|
ROCURONIUM 10 MG/ML IV SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
95812
|
|
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 |
$11.16
|
| 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
|
|
|
ROCURONIUM 50 MG/5 ML (10 MG/ML) IV SYRG
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
120775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$53.17
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.18
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Centivo All Commercial |
$34.27
|
| Rate for Payer: Cigna All Commercial |
$54.37
|
| Rate for Payer: CORVEL All Commercial |
$58.59
|
| Rate for Payer: Coventry All Commercial |
$55.44
|
| Rate for Payer: Encore All Commercial |
$57.99
|
| Rate for Payer: Frontpath All Commercial |
$57.96
|
| Rate for Payer: Humana ChoiceCare |
$54.41
|
| Rate for Payer: Humana Medicare |
$20.16
|
| Rate for Payer: Lucent All Commercial |
$34.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.70
|
| Rate for Payer: PHCS All Commercial |
$47.25
|
| Rate for Payer: PHP All Commercial |
$47.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.57
|
| Rate for Payer: Sagamore Health Network All Products |
$48.64
|
| Rate for Payer: Signature Care EPO |
$52.29
|
| Rate for Payer: Signature Care PPO |
$55.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.55
|
| Rate for Payer: United Healthcare Commercial |
$49.64
|
| Rate for Payer: United Healthcare Medicare |
$20.16
|
|
|
ROCURONIUM 50 MG/5 ML (10 MG/ML) IV SYRG
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
120775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$54.43
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cigna All Commercial |
$54.37
|
| Rate for Payer: CORVEL All Commercial |
$58.59
|
| Rate for Payer: Coventry All Commercial |
$55.44
|
| Rate for Payer: Encore All Commercial |
$57.99
|
| Rate for Payer: Frontpath All Commercial |
$57.96
|
| Rate for Payer: Humana ChoiceCare |
$54.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.70
|
| Rate for Payer: PHCS All Commercial |
$47.25
|
| Rate for Payer: PHP All Commercial |
$47.78
|
| Rate for Payer: Sagamore Health Network All Products |
$48.64
|
| Rate for Payer: Signature Care EPO |
$52.29
|
| Rate for Payer: Signature Care PPO |
$55.44
|
| Rate for Payer: United Healthcare Commercial |
$49.64
|
|
|
ROFLUMILAST 500 MCG ORAL TAB
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
109401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.32
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| Rate for Payer: Cigna All Commercial |
$3.24
|
| Rate for Payer: CORVEL All Commercial |
$3.49
|
| Rate for Payer: Coventry All Commercial |
$3.30
|
| Rate for Payer: Encore All Commercial |
$3.45
|
| Rate for Payer: Frontpath All Commercial |
$3.45
|
| Rate for Payer: Humana ChoiceCare |
$3.24
|
| Rate for Payer: Humana Medicare |
$1.20
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.38
|
| Rate for Payer: PHCS All Commercial |
$2.81
|
| Rate for Payer: PHP All Commercial |
$2.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2.90
|
| Rate for Payer: Signature Care EPO |
$3.11
|
| Rate for Payer: Signature Care PPO |
$3.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.19
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
|
|
ROFLUMILAST 500 MCG ORAL TAB
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
109401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna All Commercial |
$3.24
|
| Rate for Payer: CORVEL All Commercial |
$3.49
|
| Rate for Payer: Coventry All Commercial |
$3.30
|
| Rate for Payer: Encore All Commercial |
$3.45
|
| Rate for Payer: Frontpath All Commercial |
$3.45
|
| Rate for Payer: Humana ChoiceCare |
$3.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.38
|
| Rate for Payer: PHCS All Commercial |
$2.81
|
| Rate for Payer: PHP All Commercial |
$2.85
|
| Rate for Payer: Sagamore Health Network All Products |
$2.90
|
| Rate for Payer: Signature Care EPO |
$3.11
|
| Rate for Payer: Signature Care PPO |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR
|
Facility
|
OP
|
$4,817.31
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
189827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$4,480.10 |
