09
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.02
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Lucent All Commercial |
$0.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.06
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.46
|
| Rate for Payer: Sagamore Health Network All Products |
$0.91
|
| Rate for Payer: Signature Care EPO |
$0.98
|
| Rate for Payer: Signature Care PPO |
$1.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
|
|
QUETIAPINE 100 MG ORAL TAB
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna All Commercial |
$1.02
|
| Rate for Payer: CORVEL All Commercial |
$1.10
|
| Rate for Payer: Coventry All Commercial |
$1.04
|
| Rate for Payer: Encore All Commercial |
$1.09
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.06
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Sagamore Health Network All Products |
$0.91
|
| Rate for Payer: Signature Care EPO |
$0.98
|
| Rate for Payer: Signature Care PPO |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
|
|
QUETIAPINE 25 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.32
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
|
|
QUETIAPINE 25 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNITS/ML IM SOLN
|
Facility
|
IP
|
$2,585.24
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
184464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,938.93 |
| Max. Negotiated Rate |
$2,404.27 |
| Rate for Payer: Aetna Commercial |
$2,233.65
|
| Rate for Payer: Aetna Commercial |
$9,772.21
|
| Rate for Payer: Cash Price |
$1,602.85
|
| Rate for Payer: Cash Price |
$7,012.46
|
| Rate for Payer: Cigna All Commercial |
$2,231.06
|
| Rate for Payer: Cigna All Commercial |
$9,760.90
|
| Rate for Payer: CORVEL All Commercial |
$10,518.70
|
| Rate for Payer: CORVEL All Commercial |
$2,404.27
|
| Rate for Payer: Coventry All Commercial |
$9,953.17
|
| Rate for Payer: Coventry All Commercial |
$2,275.01
|
| Rate for Payer: Encore All Commercial |
$2,379.71
|
| Rate for Payer: Encore All Commercial |
$10,411.25
|
| Rate for Payer: Frontpath All Commercial |
$10,405.59
|
| Rate for Payer: Frontpath All Commercial |
$2,378.42
|
| Rate for Payer: Humana ChoiceCare |
$2,232.87
|
| Rate for Payer: Humana ChoiceCare |
$9,768.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,326.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,179.38
|
| Rate for Payer: PHCS All Commercial |
$8,482.82
|
| Rate for Payer: PHCS All Commercial |
$1,938.93
|
| Rate for Payer: PHP All Commercial |
$8,577.83
|
| Rate for Payer: PHP All Commercial |
$1,960.65
|
| Rate for Payer: Sagamore Health Network All Products |
$8,731.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,995.81
|
| Rate for Payer: Signature Care EPO |
$9,387.65
|
| Rate for Payer: Signature Care EPO |
$2,145.75
|
| Rate for Payer: Signature Care PPO |
$2,275.01
|
| Rate for Payer: Signature Care PPO |
$9,953.17
|
| Rate for Payer: United Healthcare Commercial |
$8,912.61
|
| Rate for Payer: United Healthcare Commercial |
$2,037.17
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNITS/ML IM SOLN
|
Facility
|
OP
|
$2,585.24
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
184464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$714.52 |
| Max. Negotiated Rate |
$2,404.27 |
| Rate for Payer: Aetna Commercial |
$2,181.94
|
| Rate for Payer: Aetna Commercial |
$9,546.00
|
| Rate for Payer: Aetna Medicare |
$827.28
|
| Rate for Payer: Aetna Medicare |
$3,619.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$714.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$714.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$801.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,506.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,495.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,484.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,616.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,070.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$714.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$714.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$951.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,162.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$910.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,981.27
|
| Rate for Payer: Cash Price |
$1,602.85
|
| Rate for Payer: Cash Price |
$7,012.46
|
| Rate for Payer: Cash Price |
$7,012.46
|
| Rate for Payer: Cash Price |
$1,602.85
|
| Rate for Payer: Centivo All Commercial |
$6,152.87
|
| Rate for Payer: Centivo All Commercial |
$1,406.37
|
| Rate for Payer: Cigna All Commercial |
$2,231.06
|
| Rate for Payer: Cigna All Commercial |
$9,760.90
|
| Rate for Payer: CORVEL All Commercial |
$2,404.27
|
| Rate for Payer: CORVEL All Commercial |
$10,518.70
|
| Rate for Payer: Coventry All Commercial |
$2,275.01
|
| Rate for Payer: Coventry All Commercial |
$9,953.17
