|
LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN
|
Facility
OP
|
$32.62
|
|
|
Service Code
|
NDC 63323048227
|
| Hospital Charge Code |
10427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$27.53
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.84
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Centivo All Commercial |
$16.64
|
| Rate for Payer: Cigna All Commercial |
$28.15
|
| Rate for Payer: CORVEL All Commercial |
$30.34
|
| Rate for Payer: Coventry All Commercial |
$28.71
|
| Rate for Payer: Encore All Commercial |
$30.03
|
| Rate for Payer: Frontpath All Commercial |
$30.01
|
| Rate for Payer: Humana ChoiceCare |
$28.17
|
| Rate for Payer: Humana Medicare |
$16.64
|
| Rate for Payer: Lucent All Commercial |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.36
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$24.46
|
| Rate for Payer: PHP All Commercial |
$24.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.72
|
| Rate for Payer: Sagamore Health Network All Products |
$25.18
|
| Rate for Payer: Signature Care EPO |
$27.07
|
| Rate for Payer: Signature Care PPO |
$28.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.73
|
| Rate for Payer: United Healthcare Commercial |
$25.70
|
| Rate for Payer: United Healthcare Medicare |
$10.76
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN
|
Facility
OP
|
$30.87
|
|
|
Service Code
|
NDC 00409317802
|
| Hospital Charge Code |
10427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$26.05
|
| Rate for Payer: Aetna Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.21
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Centivo All Commercial |
$15.74
|
| Rate for Payer: Cigna All Commercial |
$26.64
|
| Rate for Payer: CORVEL All Commercial |
$28.71
|
| Rate for Payer: Coventry All Commercial |
$27.17
|
| Rate for Payer: Encore All Commercial |
$28.42
|
| Rate for Payer: Frontpath All Commercial |
$28.40
|
| Rate for Payer: Humana ChoiceCare |
$26.66
|
| Rate for Payer: Humana Medicare |
$15.74
|
| Rate for Payer: Lucent All Commercial |
$15.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.78
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$23.15
|
| Rate for Payer: PHP All Commercial |
$23.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.04
|
| Rate for Payer: Sagamore Health Network All Products |
$23.83
|
| Rate for Payer: Signature Care EPO |
$25.62
|
| Rate for Payer: Signature Care PPO |
$27.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.24
|
| Rate for Payer: United Healthcare Commercial |
$24.33
|
| Rate for Payer: United Healthcare Medicare |
$10.19
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
NDC 00409318201
|
| Hospital Charge Code |
10430
|
|
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 |
$11.16
|
| 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
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
NDC 00409318201
|
| Hospital Charge Code |
10430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| 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 |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| 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 |
$5.94
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJ SOLN
|
Facility
IP
|
$89.67
|
|
|
Service Code
|
NDC 63323048737
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.25 |
| Max. Negotiated Rate |
$83.39 |
| Rate for Payer: Aetna Commercial |
$77.47
|
| Rate for Payer: Cash Price |
$55.60
|
| Rate for Payer: Cigna All Commercial |
$77.39
|
| Rate for Payer: CORVEL All Commercial |
$83.39
|
| Rate for Payer: Coventry All Commercial |
$78.91
|
| Rate for Payer: Encore All Commercial |
$82.54
|
| Rate for Payer: Frontpath All Commercial |
$82.50
|
| Rate for Payer: Humana ChoiceCare |
$77.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.70
|
| Rate for Payer: PHCS All Commercial |
$67.25
|
| Rate for Payer: PHP All Commercial |
$68.01
|
| Rate for Payer: Sagamore Health Network All Products |
$69.23
|
| Rate for Payer: Signature Care EPO |
$74.43
|
| Rate for Payer: Signature Care PPO |
$78.91
|
| Rate for Payer: United Healthcare Commercial |
$70.66
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJ SOLN
|
Facility
OP
|
$89.67
|
|
|
Service Code
|
NDC 63323048737
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$83.39 |
| Rate for Payer: Aetna Commercial |
$75.68
|
| Rate for Payer: Aetna Medicare |
$29.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.55
|
| Rate for Payer: Cash Price |
$55.60
|
| Rate for Payer: Cash Price |
$55.60
|
| Rate for Payer: Centivo All Commercial |
$45.73
|
| Rate for Payer: Cigna All Commercial |
