|
PREDNISOLONE 15 MG/5 ML ORAL SOLN
|
Facility
OP
|
$300.96
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.32 |
| Max. Negotiated Rate |
$279.89 |
| Rate for Payer: Aetna Commercial |
$254.01
|
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Aetna Medicare |
$99.32
|
| Rate for Payer: Aetna Medicare |
$2.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$99.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$172.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$188.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.25
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Centivo All Commercial |
$153.49
|
| Rate for Payer: Centivo All Commercial |
$3.73
|
| Rate for Payer: Cigna All Commercial |
$6.31
|
| Rate for Payer: Cigna All Commercial |
$259.73
|
| Rate for Payer: CORVEL All Commercial |
$279.89
|
| Rate for Payer: CORVEL All Commercial |
$6.80
|
| Rate for Payer: Coventry All Commercial |
$6.44
|
| Rate for Payer: Coventry All Commercial |
$264.84
|
| Rate for Payer: Encore All Commercial |
$277.03
|
| Rate for Payer: Encore All Commercial |
$6.73
|
| Rate for Payer: Frontpath All Commercial |
$6.73
|
| Rate for Payer: Frontpath All Commercial |
$276.88
|
| Rate for Payer: Humana ChoiceCare |
$259.94
|
| Rate for Payer: Humana ChoiceCare |
$6.32
|
| Rate for Payer: Humana Medicare |
$3.73
|
| Rate for Payer: Humana Medicare |
$153.49
|
| Rate for Payer: Lucent All Commercial |
$153.49
|
| Rate for Payer: Lucent All Commercial |
$3.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.58
|
| Rate for Payer: PHCS All Commercial |
$225.72
|
| Rate for Payer: PHCS All Commercial |
$5.49
|
| Rate for Payer: PHP All Commercial |
$5.55
|
| Rate for Payer: PHP All Commercial |
$228.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.85
|
| Rate for Payer: Sagamore Health Network All Products |
$232.34
|
| Rate for Payer: Sagamore Health Network All Products |
$5.65
|
| Rate for Payer: Signature Care EPO |
$6.07
|
| Rate for Payer: Signature Care EPO |
$249.80
|
| Rate for Payer: Signature Care PPO |
$264.84
|
| Rate for Payer: Signature Care PPO |
$6.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$255.82
|
| Rate for Payer: United Healthcare Commercial |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$5.76
|
| Rate for Payer: United Healthcare Medicare |
$99.32
|
| Rate for Payer: United Healthcare Medicare |
$2.41
|
|
|
PREDNISOLONE ACETATE 1 % OPHT DRPS
|
Facility
IP
|
$216.51
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.38 |
| Max. Negotiated Rate |
$201.35 |
| Rate for Payer: Aetna Commercial |
$187.06
|
| Rate for Payer: Cash Price |
$134.24
|
| Rate for Payer: Cigna All Commercial |
$186.85
|
| Rate for Payer: CORVEL All Commercial |
$201.35
|
| Rate for Payer: Coventry All Commercial |
$190.53
|
| Rate for Payer: Encore All Commercial |
$199.30
|
| Rate for Payer: Frontpath All Commercial |
$199.19
|
| Rate for Payer: Humana ChoiceCare |
$187.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.86
|
| Rate for Payer: PHCS All Commercial |
$162.38
|
| Rate for Payer: PHP All Commercial |
$164.20
|
| Rate for Payer: Sagamore Health Network All Products |
$167.15
|
| Rate for Payer: Signature Care EPO |
$179.70
|
| Rate for Payer: Signature Care PPO |
$190.53
|
| Rate for Payer: United Healthcare Commercial |
$170.61
|
|
|
PREDNISOLONE ACETATE 1 % OPHT DRPS
|
Facility
OP
|
$216.51
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$201.35 |
| Rate for Payer: Aetna Commercial |
$182.73
|
| Rate for Payer: Aetna Medicare |
$71.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.59
|
| Rate for Payer: Cash Price |
$134.24
|
| Rate for Payer: Cash Price |
$134.24
|
| Rate for Payer: Centivo All Commercial |
$110.42
|
| Rate for Payer: Cigna All Commercial |
$186.85
|
| Rate for Payer: CORVEL All Commercial |
$201.35
|
| Rate for Payer: Coventry All Commercial |
$190.53
|
| Rate for Payer: Encore All Commercial |
$199.30
|
| Rate for Payer: Frontpath All Commercial |
$199.19
|
| Rate for Payer: Humana ChoiceCare |
$187.00
|
| Rate for Payer: Humana Medicare |
$110.42
|
| Rate for Payer: Lucent All Commercial |
$110.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$194.86
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$162.38
|
| Rate for Payer: PHP All Commercial |
$164.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.44
|