|
| Rate for Payer: Encore All Commercial |
$2,379.71
|
| Rate for Payer: Encore All Commercial |
$10,411.25
|
| Rate for Payer: Frontpath All Commercial |
$10,405.59
|
| Rate for Payer: Frontpath All Commercial |
$2,378.42
|
| Rate for Payer: Humana ChoiceCare |
$2,232.87
|
| Rate for Payer: Humana ChoiceCare |
$9,768.81
|
| Rate for Payer: Humana Medicare |
$3,619.34
|
| Rate for Payer: Humana Medicare |
$827.28
|
| Rate for Payer: Lucent All Commercial |
$1,406.37
|
| Rate for Payer: Lucent All Commercial |
$6,152.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,326.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,179.38
|
| Rate for Payer: Managed Health Services Medicaid |
$714.52
|
| Rate for Payer: Managed Health Services Medicaid |
$714.52
|
| Rate for Payer: MDWise Medicaid |
$714.52
|
| Rate for Payer: MDWise Medicaid |
$714.52
|
| Rate for Payer: PHCS All Commercial |
$8,482.82
|
| Rate for Payer: PHCS All Commercial |
$1,938.93
|
| Rate for Payer: PHP All Commercial |
$1,960.65
|
| Rate for Payer: PHP All Commercial |
$8,577.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,411.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,008.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8,731.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,995.81
|
| Rate for Payer: Signature Care EPO |
$2,145.75
|
| Rate for Payer: Signature Care EPO |
$9,387.65
|
| Rate for Payer: Signature Care PPO |
$9,953.17
|
| Rate for Payer: Signature Care PPO |
$2,275.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,197.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,613.86
|
| Rate for Payer: United Healthcare Commercial |
$8,912.61
|
| Rate for Payer: United Healthcare Commercial |
$2,037.17
|
| Rate for Payer: United Healthcare Medicare |
$3,619.34
|
| Rate for Payer: United Healthcare Medicare |
$827.28
|
|
|
RABIES VACCINE, PCEC (PF) 2.5 UNITS IM SUSR
|
Facility
|
OP
|
$1,629.80
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$397.99 |
| Max. Negotiated Rate |
$1,515.71 |
| Rate for Payer: Aetna Commercial |
$1,375.55
|
| Rate for Payer: Aetna Medicare |
$521.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$397.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$505.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$935.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,018.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$397.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$599.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$573.69
|
| Rate for Payer: Cash Price |
$1,010.48
|
| Rate for Payer: Cash Price |
$1,010.48
|
| Rate for Payer: Centivo All Commercial |
$886.61
|
| Rate for Payer: Cigna All Commercial |
$1,406.52
|
| Rate for Payer: CORVEL All Commercial |
$1,515.71
|
| Rate for Payer: Coventry All Commercial |
$1,434.22
|
| Rate for Payer: Encore All Commercial |
$1,500.23
|
| Rate for Payer: Frontpath All Commercial |
$1,499.42
|
| Rate for Payer: Humana ChoiceCare |
$1,407.66
|
| Rate for Payer: Humana Medicare |
$521.54
|
| Rate for Payer: Lucent All Commercial |
$886.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,466.82
|
| Rate for Payer: Managed Health Services Medicaid |
$397.99
|
| Rate for Payer: MDWise Medicaid |
$397.99
|
| Rate for Payer: PHCS All Commercial |
$1,222.35
|
| Rate for Payer: PHP All Commercial |
$1,236.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$635.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.21
|
| Rate for Payer: Signature Care EPO |
$1,352.73
|
| Rate for Payer: Signature Care PPO |
$1,434.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,385.33
|
| Rate for Payer: United Healthcare Commercial |
$1,284.28
|
| Rate for Payer: United Healthcare Medicare |
$521.54
|
|
|
RABIES VACCINE, PCEC (PF) 2.5 UNITS IM SUSR
|
Facility
|
IP
|
$1,629.80
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,222.35 |
| Max. Negotiated Rate |
$1,515.71 |
| Rate for Payer: Aetna Commercial |
$1,408.15
|
| Rate for Payer: Cash Price |
$1,010.48
|
| Rate for Payer: Cigna All Commercial |
$1,406.52
|
| Rate for Payer: CORVEL All Commercial |
$1,515.71
|
| Rate for Payer: Coventry All Commercial |
$1,434.22
|
| Rate for Payer: Encore All Commercial |
$1,500.23
|
| Rate for Payer: Frontpath All Commercial |
$1,499.42
|
| Rate for Payer: Humana ChoiceCare |
$1,407.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,466.82
|
| Rate for Payer: PHCS All Commercial |
$1,222.35
|
| Rate for Payer: PHP All Commercial |
$1,236.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.21
|
| Rate for Payer: Signature Care EPO |
$1,352.73
|
| Rate for Payer: Signature Care PPO |
$1,434.22
|
| Rate for Payer: United Healthcare Commercial |
$1,284.28
|
|
|
RACEPINEPHRINE 2.25 % INHL NEBU
|
Facility
|
OP
|
$11.17
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$10.38 |
| Rate for Payer: Aetna Commercial |
$9.42
|
