|
LISINOPRIL 10 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| 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 |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| 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 |
$0.33
|
|
|
LISINOPRIL 10 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
10449
|
|
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
|
|
|
LISINOPRIL 20 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
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
|
|
|
LISINOPRIL 20 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687033301
|
| Hospital Charge Code |
4526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| 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 |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| 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 |
$0.33
|
|
|
LISINOPRIL 5 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| 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 |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| 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 |
$0.33
|
|
|
LISINOPRIL 5 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904679761
|
| Hospital Charge Code |
10451
|
|
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
|
|
|
LITHIUM CARBONATE 150 MG ORAL CAP
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
NDC 00054852625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna All Commercial |
$1.04
|
| Rate for Payer: CORVEL All Commercial |
$1.12
|
| Rate for Payer: Coventry All Commercial |
$1.06
|
| Rate for Payer: Encore All Commercial |
$1.11
|
| Rate for Payer: Frontpath All Commercial |
$1.11
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.08
|
| Rate for Payer: PHCS All Commercial |
$0.90
|
| Rate for Payer: PHP All Commercial |
$0.91
|
| Rate for Payer: Sagamore Health Network All Products |
$0.93
|
| Rate for Payer: Signature Care EPO |
$1.00
|
| Rate for Payer: Signature Care PPO |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
LITHIUM CARBONATE 150 MG ORAL CAP
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 00054852625
|
| Hospital Charge Code |
4528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna Commercial |
$1.02
|
| Rate for Payer: Aetna Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.44
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Centivo All Commercial |
$0.61
|
| Rate for Payer: Cigna All Commercial |
$1.04
|
| Rate for Payer: CORVEL All Commercial |
$1.12
|
| Rate for Payer: Coventry All Commercial |
$1.06
|
| Rate for Payer: Encore All Commercial |
$1.11
|
| Rate for Payer: Frontpath All Commercial |
$1.11
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Humana Medicare |
$0.61
|
| Rate for Payer: Lucent All Commercial |
$0.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.08
|
| Rate for Payer: PHCS All Commercial |
$0.90
|
| Rate for Payer: PHP All Commercial |
$0.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.47
|
| Rate for Payer: Sagamore Health Network All Products |
$0.93
|
| Rate for Payer: Signature Care EPO |
$1.00
|
| Rate for Payer: Signature Care PPO |
$1.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
|
|
LOPERAMIDE 2 MG ORAL CAP
|
Facility
OP
|
$4.91
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.78
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Centivo All Commercial |
$2.51
|
| Rate for Payer: Cigna All Commercial |
$4.24
|
| Rate for Payer: CORVEL All Commercial |
$4.57
|
| Rate for Payer: Coventry All Commercial |
$4.32
|
| Rate for Payer: Encore All Commercial |
$4.52
|
| Rate for Payer: Frontpath All Commercial |
$4.52
|
| Rate for Payer: Humana ChoiceCare |
$4.24
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Lucent All Commercial |
$2.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.42
|
| Rate for Payer: PHCS All Commercial |
$3.69
|
| Rate for Payer: PHP All Commercial |
$3.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.92
|
| Rate for Payer: Sagamore Health Network All Products |
$3.79
|
| Rate for Payer: Signature Care EPO |
$4.08
|
| Rate for Payer: Signature Care PPO |
$4.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.18
|
| Rate for Payer: United Healthcare Commercial |
$3.87
|
| Rate for Payer: United Healthcare Medicare |
$1.62
|
|
|
LOPERAMIDE 2 MG ORAL CAP
|
Facility
IP
|
$4.91
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna All Commercial |
$4.24
|
| Rate for Payer: CORVEL All Commercial |
$4.57
|
| Rate for Payer: Coventry All Commercial |
$4.32
|
| Rate for Payer: Encore All Commercial |
$4.52
|
| Rate for Payer: Frontpath All Commercial |
$4.52
|
| Rate for Payer: Humana ChoiceCare |
$4.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.42
|
| Rate for Payer: PHCS All Commercial |
$3.69
|
| Rate for Payer: PHP All Commercial |
$3.73
|
| Rate for Payer: Sagamore Health Network All Products |
$3.79
|
| Rate for Payer: Signature Care EPO |
$4.08
|
| Rate for Payer: Signature Care PPO |
$4.32
|
| Rate for Payer: United Healthcare Commercial |
$3.87
|
|
|
LORAZEPAM 0.5 MG ORAL TAB
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
LORAZEPAM 0.5 MG ORAL TAB
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
|
|
LORAZEPAM 1 MG ORAL TAB
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
LORAZEPAM 1 MG ORAL TAB
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
4573
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
|
|
LORAZEPAM 2 MG/ML INJECTION S.O.