| Rate for Payer: Aetna Commercial |
$4,065.81
|
| Rate for Payer: Aetna Medicare |
$1,541.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,493.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,766.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,011.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,772.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,695.69
|
| Rate for Payer: Cash Price |
$2,986.73
|
| Rate for Payer: Cash Price |
$2,986.73
|
| Rate for Payer: Centivo All Commercial |
$2,620.62
|
| Rate for Payer: Cigna All Commercial |
$4,157.34
|
| Rate for Payer: CORVEL All Commercial |
$4,480.10
|
| Rate for Payer: Coventry All Commercial |
$4,239.24
|
| Rate for Payer: Encore All Commercial |
$4,434.34
|
| Rate for Payer: Frontpath All Commercial |
$4,431.93
|
| Rate for Payer: Humana ChoiceCare |
$4,160.71
|
| Rate for Payer: Humana Medicare |
$1,541.54
|
| Rate for Payer: Lucent All Commercial |
$2,620.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,335.58
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$3,612.98
|
| Rate for Payer: PHP All Commercial |
$3,653.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,878.75
|
| Rate for Payer: Sagamore Health Network All Products |
$3,718.97
|
| Rate for Payer: Signature Care EPO |
$3,998.37
|
| Rate for Payer: Signature Care PPO |
$4,239.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,094.72
|
| Rate for Payer: United Healthcare Commercial |
$3,796.04
|
| Rate for Payer: United Healthcare Medicare |
$1,541.54
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR
|
Facility
|
IP
|
$4,817.31
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
189827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,612.98 |
| Max. Negotiated Rate |
$4,480.10 |
| Rate for Payer: Aetna Commercial |
$4,162.16
|
| Rate for Payer: Cash Price |
$2,986.73
|
| Rate for Payer: Cigna All Commercial |
$4,157.34
|
| Rate for Payer: CORVEL All Commercial |
$4,480.10
|
| Rate for Payer: Coventry All Commercial |
$4,239.24
|
| Rate for Payer: Encore All Commercial |
$4,434.34
|
| Rate for Payer: Frontpath All Commercial |
$4,431.93
|
| Rate for Payer: Humana ChoiceCare |
$4,160.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,335.58
|
| Rate for Payer: PHCS All Commercial |
$3,612.98
|
| Rate for Payer: PHP All Commercial |
$3,653.45
|
| Rate for Payer: Sagamore Health Network All Products |
$3,718.97
|
| Rate for Payer: Signature Care EPO |
$3,998.37
|
| Rate for Payer: Signature Care PPO |
$4,239.24
|
| Rate for Payer: United Healthcare Commercial |
$3,796.04
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR (CAMERON)
|
Facility
|
OP
|
$4,817.31
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
14010189827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$4,480.10 |
| Rate for Payer: Aetna Commercial |
$4,065.81
|
| Rate for Payer: Aetna Medicare |
$1,541.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,493.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,766.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,011.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,772.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,695.69
|
| Rate for Payer: Cash Price |
$2,986.73
|
| Rate for Payer: Cash Price |
$2,986.73
|
| Rate for Payer: Centivo All Commercial |
$2,620.62
|
| Rate for Payer: Cigna All Commercial |
$4,157.34
|
| Rate for Payer: CORVEL All Commercial |
$4,480.10
|
| Rate for Payer: Coventry All Commercial |
$4,239.24
|
| Rate for Payer: Encore All Commercial |
$4,434.34
|
| Rate for Payer: Frontpath All Commercial |
$4,431.93
|
| Rate for Payer: Humana ChoiceCare |
$4,160.71
|
| Rate for Payer: Humana Medicare |
$1,541.54
|
| Rate for Payer: Lucent All Commercial |
$2,620.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,335.58
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$3,612.98
|
| Rate for Payer: PHP All Commercial |
$3,653.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,878.75
|
| Rate for Payer: Sagamore Health Network All Products |
$3,718.97
|
| Rate for Payer: Signature Care EPO |
$3,998.37
|
| Rate for Payer: Signature Care PPO |
