|
Repair, primary, torn ligament and/or capsule, knee; collateral
|
Facility
OP
|
$2,273.62
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
CPT-27405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,273.62 |
| Max. Negotiated Rate |
$2,273.62 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,273.62
|
| Rate for Payer: Managed Health Services Medicaid |
$2,273.62
|
| Rate for Payer: MDWise Medicaid |
$2,273.62
|
|
|
Repair recurrent inguinal hernia, any age; reducible
|
Facility
OP
|
$3,957.76
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
CPT-49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,957.76 |
| Max. Negotiated Rate |
$3,957.76 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3,957.76
|
| Rate for Payer: Managed Health Services Medicaid |
$3,957.76
|
| Rate for Payer: MDWise Medicaid |
$3,957.76
|
|
|
Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access
|
Facility
OP
|
$4,315.74
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
CPT-36582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,315.74 |
| Max. Negotiated Rate |
$4,315.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4,315.74
|
| Rate for Payer: Managed Health Services Medicaid |
$4,315.74
|
| Rate for Payer: MDWise Medicaid |
$4,315.74
|
|
|
Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component
|
Facility
OP
|
$26,103.48
|
|
|
Service Code
|
CPT 23473
|
| Hospital Charge Code |
CPT-23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26,103.48 |
| Max. Negotiated Rate |
$26,103.48 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$26,103.48
|
| Rate for Payer: Managed Health Services Medicaid |
$26,103.48
|
| Rate for Payer: MDWise Medicaid |
$26,103.48
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJ SYRG
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$328.50 |
| Max. Negotiated Rate |
$407.34 |
| Rate for Payer: Aetna Commercial |
$378.43
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cigna All Commercial |
$377.99
|
| Rate for Payer: CORVEL All Commercial |
$407.34
|
| Rate for Payer: Coventry All Commercial |
$385.44
|
| Rate for Payer: Encore All Commercial |
$403.18
|
| Rate for Payer: Frontpath All Commercial |
$402.96
|
| Rate for Payer: Humana ChoiceCare |
$378.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.20
|
| Rate for Payer: PHCS All Commercial |
$328.50
|
| Rate for Payer: PHP All Commercial |
$332.18
|
| Rate for Payer: Sagamore Health Network All Products |
$338.14
|
| Rate for Payer: Signature Care EPO |
$363.54
|
| Rate for Payer: Signature Care PPO |
$385.44
|
| Rate for Payer: United Healthcare Commercial |
$345.14
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJ SYRG
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$407.34 |
| Rate for Payer: Aetna Commercial |
$369.67
|
| Rate for Payer: Aetna Medicare |
$144.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$273.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.99
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Centivo All Commercial |
$223.38
|
| Rate for Payer: Cigna All Commercial |
$377.99
|
| Rate for Payer: CORVEL All Commercial |
$407.34
|
| Rate for Payer: Coventry All Commercial |
$385.44
|
| Rate for Payer: Encore All Commercial |
$403.18
|
| Rate for Payer: Frontpath All Commercial |
$402.96
|
| Rate for Payer: Humana ChoiceCare |
$378.30
|
| Rate for Payer: Humana Medicare |
$223.38
|
| Rate for Payer: Lucent All Commercial |
$223.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$394.20
|
| Rate for Payer: Managed Health Services Medicaid |
$10.21
|
| Rate for Payer: MDWise Medicaid |
$10.21
|
| Rate for Payer: PHCS All Commercial |
$328.50
|
| Rate for Payer: PHP All Commercial |
$332.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.82
|
| Rate for Payer: Sagamore Health Network All Products |
$338.14
|
| Rate for Payer: Signature Care EPO |
$363.54
|
| Rate for Payer: Signature Care PPO |
$385.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.30
|
| Rate for Payer: United Healthcare Commercial |
$345.14
|
| Rate for Payer: United Healthcare Medicare |
$144.54
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG
|
Facility
IP
|