| Rate for Payer: Sagamore Health Network All Products |
$167.15
|
| Rate for Payer: Signature Care EPO |
$179.70
|
| Rate for Payer: Signature Care PPO |
$190.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$184.03
|
| Rate for Payer: United Healthcare Commercial |
$170.61
|
| Rate for Payer: United Healthcare Medicare |
$71.45
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN
|
Facility
OP
|
$245.53
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$228.34 |
| Rate for Payer: Aetna Commercial |
$207.23
|
| Rate for Payer: Aetna Commercial |
$4.37
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna Medicare |
$81.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.13
|
| Rate for Payer: Cash Price |
$152.23
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Centivo All Commercial |
$125.22
|
| Rate for Payer: Centivo All Commercial |
$2.64
|
| Rate for Payer: Cigna All Commercial |
$4.47
|
| Rate for Payer: Cigna All Commercial |
$211.89
|
| Rate for Payer: CORVEL All Commercial |
$228.34
|
| Rate for Payer: CORVEL All Commercial |
$4.82
|
| Rate for Payer: Coventry All Commercial |
$4.56
|
| Rate for Payer: Coventry All Commercial |
$216.07
|
| Rate for Payer: Encore All Commercial |
$226.01
|
| Rate for Payer: Encore All Commercial |
$4.77
|
| Rate for Payer: Frontpath All Commercial |
$225.89
|
| Rate for Payer: Frontpath All Commercial |
$4.77
|
| Rate for Payer: Humana ChoiceCare |
$4.47
|
| Rate for Payer: Humana ChoiceCare |
$212.07
|
| Rate for Payer: Humana Medicare |
$125.22
|
| Rate for Payer: Humana Medicare |
$2.64
|
| Rate for Payer: Lucent All Commercial |
$125.22
|
| Rate for Payer: Lucent All Commercial |
$2.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.98
|
| Rate for Payer: PHCS All Commercial |
$184.15
|
| Rate for Payer: PHCS All Commercial |
$3.88
|
| Rate for Payer: PHP All Commercial |
$186.21
|
| Rate for Payer: PHP All Commercial |
$3.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.76
|
| Rate for Payer: Sagamore Health Network All Products |
$4.00
|
| Rate for Payer: Sagamore Health Network All Products |
$189.55
|
| Rate for Payer: Signature Care EPO |
$4.30
|
| Rate for Payer: Signature Care EPO |
$203.79
|
| Rate for Payer: Signature Care PPO |
$216.07
|
| Rate for Payer: Signature Care PPO |
$4.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.70
|
| Rate for Payer: United Healthcare Commercial |
$193.48
|
| Rate for Payer: United Healthcare Commercial |
$4.08
|
| Rate for Payer: United Healthcare Medicare |
$81.03
|
| Rate for Payer: United Healthcare Medicare |
$1.71
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN
|
Facility
IP
|
$5.18
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Commercial |
$212.14
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$152.23
|
| Rate for Payer: Cigna All Commercial |
$211.89
|
| Rate for Payer: Cigna All Commercial |
$4.47
|
| Rate for Payer: CORVEL All Commercial |
$4.82
|
| Rate for Payer: CORVEL All Commercial |
$228.34
|
| Rate for Payer: Coventry All Commercial |
$216.07
|
| Rate for Payer: Coventry All Commercial |
$4.56
|
| Rate for Payer: Encore All Commercial |
$226.01
|
| Rate for Payer: Encore All Commercial |
$4.77
|
| Rate for Payer: Frontpath All Commercial |
$4.77
|
| Rate for Payer: Frontpath All Commercial |
$225.89
|
| Rate for Payer: Humana ChoiceCare |
$212.07
|
| Rate for Payer: Humana ChoiceCare |
$4.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.66
|
| Rate for Payer: PHCS All Commercial |
$184.15
|
| Rate for Payer: PHCS All Commercial |
$3.88
|
| Rate for Payer: PHP All Commercial |
$3.93
|
| Rate for Payer: PHP All Commercial |
$186.21
|
| Rate for Payer: Sagamore Health Network All Products |
$189.55
|
| Rate for Payer: Sagamore Health Network All Products |
$4.00
|
| Rate for Payer: Signature Care EPO |
$203.79
|
| Rate for Payer: Signature Care EPO |
$4.30
|
| Rate for Payer: Signature Care PPO |
$216.07
|
| Rate for Payer: Signature Care PPO |
$4.56
|
| Rate for Payer: United Healthcare Commercial |
$193.48
|
| Rate for Payer: United Healthcare Commercial |
$4.08
|
|
|
PREDNISONE 10 MG ORAL TAB
|
Facility
IP
|
$2.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna All Commercial |
$1.92
|
| Rate for Payer: CORVEL All Commercial |
$2.07
|
| Rate for Payer: Coventry All Commercial |
$1.96
|
| Rate for Payer: Encore All Commercial |
$2.05
|