$4,239.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,094.72
|
| Rate for Payer: United Healthcare Commercial |
$3,796.04
|
| Rate for Payer: United Healthcare Medicare |
$1,541.54
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR (CAMERON)
|
Facility
|
IP
|
$4,817.31
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
14010189827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,612.98 |
| Max. Negotiated Rate |
$4,480.10 |
| Rate for Payer: Aetna Commercial |
$4,162.16
|
| Rate for Payer: Cash Price |
$2,986.73
|
| Rate for Payer: Cigna All Commercial |
$4,157.34
|
| Rate for Payer: CORVEL All Commercial |
$4,480.10
|
| Rate for Payer: Coventry All Commercial |
$4,239.24
|
| Rate for Payer: Encore All Commercial |
$4,434.34
|
| Rate for Payer: Frontpath All Commercial |
$4,431.93
|
| Rate for Payer: Humana ChoiceCare |
$4,160.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,335.58
|
| Rate for Payer: PHCS All Commercial |
$3,612.98
|
| Rate for Payer: PHP All Commercial |
$3,653.45
|
| Rate for Payer: Sagamore Health Network All Products |
$3,718.97
|
| Rate for Payer: Signature Care EPO |
$3,998.37
|
| Rate for Payer: Signature Care PPO |
$4,239.24
|
| Rate for Payer: United Healthcare Commercial |
$3,796.04
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR
|
Facility
|
IP
|
$9,634.63
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,225.97 |
| Max. Negotiated Rate |
$8,960.20 |
| Rate for Payer: Aetna Commercial |
$8,324.32
|
| Rate for Payer: Cash Price |
$5,973.47
|
| Rate for Payer: Cigna All Commercial |
$8,314.68
|
| Rate for Payer: CORVEL All Commercial |
$8,960.20
|
| Rate for Payer: Coventry All Commercial |
$8,478.47
|
| Rate for Payer: Encore All Commercial |
$8,868.67
|
| Rate for Payer: Frontpath All Commercial |
$8,863.85
|
| Rate for Payer: Humana ChoiceCare |
$8,321.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,671.16
|
| Rate for Payer: PHCS All Commercial |
$7,225.97
|
| Rate for Payer: PHP All Commercial |
$7,306.90
|
| Rate for Payer: Sagamore Health Network All Products |
$7,437.93
|
| Rate for Payer: Signature Care EPO |
$7,996.74
|
| Rate for Payer: Signature Care PPO |
$8,478.47
|
| Rate for Payer: United Healthcare Commercial |
$7,592.08
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR
|
Facility
|
OP
|
$9,634.63
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$8,960.20 |
| Rate for Payer: Aetna Commercial |
$8,131.62
|
| Rate for Payer: Aetna Medicare |
$3,083.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,986.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,533.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,022.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,545.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,391.39
|
| Rate for Payer: Cash Price |
$5,973.47
|
| Rate for Payer: Cash Price |
$5,973.47
|
| Rate for Payer: Centivo All Commercial |
$5,241.24
|
| Rate for Payer: Cigna All Commercial |
$8,314.68
|
| Rate for Payer: CORVEL All Commercial |
$8,960.20
|
| Rate for Payer: Coventry All Commercial |
$8,478.47
|
| Rate for Payer: Encore All Commercial |
$8,868.67
|
| Rate for Payer: Frontpath All Commercial |
$8,863.85
|
| Rate for Payer: Humana ChoiceCare |
$8,321.43
|
| Rate for Payer: Humana Medicare |
$3,083.08
|
| Rate for Payer: Lucent All Commercial |
$5,241.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,671.16
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$7,225.97
|
| Rate for Payer: PHP All Commercial |
$7,306.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,757.50
|
| Rate for Payer: Sagamore Health Network All Products |
$7,437.93
|
| Rate for Payer: Signature Care EPO |
$7,996.74
|
| Rate for Payer: Signature Care PPO |
$8,478.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,189.43
|
| Rate for Payer: United Healthcare Commercial |
$7,592.08
|
| Rate for Payer: United Healthcare Medicare |
$3,083.08
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR (CAMERON)
|
Facility
|
IP
|
$9,634.63
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
140109366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,225.97 |
| Max. Negotiated Rate |
$8,960.20 |
| Rate for Payer: Aetna Commercial |