$77.39
|
| Rate for Payer: CORVEL All Commercial |
$83.39
|
| Rate for Payer: Coventry All Commercial |
$78.91
|
| Rate for Payer: Encore All Commercial |
$82.54
|
| Rate for Payer: Frontpath All Commercial |
$82.50
|
| Rate for Payer: Humana ChoiceCare |
$77.45
|
| Rate for Payer: Humana Medicare |
$45.73
|
| Rate for Payer: Lucent All Commercial |
$45.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.70
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$67.25
|
| Rate for Payer: PHP All Commercial |
$68.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.97
|
| Rate for Payer: Sagamore Health Network All Products |
$69.23
|
| Rate for Payer: Signature Care EPO |
$74.43
|
| Rate for Payer: Signature Care PPO |
$78.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.22
|
| Rate for Payer: United Healthcare Commercial |
$70.66
|
| Rate for Payer: United Healthcare Medicare |
$29.59
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJ SOLN
|
Facility
IP
|
$63.63
|
|
|
Service Code
|
NDC 63323048817
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Aetna Commercial |
$54.98
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Cigna All Commercial |
$54.91
|
| Rate for Payer: CORVEL All Commercial |
$59.18
|
| Rate for Payer: Coventry All Commercial |
$55.99
|
| Rate for Payer: Encore All Commercial |
$58.57
|
| Rate for Payer: Frontpath All Commercial |
$58.54
|
| Rate for Payer: Humana ChoiceCare |
$54.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.27
|
| Rate for Payer: PHCS All Commercial |
$47.72
|
| Rate for Payer: PHP All Commercial |
$48.26
|
| Rate for Payer: Sagamore Health Network All Products |
$49.12
|
| Rate for Payer: Signature Care EPO |
$52.81
|
| Rate for Payer: Signature Care PPO |
$55.99
|
| Rate for Payer: United Healthcare Commercial |
$50.14
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJ SOLN
|
Facility
IP
|
$63.63
|
|
|
Service Code
|
NDC 63323048801
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Aetna Commercial |
$54.98
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Cigna All Commercial |
$54.91
|
| Rate for Payer: CORVEL All Commercial |
$59.18
|
| Rate for Payer: Coventry All Commercial |
$55.99
|
| Rate for Payer: Encore All Commercial |
$58.57
|
| Rate for Payer: Frontpath All Commercial |
$58.54
|
| Rate for Payer: Humana ChoiceCare |
$54.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.27
|
| Rate for Payer: PHCS All Commercial |
$47.72
|
| Rate for Payer: PHP All Commercial |
$48.26
|
| Rate for Payer: Sagamore Health Network All Products |
$49.12
|
| Rate for Payer: Signature Care EPO |
$52.81
|
| Rate for Payer: Signature Care PPO |
$55.99
|
| Rate for Payer: United Healthcare Commercial |
$50.14
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJ SOLN
|
Facility
OP
|
$63.63
|
|
|
Service Code
|
NDC 63323048801
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Aetna Commercial |
$53.70
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.10
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Centivo All Commercial |
$32.45
|
| Rate for Payer: Cigna All Commercial |
$54.91
|
| Rate for Payer: CORVEL All Commercial |
$59.18
|
| Rate for Payer: Coventry All Commercial |
$55.99
|
| Rate for Payer: Encore All Commercial |
$58.57
|
| Rate for Payer: Frontpath All Commercial |
$58.54
|
| Rate for Payer: Humana ChoiceCare |
$54.96
|
| Rate for Payer: Humana Medicare |
$32.45
|
| Rate for Payer: Lucent All Commercial |
$32.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.27
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$47.72
|
| Rate for Payer: PHP All Commercial |
$48.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.82
|
| Rate for Payer: Sagamore Health Network All Products |
$49.12
|
| Rate for Payer: Signature Care EPO |
$52.81
|
| Rate for Payer: Signature Care PPO |
$55.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.09
|
| Rate for Payer: United Healthcare Commercial |
$50.14
|
| Rate for Payer: United Healthcare Medicare |
$21.00
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJ SOLN
|
Facility
OP
|
$63.63
|
|
|
Service Code
|
NDC 63323048817
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Aetna Commercial |
$53.70
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.10
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Centivo All Commercial |
$32.45
|
| Rate for Payer: Cigna All Commercial |
$54.91
|
| Rate for Payer: CORVEL All Commercial |
$59.18
|
| Rate for Payer: Coventry All Commercial |
$55.99
|
| Rate for Payer: Encore All Commercial |
$58.57
|
| Rate for Payer: Frontpath All Commercial |
$58.54
|