| Rate for Payer: Frontpath All Commercial |
$2.05
|
| Rate for Payer: Humana ChoiceCare |
$1.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.00
|
| Rate for Payer: PHCS All Commercial |
$1.67
|
| Rate for Payer: PHP All Commercial |
$1.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1.72
|
| Rate for Payer: Signature Care EPO |
$1.85
|
| Rate for Payer: Signature Care PPO |
$1.96
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
|
|
PREDNISONE 10 MG ORAL TAB
|
Facility
OP
|
$2.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6494
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Centivo All Commercial |
$1.14
|
| Rate for Payer: Cigna All Commercial |
$1.92
|
| Rate for Payer: CORVEL All Commercial |
$2.07
|
| Rate for Payer: Coventry All Commercial |
$1.96
|
| Rate for Payer: Encore All Commercial |
$2.05
|
| Rate for Payer: Frontpath All Commercial |
$2.05
|
| Rate for Payer: Humana ChoiceCare |
$1.92
|
| Rate for Payer: Humana Medicare |
$1.14
|
| Rate for Payer: Lucent All Commercial |
$1.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.00
|
| Rate for Payer: PHCS All Commercial |
$1.67
|
| Rate for Payer: PHP All Commercial |
$1.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1.72
|
| Rate for Payer: Signature Care EPO |
$1.85
|
| Rate for Payer: Signature Care PPO |
$1.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.89
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
|
|
PREDNISONE 1 MG ORAL TAB
|
Facility
OP
|
$1.95
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6493
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Centivo All Commercial |
$0.99
|
| Rate for Payer: Cigna All Commercial |
$1.68
|
| Rate for Payer: CORVEL All Commercial |
$1.81
|
| Rate for Payer: Coventry All Commercial |
$1.71
|
| Rate for Payer: Encore All Commercial |
$1.79
|
| Rate for Payer: Frontpath All Commercial |
$1.79
|
| Rate for Payer: Humana ChoiceCare |
$1.68
|
| Rate for Payer: Humana Medicare |
$0.99
|
| Rate for Payer: Lucent All Commercial |
$0.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.75
|
| Rate for Payer: PHCS All Commercial |
$1.46
|
| Rate for Payer: PHP All Commercial |
$1.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1.50
|
| Rate for Payer: Signature Care EPO |
$1.62
|
| Rate for Payer: Signature Care PPO |
$1.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.65
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
|
|
PREDNISONE 1 MG ORAL TAB
|
Facility
IP
|
$1.95
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna All Commercial |
$1.68
|
| Rate for Payer: CORVEL All Commercial |
$1.81
|
| Rate for Payer: Coventry All Commercial |
$1.71
|
| Rate for Payer: Encore All Commercial |
$1.79
|
| Rate for Payer: Frontpath All Commercial |
$1.79
|
| Rate for Payer: Humana ChoiceCare |
$1.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.75
|
| Rate for Payer: PHCS All Commercial |
$1.46
|
| Rate for Payer: PHP All Commercial |
$1.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1.50
|
| Rate for Payer: Signature Care EPO |
$1.62
|
| Rate for Payer: Signature Care PPO |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
|
|
PREDNISONE 20 MG ORAL TAB
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6496
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cigna All Commercial |
$1.72
|
| Rate for Payer: CORVEL All Commercial |
$1.86
|
| Rate for Payer: Coventry All Commercial |
$1.76
|
| Rate for Payer: Encore All Commercial |
$1.84
|
| Rate for Payer: Frontpath All Commercial |
$1.84
|
| Rate for Payer: Humana ChoiceCare |
$1.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.80
|
| Rate for Payer: PHCS All Commercial |
$1.50
|
| Rate for Payer: PHP All Commercial |
$1.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1.54
|
| Rate for Payer: Signature Care EPO |
$1.66
|
| Rate for Payer: Signature Care PPO |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
PREDNISONE 20 MG ORAL TAB
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.25
|
| 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 |
$1.24
|
| Rate for Payer: Centivo All Commercial |
$1.02
|
| Rate for Payer: Cigna All Commercial |
$1.72
|
| Rate for Payer: CORVEL All Commercial |
$1.86
|
| Rate for Payer: Coventry All Commercial |
$1.76
|
| Rate for Payer: Encore All Commercial |
$1.84
|
| Rate for Payer: Frontpath All Commercial |