| Rate for Payer: Aetna Medicare |
$3.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Centivo All Commercial |
$6.07
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.38
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.27
|
| Rate for Payer: Humana ChoiceCare |
$9.64
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: Lucent All Commercial |
$6.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$8.37
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.35
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$3.57
|
|
|
RACEPINEPHRINE 2.25 % INHL NEBU
|
Facility
|
IP
|
$11.17
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$10.38 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.38
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.27
|
| Rate for Payer: Humana ChoiceCare |
$9.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: PHCS All Commercial |
$8.37
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM 24 MARKERS ORAL CAP
|
Facility
|
IP
|
$639.36
|
|
|
Service Code
|
NDC 10858008110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$479.52 |
| Max. Negotiated Rate |
$594.60 |
| Rate for Payer: Aetna Commercial |
$552.41
|
| Rate for Payer: Cash Price |
$396.40
|
| Rate for Payer: Cigna All Commercial |
$551.77
|
| Rate for Payer: CORVEL All Commercial |
$594.60
|
| Rate for Payer: Coventry All Commercial |
$562.64
|
| Rate for Payer: Encore All Commercial |
$588.53
|
| Rate for Payer: Frontpath All Commercial |
$588.21
|
| Rate for Payer: Humana ChoiceCare |
$552.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$575.42
|
| Rate for Payer: PHCS All Commercial |
$479.52
|
| Rate for Payer: PHP All Commercial |
$484.89
|
| Rate for Payer: Sagamore Health Network All Products |
$493.59
|
| Rate for Payer: Signature Care EPO |
$530.67
|
| Rate for Payer: Signature Care PPO |
$562.64
|
| Rate for Payer: United Healthcare Commercial |
$503.82
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM 24 MARKERS ORAL CAP
|
Facility
|
OP
|
$639.36
|
|
|
Service Code
|
NDC 10858008110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$594.60 |
| Rate for Payer: Aetna Commercial |
$539.62
|
| Rate for Payer: Aetna Medicare |
$204.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$367.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$399.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$235.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.05
|
| Rate for Payer: Cash Price |
$396.40
|
| Rate for Payer: Cash Price |
$396.40
|
| Rate for Payer: Centivo All Commercial |
$347.81
|
| Rate for Payer: Cigna All Commercial |
$551.77
|
| Rate for Payer: CORVEL All Commercial |
$594.60
|
| Rate for Payer: Coventry All Commercial |
$562.64
|
| Rate for Payer: Encore All Commercial |
$588.53
|
| Rate for Payer: Frontpath All Commercial |
$588.21
|
| Rate for Payer: Humana ChoiceCare |
$552.22
|
| Rate for Payer: Humana Medicare |
$204.60
|
| Rate for Payer: Lucent All Commercial |
$347.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$575.42
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$479.52
|
| Rate for Payer: PHP All Commercial |
$484.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.35
|
| Rate for Payer: Sagamore Health Network All Products |
$493.59
|
| Rate for Payer: Signature Care EPO |
$530.67
|
| Rate for Payer: Signature Care PPO |
$562.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$543.46
|
| Rate for Payer: United Healthcare Commercial |
$503.82
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
|
|
RALTEGRAVIR 400 MG ORAL TAB
|
Facility
|
OP
|
$236.96
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$220.38 |
| Rate for Payer: Aetna Commercial |
$200.00
|
| Rate for Payer: Aetna Medicare |
$75.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$136.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.41
|
| Rate for Payer: Cash Price |
$146.92
|
| Rate for Payer: Centivo All Commercial |
$128.91
|
| Rate for Payer: Cigna All Commercial |
$204.50
|
| Rate for Payer: CORVEL All Commercial |
$220.38
|
| Rate for Payer: Coventry All Commercial |
$208.53
|
| Rate for Payer: Encore All Commercial |
$218.13
|
| Rate for Payer: Frontpath All Commercial |
$218.01
|
| Rate for Payer: Humana ChoiceCare |
$204.67
|
| Rate for Payer: Humana Medicare |
$75.83
|
| Rate for Payer: Lucent All Commercial |
$128.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.27
|
| Rate for Payer: PHCS All Commercial |
$177.72
|
| Rate for Payer: PHP All Commercial |
$179.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.42
|
| Rate for Payer: Sagamore Health Network All Products |
$182.94
|
| Rate for Payer: Signature Care EPO |
$196.68
|
| Rate for Payer: Signature Care PPO |
$208.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.42
|
| Rate for Payer: United Healthcare Commercial |
$186.73
|
| Rate for Payer: United Healthcare Medicare |
$75.83
|
|