| Rate for Payer: Humana ChoiceCare |
$54.96
|
| Rate for Payer: Humana Medicare |
$32.45
|
| Rate for Payer: Lucent All Commercial |
$32.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.27
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$47.72
|
| Rate for Payer: PHP All Commercial |
$48.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.82
|
| Rate for Payer: Sagamore Health Network All Products |
$49.12
|
| Rate for Payer: Signature Care EPO |
$52.81
|
| Rate for Payer: Signature Care PPO |
$55.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.09
|
| Rate for Payer: United Healthcare Commercial |
$50.14
|
| Rate for Payer: United Healthcare Medicare |
$21.00
|
|
|
LIDOCAINE-EPINEPHRINE-TETRACAINE (LET) SOLN 3 ML
|
Facility
IP
|
$96.18
|
|
|
Service Code
|
NDC 70092161144
|
| Hospital Charge Code |
1401000700115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Aetna Commercial |
$83.10
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cigna All Commercial |
$83.00
|
| Rate for Payer: CORVEL All Commercial |
$89.45
|
| Rate for Payer: Coventry All Commercial |
$84.64
|
| Rate for Payer: Encore All Commercial |
$88.53
|
| Rate for Payer: Frontpath All Commercial |
$88.49
|
| Rate for Payer: Humana ChoiceCare |
$83.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.56
|
| Rate for Payer: PHCS All Commercial |
$72.14
|
| Rate for Payer: PHP All Commercial |
$72.94
|
| Rate for Payer: Sagamore Health Network All Products |
$74.25
|
| Rate for Payer: Signature Care EPO |
$79.83
|
| Rate for Payer: Signature Care PPO |
$84.64
|
| Rate for Payer: United Healthcare Commercial |
$75.79
|
|
|
LIDOCAINE-EPINEPHRINE-TETRACAINE (LET) SOLN 3 ML
|
Facility
OP
|
$96.18
|
|
|
Service Code
|
NDC 70092161144
|
| Hospital Charge Code |
1401000700115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.91
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Centivo All Commercial |
$49.05
|
| Rate for Payer: Cigna All Commercial |
$83.00
|
| Rate for Payer: CORVEL All Commercial |
$89.45
|
| Rate for Payer: Coventry All Commercial |
$84.64
|
| Rate for Payer: Encore All Commercial |
$88.53
|
| Rate for Payer: Frontpath All Commercial |
$88.49
|
| Rate for Payer: Humana ChoiceCare |
$83.07
|
| Rate for Payer: Humana Medicare |
$49.05
|
| Rate for Payer: Lucent All Commercial |
$49.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.56
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$72.14
|
| Rate for Payer: PHP All Commercial |
$72.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.51
|
| Rate for Payer: Sagamore Health Network All Products |
$74.25
|
| Rate for Payer: Signature Care EPO |
$79.83
|
| Rate for Payer: Signature Care PPO |
$84.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$75.79
|
| Rate for Payer: United Healthcare Medicare |
$31.74
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN
|
Facility
OP
|
$38.15
|
|
|
Service Code
|
NDC 63323048503
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.85
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Centivo All Commercial |
$19.46
|
| Rate for Payer: Cigna All Commercial |
$32.92
|
| Rate for Payer: CORVEL All Commercial |
$35.48
|
| Rate for Payer: Coventry All Commercial |
$33.57
|
| Rate for Payer: Encore All Commercial |
$35.12
|
| Rate for Payer: Frontpath All Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$32.95
|
| Rate for Payer: Humana Medicare |
$19.46
|
| Rate for Payer: Lucent All Commercial |
$19.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.34
|
| Rate for Payer: PHCS All Commercial |
$28.61
|
| Rate for Payer: PHP All Commercial |
$28.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.88
|
| Rate for Payer: Sagamore Health Network All Products |
$29.45
|
| Rate for Payer: Signature Care EPO |
$31.66
|
| Rate for Payer: Signature Care PPO |
$33.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.43
|
| Rate for Payer: United Healthcare Commercial |
$30.06
|
| Rate for Payer: United Healthcare Medicare |
$12.59
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
NDC 00409427601
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| 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 |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| 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 |
$5.94
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN
|
Facility
IP
|
$38.15
|
|
|
Service Code
|
NDC 63323048557
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cigna All Commercial |
$32.92
|
| Rate for Payer: CORVEL All Commercial |
$35.48
|
| Rate for Payer: Coventry All Commercial |
$33.57
|
| Rate for Payer: Encore All Commercial |
$35.12
|