$1.84
|
| Rate for Payer: Humana ChoiceCare |
$1.72
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Lucent All Commercial |
$1.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.80
|
| Rate for Payer: PHCS All Commercial |
$1.50
|
| Rate for Payer: PHP All Commercial |
$1.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1.54
|
| Rate for Payer: Signature Care EPO |
$1.66
|
| Rate for Payer: Signature Care PPO |
$1.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.70
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
|
|
PREDNISONE 5 MG ORAL TAB
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna Commercial |
$1.47
|
| Rate for Payer: Aetna Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.63
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Centivo All Commercial |
$0.89
|
| Rate for Payer: Cigna All Commercial |
$1.50
|
| Rate for Payer: CORVEL All Commercial |
$1.62
|
| Rate for Payer: Coventry All Commercial |
$1.53
|
| Rate for Payer: Encore All Commercial |
$1.60
|
| Rate for Payer: Frontpath All Commercial |
$1.60
|
| Rate for Payer: Humana ChoiceCare |
$1.51
|
| Rate for Payer: Humana Medicare |
$0.89
|
| Rate for Payer: Lucent All Commercial |
$0.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.57
|
| Rate for Payer: PHCS All Commercial |
$1.31
|
| Rate for Payer: PHP All Commercial |
$1.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1.35
|
| Rate for Payer: Signature Care EPO |
$1.45
|
| Rate for Payer: Signature Care PPO |
$1.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
|
|
PREDNISONE 5 MG ORAL TAB
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna All Commercial |
$1.50
|
| Rate for Payer: CORVEL All Commercial |
$1.62
|
| Rate for Payer: Coventry All Commercial |
$1.53
|
| Rate for Payer: Encore All Commercial |
$1.60
|
| Rate for Payer: Frontpath All Commercial |
$1.60
|
| Rate for Payer: Humana ChoiceCare |
$1.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.57
|
| Rate for Payer: PHCS All Commercial |
$1.31
|
| Rate for Payer: PHP All Commercial |
$1.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1.35
|
| Rate for Payer: Signature Care EPO |
$1.45
|
| Rate for Payer: Signature Care PPO |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
PREGABALIN 25 MG ORAL CAP
|
Facility
IP
|
$4.03
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna All Commercial |
$3.47
|
| Rate for Payer: CORVEL All Commercial |
$3.74
|
| Rate for Payer: Coventry All Commercial |
$3.54
|
| Rate for Payer: Encore All Commercial |
$3.71
|
| Rate for Payer: Frontpath All Commercial |
$3.70
|
| Rate for Payer: Humana ChoiceCare |
$3.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.62
|
| Rate for Payer: PHCS All Commercial |
$3.02
|
| Rate for Payer: PHP All Commercial |
$3.05
|
| Rate for Payer: Sagamore Health Network All Products |
$3.11
|
| Rate for Payer: Signature Care EPO |
$3.34
|
| Rate for Payer: Signature Care PPO |
$3.54
|
| Rate for Payer: United Healthcare Commercial |
$3.17
|
|
|
PREGABALIN 25 MG ORAL CAP
|
Facility
OP
|
$4.03
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.46
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Centivo All Commercial |
$2.05
|
| Rate for Payer: Cigna All Commercial |
$3.47
|
| Rate for Payer: CORVEL All Commercial |
$3.74
|
| Rate for Payer: Coventry All Commercial |
$3.54
|
| Rate for Payer: Encore All Commercial |
$3.71
|
| Rate for Payer: Frontpath All Commercial |
$3.70
|
| Rate for Payer: Humana ChoiceCare |
$3.48
|
| Rate for Payer: Humana Medicare |
$2.05
|
| Rate for Payer: Lucent All Commercial |
$2.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.62
|
| Rate for Payer: PHCS All Commercial |
$3.02
|
| Rate for Payer: PHP All Commercial |
$3.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.57
|
| Rate for Payer: Sagamore Health Network All Products |
$3.11
|
| Rate for Payer: Signature Care EPO |
$3.34
|
| Rate for Payer: Signature Care PPO |
$3.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.42
|
| Rate for Payer: United Healthcare Commercial |
$3.17
|
| Rate for Payer: United Healthcare Medicare |
$1.33
|
|
|
PREGABALIN 75 MG ORAL CAP
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
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
|
|
|
PREGABALIN 75 MG ORAL CAP
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
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