$8,324.32
|
| Rate for Payer: Cash Price |
$5,973.47
|
| Rate for Payer: Cigna All Commercial |
$8,314.68
|
| Rate for Payer: CORVEL All Commercial |
$8,960.20
|
| Rate for Payer: Coventry All Commercial |
$8,478.47
|
| Rate for Payer: Encore All Commercial |
$8,868.67
|
| Rate for Payer: Frontpath All Commercial |
$8,863.85
|
| Rate for Payer: Humana ChoiceCare |
$8,321.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,671.16
|
| Rate for Payer: PHCS All Commercial |
$7,225.97
|
| Rate for Payer: PHP All Commercial |
$7,306.90
|
| Rate for Payer: Sagamore Health Network All Products |
$7,437.93
|
| Rate for Payer: Signature Care EPO |
$7,996.74
|
| Rate for Payer: Signature Care PPO |
$8,478.47
|
| Rate for Payer: United Healthcare Commercial |
$7,592.08
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR (CAMERON)
|
Facility
|
OP
|
$9,634.63
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
140109366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$8,960.20 |
| Rate for Payer: Aetna Commercial |
$8,131.62
|
| Rate for Payer: Aetna Medicare |
$3,083.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,986.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,533.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,022.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,545.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,391.39
|
| Rate for Payer: Cash Price |
$5,973.47
|
| Rate for Payer: Cash Price |
$5,973.47
|
| Rate for Payer: Centivo All Commercial |
$5,241.24
|
| Rate for Payer: Cigna All Commercial |
$8,314.68
|
| Rate for Payer: CORVEL All Commercial |
$8,960.20
|
| Rate for Payer: Coventry All Commercial |
$8,478.47
|
| Rate for Payer: Encore All Commercial |
$8,868.67
|
| Rate for Payer: Frontpath All Commercial |
$8,863.85
|
| Rate for Payer: Humana ChoiceCare |
$8,321.43
|
| Rate for Payer: Humana Medicare |
$3,083.08
|
| Rate for Payer: Lucent All Commercial |
$5,241.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,671.16
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$7,225.97
|
| Rate for Payer: PHP All Commercial |
$7,306.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,757.50
|
| Rate for Payer: Sagamore Health Network All Products |
$7,437.93
|
| Rate for Payer: Signature Care EPO |
$7,996.74
|
| Rate for Payer: Signature Care PPO |
$8,478.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,189.43
|
| Rate for Payer: United Healthcare Commercial |
$7,592.08
|
| Rate for Payer: United Healthcare Medicare |
$3,083.08
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR
|
Facility
|
IP
|
$19,269.25
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14,451.94 |
| Max. Negotiated Rate |
$17,920.40 |
| Rate for Payer: Aetna Commercial |
$16,648.63
|
| Rate for Payer: Cash Price |
$11,946.94
|
| Rate for Payer: Cigna All Commercial |
$16,629.36
|
| Rate for Payer: CORVEL All Commercial |
$17,920.40
|
| Rate for Payer: Coventry All Commercial |
$16,956.94
|
| Rate for Payer: Encore All Commercial |
$17,737.34
|
| Rate for Payer: Frontpath All Commercial |
$17,727.71
|
| Rate for Payer: Humana ChoiceCare |
$16,642.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,342.33
|
| Rate for Payer: PHCS All Commercial |
$14,451.94
|
| Rate for Payer: PHP All Commercial |
$14,613.80
|
| Rate for Payer: Sagamore Health Network All Products |
$14,875.86
|
| Rate for Payer: Signature Care EPO |
$15,993.48
|
| Rate for Payer: Signature Care PPO |
$16,956.94
|
| Rate for Payer: United Healthcare Commercial |
$15,184.17
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR
|
Facility
|
OP
|
$19,269.25
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$17,920.40 |
| Rate for Payer: Aetna Commercial |
$16,263.25
|
| Rate for Payer: Aetna Medicare |
$6,166.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,973.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11,066.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,045.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,091.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,782.78
|
| Rate for Payer: Cash Price |
$11,946.94
|
| Rate for Payer: Cash Price |
$11,946.94
|
| Rate for Payer: Centivo All Commercial |