| Rate for Payer: Frontpath All Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$32.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.34
|
| Rate for Payer: PHCS All Commercial |
$28.61
|
| Rate for Payer: PHP All Commercial |
$28.93
|
| Rate for Payer: Sagamore Health Network All Products |
$29.45
|
| Rate for Payer: Signature Care EPO |
$31.66
|
| Rate for Payer: Signature Care PPO |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$30.06
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN
|
Facility
IP
|
$38.15
|
|
|
Service Code
|
NDC 63323048503
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cigna All Commercial |
$32.92
|
| Rate for Payer: CORVEL All Commercial |
$35.48
|
| Rate for Payer: Coventry All Commercial |
$33.57
|
| Rate for Payer: Encore All Commercial |
$35.12
|
| Rate for Payer: Frontpath All Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$32.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.34
|
| Rate for Payer: PHCS All Commercial |
$28.61
|
| Rate for Payer: PHP All Commercial |
$28.93
|
| Rate for Payer: Sagamore Health Network All Products |
$29.45
|
| Rate for Payer: Signature Care EPO |
$31.66
|
| Rate for Payer: Signature Care PPO |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$30.06
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
NDC 00409427601
|
| Hospital Charge Code |
4452
|
|
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 |
$11.16
|
| 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
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN
|
Facility
OP
|
$38.15
|
|
|
Service Code
|
NDC 63323048557
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna Commercial |
$32.20
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.85
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Centivo All Commercial |
$19.46
|
| Rate for Payer: Cigna All Commercial |
$32.92
|
| Rate for Payer: CORVEL All Commercial |
$35.48
|
| Rate for Payer: Coventry All Commercial |
$33.57
|
| Rate for Payer: Encore All Commercial |
$35.12
|
| Rate for Payer: Frontpath All Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$32.95
|
| Rate for Payer: Humana Medicare |
$19.46
|
| Rate for Payer: Lucent All Commercial |
$19.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.34
|
| Rate for Payer: PHCS All Commercial |
$28.61
|
| Rate for Payer: PHP All Commercial |
$28.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.88
|
| Rate for Payer: Sagamore Health Network All Products |
$29.45
|
| Rate for Payer: Signature Care EPO |
$31.66
|
| Rate for Payer: Signature Care PPO |
$33.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.43
|
| Rate for Payer: United Healthcare Commercial |
$30.06
|
| Rate for Payer: United Healthcare Medicare |
$12.59
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
NDC 00409427701
|
| Hospital Charge Code |
4454
|
|
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 |
$11.16
|
| 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
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
NDC 00409427701
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| 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 |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| 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 |
$5.94
|
|
|
LIDOCAINE HCL 2 % MM JELL
|
Facility
OP
|
$46.48
|
|
|
Service Code
|
NDC 17478071131
|
| Hospital Charge Code |
4448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Aetna Commercial |
$39.23
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.87
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Centivo All Commercial |
$23.70
|
| Rate for Payer: Cigna All Commercial |
$40.11
|
| Rate for Payer: CORVEL All Commercial |
$43.23
|
| Rate for Payer: Coventry All Commercial |
$40.90
|
| Rate for Payer: Encore All Commercial |
$42.78
|
| Rate for Payer: Frontpath All Commercial |
$42.76
|
| Rate for Payer: Humana ChoiceCare |
$40.14
|
| Rate for Payer: Humana Medicare |
$23.70
|
| Rate for Payer: Lucent All Commercial |
$23.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.83
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$34.86
|
| Rate for Payer: PHP All Commercial |
$35.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.13
|
| Rate for Payer: Sagamore Health Network All Products |
$35.88
|
| Rate for Payer: Signature Care EPO |
$38.58
|
| Rate for Payer: Signature Care PPO |
$40.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.51
|
| Rate for Payer: United Healthcare Commercial |
$36.63
|
| Rate for Payer: United Healthcare Medicare |
$15.34
|
|
|
LIDOCAINE HCL 2 % MM JELL
|
Facility
OP
|
$507.30
|
|
|