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
$1,975.64
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
z43249
|
| Min. Negotiated Rate |
$142.26 |
| Max. Negotiated Rate |
$1,481.73 |
| Rate for Payer: Aetna Medicare |
$142.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.49
|
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: Coventry All Commercial |
$170.71
|
| Rate for Payer: Frontpath All Commercial |
$197.48
|
| Rate for Payer: Humana ChoiceCare |
$185.63
|
| Rate for Payer: Humana Medicare |
$142.26
|
| Rate for Payer: Lucent All Commercial |
$241.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.00
|
| Rate for Payer: PHCS All Commercial |
$1,481.73
|
| Rate for Payer: PHP All Commercial |
$242.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.26
|
| Rate for Payer: Signature Care EPO |
$906.78
|
| Rate for Payer: Signature Care PPO |
$906.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.00
|
| Rate for Payer: United Healthcare Commercial |
$200.84
|
| Rate for Payer: United Healthcare Medicare |
$142.26
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
$701.30
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
z43247
|
| Min. Negotiated Rate |
$163.69 |
| Max. Negotiated Rate |
$525.98 |
| Rate for Payer: Aetna Medicare |
$163.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.06
|
| Rate for Payer: Cash Price |
$434.81
|
| Rate for Payer: Cash Price |
$434.81
|
| Rate for Payer: Coventry All Commercial |
$196.43
|
| Rate for Payer: Frontpath All Commercial |
$228.11
|
| Rate for Payer: Humana ChoiceCare |
$214.97
|
| Rate for Payer: Humana Medicare |
$163.69
|
| Rate for Payer: Lucent All Commercial |
$278.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: PHCS All Commercial |
$525.98
|
| Rate for Payer: PHP All Commercial |
$279.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.69
|
| Rate for Payer: Signature Care EPO |
$330.95
|
| Rate for Payer: Signature Care PPO |
$330.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.00
|
| Rate for Payer: United Healthcare Commercial |
$230.86
|
| Rate for Payer: United Healthcare Medicare |
$163.69
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
$823.70
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
z43250
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$617.78 |
| Rate for Payer: Aetna Medicare |
$156.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.66
|
| Rate for Payer: Cash Price |
$510.69
|
| Rate for Payer: Cash Price |
$510.69
|
| Rate for Payer: Coventry All Commercial |
$188.35
|
| Rate for Payer: Frontpath All Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$204.15
|
| Rate for Payer: Humana Medicare |
$156.96
|
| Rate for Payer: Lucent All Commercial |
$266.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.00
|
| Rate for Payer: PHCS All Commercial |
$617.78
|
| Rate for Payer: PHP All Commercial |
$267.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.96
|
| Rate for Payer: Signature Care EPO |
$373.20
|
| Rate for Payer: Signature Care PPO |
$373.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.00
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Medicare |
$156.96
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
$360.18
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
z43246
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$373.80 |
| Rate for Payer: Aetna Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.05
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Coventry All Commercial |
$221.51
|
| Rate for Payer: Frontpath All Commercial |
$259.27
|
| Rate for Payer: Humana ChoiceCare |
$272.15
|
| Rate for Payer: Humana Medicare |
$184.59
|
| Rate for Payer: Lucent All Commercial |
$313.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.00
|
| Rate for Payer: PHCS All Commercial |
$270.14
|
| Rate for Payer: PHP All Commercial |
$315.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.59
|
| Rate for Payer: Signature Care EPO |
$318.44
|
| Rate for Payer: Signature Care PPO |
$318.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$289.20
|
| Rate for Payer: United Healthcare Medicare |
$184.59
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
$907.04
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
z43251
|
| Min. Negotiated Rate |