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
408010467
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cigna All Commercial |
$57.93
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$62.43
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Coventry All Commercial |
$59.07
|
| Rate for Payer: Encore All Commercial |
$61.79
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Frontpath All Commercial |
$61.76
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$50.35
|
| Rate for Payer: PHP All Commercial |
$50.91
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$51.82
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$55.72
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$59.07
|
| Rate for Payer: United Healthcare Commercial |
$52.90
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
LORAZEPAM 2 MG/ML INJECTION S.O.
|
Facility
OP
|
$67.13
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
408010467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$56.66
|
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$22.15
|
| 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 Medicare |
$22.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.55
|
| 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: Anthem Blue Cross of IN Traditional |
$41.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Centivo All Commercial |
$34.24
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: Cigna All Commercial |
$57.93
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$62.43
|
| Rate for Payer: Coventry All Commercial |
$59.07
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$61.79
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$61.76
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Humana Medicare |
$34.24
|
| Rate for Payer: Lucent All Commercial |
$34.24
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$50.35
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: PHP All Commercial |
$50.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.18
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Sagamore Health Network All Products |
$51.82
|
| Rate for Payer: Signature Care EPO |
$55.72
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$59.07
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.06
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$52.90
|
| Rate for Payer: United Healthcare Medicare |
$22.15
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
LORAZEPAM 2 MG/ML INJ SOLN
|
Facility
IP
|
$67.13
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$58.00
|
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: Cigna All Commercial |
$57.93
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$62.43
|
| Rate for Payer: Coventry All Commercial |
$59.07
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$61.79
|
| Rate for Payer: Frontpath All Commercial |
$61.76
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.42
|
| Rate for Payer: PHCS All Commercial |
$50.35
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: PHP All Commercial |
$50.91
|
| Rate for Payer: Sagamore Health Network All Products |
$51.82
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$55.72
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$59.07
|
| Rate for Payer: United Healthcare Commercial |
$52.90
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
LORAZEPAM 2 MG/ML INJ SOLN
|
Facility
OP
|
$67.13
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Aetna Commercial |
$56.66
|
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$22.15
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.15
|
| 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 PPO/Exchange |
$38.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.96
|
| 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 Just 4 Me |
$25.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.37
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Centivo All Commercial |
$34.24
|
| Rate for Payer: Cigna All Commercial |
$57.93
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$62.43
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Coventry All Commercial |
$59.07
|
| Rate for Payer: Encore All Commercial |
$61.79
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$61.76
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$34.24
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$34.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$50.35
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: PHP All Commercial |
$50.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.18
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Sagamore Health Network All Products |
$51.82
|
| Rate for Payer: Signature Care EPO |
$55.72
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$59.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$52.90
|
| Rate for Payer: United Healthcare Medicare |
$22.15
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
LORAZEPAM 2 MG/ML ORAL CONC
|
Facility
OP
|
$4.14
|
|
|
Service Code
|
NDC 00543532