Service Code
|
NDC 17478071130
|
| Hospital Charge Code |
4448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$471.79 |
| Rate for Payer: Aetna Commercial |
$428.16
|
| Rate for Payer: Aetna Medicare |
$167.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$291.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.15
|
| Rate for Payer: Cash Price |
$314.53
|
| Rate for Payer: Cash Price |
$314.53
|
| Rate for Payer: Centivo All Commercial |
$258.72
|
| Rate for Payer: Cigna All Commercial |
$437.80
|
| Rate for Payer: CORVEL All Commercial |
$471.79
|
| Rate for Payer: Coventry All Commercial |
$446.42
|
| Rate for Payer: Encore All Commercial |
$466.97
|
| Rate for Payer: Frontpath All Commercial |
$466.72
|
| Rate for Payer: Humana ChoiceCare |
$438.16
|
| Rate for Payer: Humana Medicare |
$258.72
|
| Rate for Payer: Lucent All Commercial |
$258.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$456.57
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$380.48
|
| Rate for Payer: PHP All Commercial |
$384.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$197.85
|
| Rate for Payer: Sagamore Health Network All Products |
$391.64
|
| Rate for Payer: Signature Care EPO |
$421.06
|
| Rate for Payer: Signature Care PPO |
$446.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$431.20
|
| Rate for Payer: United Healthcare Commercial |
$399.75
|
| Rate for Payer: United Healthcare Medicare |
$167.41
|
|
|
LIDOCAINE HCL 2 % MM JELL
|
Facility
IP
|
$507.30
|
|
|
Service Code
|
NDC 17478071130
|
| Hospital Charge Code |
4448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$380.48 |
| Max. Negotiated Rate |
$471.79 |
| Rate for Payer: Aetna Commercial |
$438.31
|
| Rate for Payer: Cash Price |
$314.53
|
| Rate for Payer: Cigna All Commercial |
$437.80
|
| Rate for Payer: CORVEL All Commercial |
$471.79
|
| Rate for Payer: Coventry All Commercial |
$446.42
|
| Rate for Payer: Encore All Commercial |
$466.97
|
| Rate for Payer: Frontpath All Commercial |
$466.72
|
| Rate for Payer: Humana ChoiceCare |
$438.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$456.57
|
| Rate for Payer: PHCS All Commercial |
$380.48
|
| Rate for Payer: PHP All Commercial |
$384.74
|
| Rate for Payer: Sagamore Health Network All Products |
$391.64
|
| Rate for Payer: Signature Care EPO |
$421.06
|
| Rate for Payer: Signature Care PPO |
$446.42
|
| Rate for Payer: United Healthcare Commercial |
$399.75
|
|
|
LIDOCAINE HCL 2 % MM JELL
|
Facility
OP
|
$46.48
|
|
|
Service Code
|
NDC 17478071110
|
| Hospital Charge Code |
4448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Aetna Commercial |
$39.23
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.87
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Centivo All Commercial |
$23.70
|
| Rate for Payer: Cigna All Commercial |
$40.11
|
| Rate for Payer: CORVEL All Commercial |
$43.23
|
| Rate for Payer: Coventry All Commercial |
$40.90
|
| Rate for Payer: Encore All Commercial |
$42.78
|
| Rate for Payer: Frontpath All Commercial |
$42.76
|
| Rate for Payer: Humana ChoiceCare |
$40.14
|
| Rate for Payer: Humana Medicare |
$23.70
|
| Rate for Payer: Lucent All Commercial |
$23.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.83
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$34.86
|
| Rate for Payer: PHP All Commercial |
$35.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.13
|
| Rate for Payer: Sagamore Health Network All Products |
$35.88
|
| Rate for Payer: Signature Care EPO |
$38.58
|
| Rate for Payer: Signature Care PPO |
$40.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.51
|
| Rate for Payer: United Healthcare Commercial |
$36.63
|
| Rate for Payer: United Healthcare Medicare |
$15.34
|
|
|
LIDOCAINE HCL 2 % MM JELL
|
Facility
IP
|
$46.48
|
|
|
Service Code
|
NDC 17478071110
|
| Hospital Charge Code |
4448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Aetna Commercial |
$40.16
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Cigna All Commercial |
$40.11
|
| Rate for Payer: CORVEL All Commercial |
$43.23
|
| Rate for Payer: Coventry All Commercial |
$40.90
|
| Rate for Payer: Encore All Commercial |
$42.78
|
| Rate for Payer: Frontpath All Commercial |
$42.76
|
| Rate for Payer: Humana ChoiceCare |
$40.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.83
|
| Rate for Payer: PHCS All Commercial |
$34.86
|
| Rate for Payer: PHP All Commercial |
$35.25
|
| Rate for Payer: Sagamore Health Network All Products |
$35.88
|
| Rate for Payer: Signature Care EPO |
$38.58
|
| Rate for Payer: Signature Care PPO |
$40.90
|
| Rate for Payer: United Healthcare Commercial |
$36.63
|
|