$10,482.47
|
| Rate for Payer: Cigna All Commercial |
$16,629.36
|
| Rate for Payer: CORVEL All Commercial |
$17,920.40
|
| Rate for Payer: Coventry All Commercial |
$16,956.94
|
| Rate for Payer: Encore All Commercial |
$17,737.34
|
| Rate for Payer: Frontpath All Commercial |
$17,727.71
|
| Rate for Payer: Humana ChoiceCare |
$16,642.85
|
| Rate for Payer: Humana Medicare |
$6,166.16
|
| Rate for Payer: Lucent All Commercial |
$10,482.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,342.33
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$14,451.94
|
| Rate for Payer: PHP All Commercial |
$14,613.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,515.01
|
| Rate for Payer: Sagamore Health Network All Products |
$14,875.86
|
| Rate for Payer: Signature Care EPO |
$15,993.48
|
| Rate for Payer: Signature Care PPO |
$16,956.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,378.86
|
| Rate for Payer: United Healthcare Commercial |
$15,184.17
|
| Rate for Payer: United Healthcare Medicare |
$6,166.16
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR (CAMERON)
|
Facility
|
OP
|
$19,269.25
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
14093567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$17,920.40 |
| Rate for Payer: Aetna Commercial |
$16,263.25
|
| Rate for Payer: Aetna Medicare |
$6,166.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,973.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11,066.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,045.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,091.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,782.78
|
| Rate for Payer: Cash Price |
$11,946.94
|
| Rate for Payer: Cash Price |
$11,946.94
|
| Rate for Payer: Centivo All Commercial |
$10,482.47
|
| Rate for Payer: Cigna All Commercial |
$16,629.36
|
| Rate for Payer: CORVEL All Commercial |
$17,920.40
|
| Rate for Payer: Coventry All Commercial |
$16,956.94
|
| Rate for Payer: Encore All Commercial |
$17,737.34
|
| Rate for Payer: Frontpath All Commercial |
$17,727.71
|
| Rate for Payer: Humana ChoiceCare |
$16,642.85
|
| Rate for Payer: Humana Medicare |
$6,166.16
|
| Rate for Payer: Lucent All Commercial |
$10,482.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,342.33
|
| Rate for Payer: Managed Health Services Medicaid |
$11.56
|
| Rate for Payer: MDWise Medicaid |
$11.56
|
| Rate for Payer: PHCS All Commercial |
$14,451.94
|
| Rate for Payer: PHP All Commercial |
$14,613.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,515.01
|
| Rate for Payer: Sagamore Health Network All Products |
$14,875.86
|
| Rate for Payer: Signature Care EPO |
$15,993.48
|
| Rate for Payer: Signature Care PPO |
$16,956.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,378.86
|
| Rate for Payer: United Healthcare Commercial |
$15,184.17
|
| Rate for Payer: United Healthcare Medicare |
$6,166.16
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR (CAMERON)
|
Facility
|
IP
|
$19,269.25
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
14093567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14,451.94 |
| Max. Negotiated Rate |
$17,920.40 |
| Rate for Payer: Aetna Commercial |
$16,648.63
|
| Rate for Payer: Cash Price |
$11,946.94
|
| Rate for Payer: Cigna All Commercial |
$16,629.36
|
| Rate for Payer: CORVEL All Commercial |
$17,920.40
|
| Rate for Payer: Coventry All Commercial |
$16,956.94
|
| Rate for Payer: Encore All Commercial |
$17,737.34
|
| Rate for Payer: Frontpath All Commercial |
$17,727.71
|
| Rate for Payer: Humana ChoiceCare |
$16,642.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,342.33
|
| Rate for Payer: PHCS All Commercial |
$14,451.94
|
| Rate for Payer: PHP All Commercial |
$14,613.80
|
| Rate for Payer: Sagamore Health Network All Products |
$14,875.86
|
| Rate for Payer: Signature Care EPO |
$15,993.48
|
| Rate for Payer: Signature Care PPO |
$16,956.94
|
| Rate for Payer: United Healthcare Commercial |
$15,184.17
|
|
|
ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBQ SYRG
|
Facility
|
OP
|
$4,600.61
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
187929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$4,278.57 |