$444.00
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$333.00 |
| Max. Negotiated Rate |
$412.92 |
| Rate for Payer: Aetna Commercial |
$383.62
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cigna All Commercial |
$383.17
|
| Rate for Payer: CORVEL All Commercial |
$412.92
|
| Rate for Payer: Coventry All Commercial |
$390.72
|
| Rate for Payer: Encore All Commercial |
$408.70
|
| Rate for Payer: Frontpath All Commercial |
$408.48
|
| Rate for Payer: Humana ChoiceCare |
$383.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.60
|
| Rate for Payer: PHCS All Commercial |
$333.00
|
| Rate for Payer: PHP All Commercial |
$336.73
|
| Rate for Payer: Sagamore Health Network All Products |
$342.77
|
| Rate for Payer: Signature Care EPO |
$368.52
|
| Rate for Payer: Signature Care PPO |
$390.72
|
| Rate for Payer: United Healthcare Commercial |
$349.87
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG
|
Facility
OP
|
$444.00
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$412.92 |
| Rate for Payer: Aetna Commercial |
$374.74
|
| Rate for Payer: Aetna Medicare |
$146.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$254.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$80.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.17
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Centivo All Commercial |
$226.44
|
| Rate for Payer: Cigna All Commercial |
$383.17
|
| Rate for Payer: CORVEL All Commercial |
$412.92
|
| Rate for Payer: Coventry All Commercial |
$390.72
|
| Rate for Payer: Encore All Commercial |
$408.70
|
| Rate for Payer: Frontpath All Commercial |
$408.48
|
| Rate for Payer: Humana ChoiceCare |
$383.48
|
| Rate for Payer: Humana Medicare |
$226.44
|
| Rate for Payer: Lucent All Commercial |
$226.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.60
|
| Rate for Payer: Managed Health Services Medicaid |
$80.40
|
| Rate for Payer: MDWise Medicaid |
$80.40
|
| Rate for Payer: PHCS All Commercial |
$333.00
|
| Rate for Payer: PHP All Commercial |
$336.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.16
|
| Rate for Payer: Sagamore Health Network All Products |
$342.77
|
| Rate for Payer: Signature Care EPO |
$368.52
|
| Rate for Payer: Signature Care PPO |
$390.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.40
|
| Rate for Payer: United Healthcare Commercial |
$349.87
|
| Rate for Payer: United Healthcare Medicare |
$146.52
|
|
|
RHOPHYLAC INJECTION
|
Professional
|
$9.33
|
|
|
Service Code
|
CPT J2791
|
| Hospital Charge Code |
zJ2791
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Humana ChoiceCare |
$4.98
|
| Rate for Payer: PHP All Commercial |
$9.33
|
|
|
RIFAMPIN 150 MG ORAL CAP
|
Facility
IP
|
$5.48
|
|
|
Service Code
|
NDC 68180065806
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cigna All Commercial |
$4.73
|
| Rate for Payer: CORVEL All Commercial |
$5.10
|
| Rate for Payer: Coventry All Commercial |
$4.82
|
| Rate for Payer: Encore All Commercial |
$5.05
|
| Rate for Payer: Frontpath All Commercial |
$5.04
|
| Rate for Payer: Humana ChoiceCare |
$4.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.93
|
| Rate for Payer: PHCS All Commercial |
$4.11
|
| Rate for Payer: PHP All Commercial |
$4.16
|
| Rate for Payer: Sagamore Health Network All Products |
$4.23
|
| Rate for Payer: Signature Care EPO |
$4.55
|
| Rate for Payer: Signature Care PPO |
$4.82
|
| Rate for Payer: United Healthcare Commercial |
$4.32
|
|
|
RIFAMPIN 150 MG ORAL CAP
|
Facility
OP
|
$5.48
|
|
|
Service Code
|
NDC 68180065806
|
| Hospital Charge Code |
11292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.63
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.99
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Centivo All Commercial |
$2.80
|
| Rate for Payer: Cigna All Commercial |
$4.73
|
| Rate for Payer: CORVEL All Commercial |
$5.10
|
| Rate for Payer: Coventry All Commercial |
$4.82
|
| Rate for Payer: Encore All Commercial |
$5.05
|
| Rate for Payer: Frontpath All Commercial |
$5.04
|
| Rate for Payer: Humana ChoiceCare |
$4.73
|
| Rate for Payer: Humana Medicare |
$2.80
|
| Rate for Payer: Lucent All Commercial |