$181.77 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Aetna Medicare |
$181.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$318.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$199.95
|
| Rate for Payer: Cash Price |
$562.36
|
| Rate for Payer: Cash Price |
$562.36
|
| Rate for Payer: Coventry All Commercial |
$218.12
|
| Rate for Payer: Frontpath All Commercial |
$252.19
|
| Rate for Payer: Humana ChoiceCare |
$233.95
|
| Rate for Payer: Humana Medicare |
$181.77
|
| Rate for Payer: Lucent All Commercial |
$309.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.00
|
| Rate for Payer: PHCS All Commercial |
$680.28
|
| Rate for Payer: PHP All Commercial |
$310.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.77
|
| Rate for Payer: Signature Care EPO |
$410.41
|
| Rate for Payer: Signature Care PPO |
$410.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.00
|
| Rate for Payer: United Healthcare Commercial |
$251.16
|
| Rate for Payer: United Healthcare Medicare |
$181.77
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
$688.78
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
z43239
|
| Min. Negotiated Rate |
$128.26 |
| Max. Negotiated Rate |
$516.58 |
| Rate for Payer: Aetna Medicare |
$128.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.09
|
| Rate for Payer: Cash Price |
$427.04
|
| Rate for Payer: Cash Price |
$427.04
|
| Rate for Payer: Coventry All Commercial |
$153.91
|
| Rate for Payer: Frontpath All Commercial |
$177.49
|
| Rate for Payer: Humana ChoiceCare |
$183.45
|
| Rate for Payer: Humana Medicare |
$128.26
|
| Rate for Payer: Lucent All Commercial |
$218.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: PHCS All Commercial |
$516.58
|
| Rate for Payer: PHP All Commercial |
$218.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.26
|
| Rate for Payer: Signature Care EPO |
$462.40
|
| Rate for Payer: Signature Care PPO |
$462.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$197.41
|
| Rate for Payer: United Healthcare Medicare |
$128.26
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
$1,147.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
z43255
|
| Min. Negotiated Rate |
$185.89 |
| Max. Negotiated Rate |
$860.25 |
| Rate for Payer: Aetna Medicare |
$185.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$377.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.48
|
| Rate for Payer: Cash Price |
$711.14
|
| Rate for Payer: Cash Price |
$711.14
|
| Rate for Payer: Coventry All Commercial |
$223.07
|
| Rate for Payer: Frontpath All Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$302.79
|
| Rate for Payer: Humana Medicare |
$185.89
|
| Rate for Payer: Lucent All Commercial |
$316.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: PHCS All Commercial |
$860.25
|
| Rate for Payer: PHP All Commercial |
$317.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.89
|
| Rate for Payer: Signature Care EPO |
$521.06
|
| Rate for Payer: Signature Care PPO |
$521.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.00
|
| Rate for Payer: United Healthcare Commercial |
$326.88
|
| Rate for Payer: United Healthcare Medicare |
$185.89
|
|
|
PR ELBOW ARTHROSCOP,FULL SYNOVECT
|
Professional
|
$1,067.14
|
|
|
Service Code
|
CPT 29836
|
| Hospital Charge Code |
z29836
|
| Min. Negotiated Rate |
$546.91 |
| Max. Negotiated Rate |
$929.75 |
| Rate for Payer: Aetna Medicare |
$546.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$724.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$628.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$601.60
|
| Rate for Payer: Cash Price |
$661.63
|
| Rate for Payer: Cash Price |
$661.63
|
| Rate for Payer: Coventry All Commercial |
$656.29
|
| Rate for Payer: Frontpath All Commercial |
$758.43
|
| Rate for Payer: Humana ChoiceCare |
$621.77
|
| Rate for Payer: Humana Medicare |
$546.91
|
| Rate for Payer: Lucent All Commercial |
$929.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$875.00
|
| Rate for Payer: PHCS All Commercial |
$800.36
|
| Rate for Payer: PHP All Commercial |
$928.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.91
|
| Rate for Payer: Signature Care EPO |
$828.75
|
| Rate for Payer: Signature Care PPO |
$828.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.00
|
| Rate for Payer: United Healthcare Commercial |
$626.00
|
| Rate for Payer: United Healthcare Medicare |
$546.91
|
|