| Rate for Payer: Aetna Commercial |
$3,882.91
|
| Rate for Payer: Aetna Medicare |
$1,472.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,426.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,642.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,875.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,693.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,619.41
|
| Rate for Payer: Cash Price |
$2,852.38
|
| Rate for Payer: Cash Price |
$2,852.38
|
| Rate for Payer: Centivo All Commercial |
$2,502.73
|
| Rate for Payer: Cigna All Commercial |
$3,970.33
|
| Rate for Payer: CORVEL All Commercial |
$4,278.57
|
| Rate for Payer: Coventry All Commercial |
$4,048.54
|
| Rate for Payer: Encore All Commercial |
$4,234.86
|
| Rate for Payer: Frontpath All Commercial |
$4,232.56
|
| Rate for Payer: Humana ChoiceCare |
$3,973.55
|
| Rate for Payer: Humana Medicare |
$1,472.20
|
| Rate for Payer: Lucent All Commercial |
$2,502.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,140.55
|
| Rate for Payer: Managed Health Services Medicaid |
$13.14
|
| Rate for Payer: MDWise Medicaid |
$13.14
|
| Rate for Payer: PHCS All Commercial |
$3,450.46
|
| Rate for Payer: PHP All Commercial |
$3,489.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,794.24
|
| Rate for Payer: Sagamore Health Network All Products |
$3,551.67
|
| Rate for Payer: Signature Care EPO |
$3,818.51
|
| Rate for Payer: Signature Care PPO |
$4,048.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,910.52
|
| Rate for Payer: United Healthcare Commercial |
$3,625.28
|
| Rate for Payer: United Healthcare Medicare |
$1,472.20
|
|
|
ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBQ SYRG
|
Facility
|
IP
|
$4,600.61
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
187929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,450.46 |
| Max. Negotiated Rate |
$4,278.57 |
| Rate for Payer: Aetna Commercial |
$3,974.93
|
| Rate for Payer: Cash Price |
$2,852.38
|
| Rate for Payer: Cigna All Commercial |
$3,970.33
|
| Rate for Payer: CORVEL All Commercial |
$4,278.57
|
| Rate for Payer: Coventry All Commercial |
$4,048.54
|
| Rate for Payer: Encore All Commercial |
$4,234.86
|
| Rate for Payer: Frontpath All Commercial |
$4,232.56
|
| Rate for Payer: Humana ChoiceCare |
$3,973.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,140.55
|
| Rate for Payer: PHCS All Commercial |
$3,450.46
|
| Rate for Payer: PHP All Commercial |
$3,489.10
|
| Rate for Payer: Sagamore Health Network All Products |
$3,551.67
|
| Rate for Payer: Signature Care EPO |
$3,818.51
|
| Rate for Payer: Signature Care PPO |
$4,048.54
|
| Rate for Payer: United Healthcare Commercial |
$3,625.28
|
|
|
ROPINIROLE 0.25 MG ORAL TAB
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna All Commercial |
$1.78
|
| Rate for Payer: CORVEL All Commercial |
$1.91
|
| Rate for Payer: Coventry All Commercial |
$1.81
|
| Rate for Payer: Encore All Commercial |
$1.89
|
| Rate for Payer: Frontpath All Commercial |
$1.89
|
| Rate for Payer: Humana ChoiceCare |
$1.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.85
|
| Rate for Payer: PHCS All Commercial |
$1.54
|
| Rate for Payer: PHP All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1.59
|
| Rate for Payer: Signature Care EPO |
$1.71
|
| Rate for Payer: Signature Care PPO |
$1.81
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
ROPINIROLE 0.25 MG ORAL TAB
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Centivo All Commercial |
$1.12
|
| Rate for Payer: Cigna All Commercial |
$1.78
|
| Rate for Payer: CORVEL All Commercial |
$1.91
|
| Rate for Payer: Coventry All Commercial |
$1.81
|
| Rate for Payer: Encore All Commercial |
$1.89
|
| Rate for Payer: Frontpath All Commercial |
$1.89
|
| Rate for Payer: Humana ChoiceCare |
$1.78
|
| Rate for Payer: Humana Medicare |
$0.66
|
| Rate for Payer: Lucent All Commercial |
$1.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.85
|
| Rate for Payer: PHCS All Commercial |
$1.54
|
| Rate for Payer: PHP All Commercial |
$1.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1.59
|
| Rate for Payer: Signature Care EPO |
$1.71
|
| Rate for Payer: Signature Care PPO |