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Centivo All Commercial |
$2.11
|
| Rate for Payer: Cigna All Commercial |
$3.58
|
| Rate for Payer: CORVEL All Commercial |
$3.85
|
| Rate for Payer: Coventry All Commercial |
$3.65
|
| Rate for Payer: Encore All Commercial |
$3.81
|
| Rate for Payer: Frontpath All Commercial |
$3.81
|
| Rate for Payer: Humana ChoiceCare |
$3.58
|
| Rate for Payer: Humana Medicare |
$2.11
|
| Rate for Payer: Lucent All Commercial |
$2.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.73
|
| Rate for Payer: PHCS All Commercial |
$3.11
|
| Rate for Payer: PHP All Commercial |
$3.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.62
|
| Rate for Payer: Sagamore Health Network All Products |
$3.20
|
| Rate for Payer: Signature Care EPO |
$3.44
|
| Rate for Payer: Signature Care PPO |
$3.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
| Rate for Payer: United Healthcare Medicare |
$1.37
|
|
|
LORAZEPAM 2 MG/ML ORAL CONC
|
Facility
IP
|
$4.14
|
|
|
Service Code
|
NDC 00543532
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna All Commercial |
$3.58
|
| Rate for Payer: CORVEL All Commercial |
$3.85
|
| Rate for Payer: Coventry All Commercial |
$3.65
|
| Rate for Payer: Encore All Commercial |
$3.81
|
| Rate for Payer: Frontpath All Commercial |
$3.81
|
| Rate for Payer: Humana ChoiceCare |
$3.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.73
|
| Rate for Payer: PHCS All Commercial |
$3.11
|
| Rate for Payer: PHP All Commercial |
$3.14
|
| Rate for Payer: Sagamore Health Network All Products |
$3.20
|
| Rate for Payer: Signature Care EPO |
$3.44
|
| Rate for Payer: Signature Care PPO |
$3.65
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
|
|
LORAZEPAM 2 MG/ML ORAL CONC
|
Facility
IP
|
$124.32
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cigna All Commercial |
$107.29
|
| Rate for Payer: CORVEL All Commercial |
$115.62
|
| Rate for Payer: Coventry All Commercial |
$109.40
|
| Rate for Payer: Encore All Commercial |
$114.44
|
| Rate for Payer: Frontpath All Commercial |
$114.37
|
| Rate for Payer: Humana ChoiceCare |
$107.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.89
|
| Rate for Payer: PHCS All Commercial |
$93.24
|
| Rate for Payer: PHP All Commercial |
$94.28
|
| Rate for Payer: Sagamore Health Network All Products |
$95.98
|
| Rate for Payer: Signature Care EPO |
$103.19
|
| Rate for Payer: Signature Care PPO |
$109.40
|
| Rate for Payer: United Healthcare Commercial |
$97.96
|
|
|
LORAZEPAM 2 MG/ML ORAL CONC
|
Facility
OP
|
$124.32
|
|
|
Service Code
|
NDC 00054353244
|
| Hospital Charge Code |
4571
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Medicare |
$41.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.13
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Centivo All Commercial |
$63.40
|
| Rate for Payer: Cigna All Commercial |
$107.29
|
| Rate for Payer: CORVEL All Commercial |
$115.62
|
| Rate for Payer: Coventry All Commercial |
$109.40
|
| Rate for Payer: Encore All Commercial |
$114.44
|
| Rate for Payer: Frontpath All Commercial |
$114.37
|
| Rate for Payer: Humana ChoiceCare |
$107.38
|
| Rate for Payer: Humana Medicare |
$63.40
|
| Rate for Payer: Lucent All Commercial |
$63.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.89
|
| Rate for Payer: PHCS All Commercial |
$93.24
|
| Rate for Payer: PHP All Commercial |
$94.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.48
|
| Rate for Payer: Sagamore Health Network All Products |
$95.98
|
| Rate for Payer: Signature Care EPO |
$103.19
|
| Rate for Payer: Signature Care PPO |
$109.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.67
|
| Rate for Payer: United Healthcare Commercial |
$97.96
|
| Rate for Payer: United Healthcare Medicare |
$41.03
|
|
|
LORAZEPAM 4 MG/ML INJ SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10468
|
|
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
|
|
|
LORAZEPAM 4 MG/ML INJ SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10468
|
|
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
|
|
|
LOSARTAN 50 MG ORAL TAB
|
Facility
OP
|
$1.67
|
|
|
Service Code
|
NDC 68084034701
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna Commercial |
$1.41
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Centivo All Commercial |
$0.85
|
| Rate for Payer: Cigna All Commercial |
$1.44
|
| Rate for Payer: CORVEL All Commercial |
$1.56
|
| Rate for Payer: Coventry All Commercial |
$1.47
|
| Rate for Payer: Encore All Commercial |
$1.54
|
| Rate for Payer: Frontpath All Commercial |
$1.54
|
| Rate for Payer: Humana ChoiceCare |
$1.44
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: Lucent All Commercial |
$0.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.51
|
| Rate for Payer: PHCS All Commercial |
$1.25
|
| Rate for Payer: PHP All Commercial |
$1.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1.29
|
| Rate for Payer: Signature Care EPO |
$1.39
|
| Rate for Payer: Signature Care PPO |
$1.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
|