$1.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.75
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
|
|
ROPINIROLE 1 MG ORAL TAB
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Centivo All Commercial |
$1.19
|
| Rate for Payer: Cigna All Commercial |
$1.89
|
| Rate for Payer: CORVEL All Commercial |
$2.04
|
| Rate for Payer: Coventry All Commercial |
$1.93
|
| Rate for Payer: Encore All Commercial |
$2.02
|
| Rate for Payer: Frontpath All Commercial |
$2.02
|
| Rate for Payer: Humana ChoiceCare |
$1.89
|
| Rate for Payer: Humana Medicare |
$0.70
|
| Rate for Payer: Lucent All Commercial |
$1.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.97
|
| Rate for Payer: PHCS All Commercial |
$1.64
|
| Rate for Payer: PHP All Commercial |
$1.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1.69
|
| Rate for Payer: Signature Care EPO |
$1.82
|
| Rate for Payer: Signature Care PPO |
$1.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.86
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
|
|
ROPINIROLE 1 MG ORAL TAB
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna All Commercial |
$1.89
|
| Rate for Payer: CORVEL All Commercial |
$2.04
|
| Rate for Payer: Coventry All Commercial |
$1.93
|
| Rate for Payer: Encore All Commercial |
$2.02
|
| Rate for Payer: Frontpath All Commercial |
$2.02
|
| Rate for Payer: Humana ChoiceCare |
$1.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.97
|
| Rate for Payer: PHCS All Commercial |
$1.64
|
| Rate for Payer: PHP All Commercial |
$1.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1.69
|
| Rate for Payer: Signature Care EPO |
$1.82
|
| Rate for Payer: Signature Care PPO |
$1.93
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
|
|
ROPIVACAINE-EPI-CLONID-KETOROL 2.46-0.005- 0.0008-0.3MG/ML PATC SYRG
|
Facility
|
IP
|
$349.50
|
|
|
Service Code
|
NDC 70092143350
|
| Hospital Charge Code |
183693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.12 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$301.97
|
| Rate for Payer: Cash Price |
$216.69
|
| Rate for Payer: Cigna All Commercial |
$301.62
|
| Rate for Payer: CORVEL All Commercial |
$325.04
|
| Rate for Payer: Coventry All Commercial |
$307.56
|
| Rate for Payer: Encore All Commercial |
$321.71
|
| Rate for Payer: Frontpath All Commercial |
$321.54
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.55
|
| Rate for Payer: PHCS All Commercial |
$262.12
|
| Rate for Payer: PHP All Commercial |
$265.06
|
| Rate for Payer: Sagamore Health Network All Products |
$269.81
|
| Rate for Payer: Signature Care EPO |
$290.08
|
| Rate for Payer: Signature Care PPO |
$307.56
|
| Rate for Payer: United Healthcare Commercial |
$275.41
|
|
|
ROPIVACAINE-EPI-CLONID-KETOROL 2.46-0.005- 0.0008-0.3MG/ML PATC SYRG
|
Facility
|
OP
|
$349.50
|
|
|
Service Code
|
NDC 70092143350
|
| Hospital Charge Code |
183693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$294.98
|
| Rate for Payer: Aetna Medicare |
$111.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$200.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.02
|
| Rate for Payer: Cash Price |
$216.69
|
| Rate for Payer: Cash Price |
$216.69
|
| Rate for Payer: Centivo All Commercial |
$190.13
|
| Rate for Payer: Cigna All Commercial |
$301.62
|
| Rate for Payer: CORVEL All Commercial |
$325.04
|
| Rate for Payer: Coventry All Commercial |
$307.56
|
| Rate for Payer: Encore All Commercial |
$321.71
|
| Rate for Payer: Frontpath All Commercial |
$321.54
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Humana Medicare |
$111.84
|
| Rate for Payer: Lucent All Commercial |
$190.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.55
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$262.12
|
| Rate for Payer: PHP All Commercial |
$265.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.31
|
| Rate for Payer: Sagamore Health Network All Products |
$269.81
|
| Rate for Payer: Signature Care EPO |
$290.08
|
| Rate for Payer: Signature Care PPO |
$307.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.07
|
| Rate for Payer: United Healthcare Commercial |
$275.41
|
| Rate for Payer: United Healthcare Medicare |
$111.84
|
|