$2.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.93
|
| Rate for Payer: PHCS All Commercial |
$4.11
|
| Rate for Payer: PHP All Commercial |
$4.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.14
|
| Rate for Payer: Sagamore Health Network All Products |
$4.23
|
| Rate for Payer: Signature Care EPO |
$4.55
|
| Rate for Payer: Signature Care PPO |
$4.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.66
|
| Rate for Payer: United Healthcare Commercial |
$4.32
|
| Rate for Payer: United Healthcare Medicare |
$1.81
|
|
|
RIFAXIMIN 200 MG ORAL TAB
|
Facility
OP
|
$70.32
|
|
|
Service Code
|
NDC 65649030103
|
| Hospital Charge Code |
39063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$65.39 |
| Rate for Payer: Aetna Commercial |
$59.35
|
| Rate for Payer: Aetna Medicare |
$23.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.52
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Centivo All Commercial |
$35.86
|
| Rate for Payer: Cigna All Commercial |
$60.68
|
| Rate for Payer: CORVEL All Commercial |
$65.39
|
| Rate for Payer: Coventry All Commercial |
$61.88
|
| Rate for Payer: Encore All Commercial |
$64.72
|
| Rate for Payer: Frontpath All Commercial |
$64.69
|
| Rate for Payer: Humana ChoiceCare |
$60.73
|
| Rate for Payer: Humana Medicare |
$35.86
|
| Rate for Payer: Lucent All Commercial |
$35.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.28
|
| Rate for Payer: PHCS All Commercial |
$52.74
|
| Rate for Payer: PHP All Commercial |
$53.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.42
|
| Rate for Payer: Sagamore Health Network All Products |
$54.28
|
| Rate for Payer: Signature Care EPO |
$58.36
|
| Rate for Payer: Signature Care PPO |
$61.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.77
|
| Rate for Payer: United Healthcare Commercial |
$55.41
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
|
|
RIFAXIMIN 200 MG ORAL TAB
|
Facility
IP
|
$70.32
|
|
|
Service Code
|
NDC 65649030103
|
| Hospital Charge Code |
39063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$65.39 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Cigna All Commercial |
$60.68
|
| Rate for Payer: CORVEL All Commercial |
$65.39
|
| Rate for Payer: Coventry All Commercial |
$61.88
|
| Rate for Payer: Encore All Commercial |
$64.72
|
| Rate for Payer: Frontpath All Commercial |
$64.69
|
| Rate for Payer: Humana ChoiceCare |
$60.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.28
|
| Rate for Payer: PHCS All Commercial |
$52.74
|
| Rate for Payer: PHP All Commercial |
$53.33
|
| Rate for Payer: Sagamore Health Network All Products |
$54.28
|
| Rate for Payer: Signature Care EPO |
$58.36
|
| Rate for Payer: Signature Care PPO |
$61.88
|
| Rate for Payer: United Healthcare Commercial |
$55.41
|
|
|
RIFAXIMIN 550 MG ORAL TAB
|
Facility
OP
|
$309.89
|
|
|
Service Code
|
NDC 65649030302
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.27 |
| Max. Negotiated Rate |
$288.20 |
| Rate for Payer: Aetna Commercial |
$261.55
|
| Rate for Payer: Aetna Medicare |
$102.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$177.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.49
|
| Rate for Payer: Cash Price |
$192.13
|
| Rate for Payer: Centivo All Commercial |
$158.05
|
| Rate for Payer: Cigna All Commercial |
$267.44
|
| Rate for Payer: CORVEL All Commercial |
$288.20
|
| Rate for Payer: Coventry All Commercial |
$272.71
|
| Rate for Payer: Encore All Commercial |
$285.26
|
| Rate for Payer: Frontpath All Commercial |
$285.10
|
| Rate for Payer: Humana ChoiceCare |
$267.66
|
| Rate for Payer: Humana Medicare |
$158.05
|
| Rate for Payer: Lucent All Commercial |
$158.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.90
|
| Rate for Payer: PHCS All Commercial |
$232.42
|
| Rate for Payer: PHP All Commercial |
$235.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.86
|
| Rate for Payer: Sagamore Health Network All Products |
$239.24
|
| Rate for Payer: Signature Care EPO |
$257.21
|
| Rate for Payer: Signature Care PPO |
$272.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263.41
|
| Rate for Payer: United Healthcare Commercial |
$244.20
|
| Rate for Payer: United Healthcare Medicare |
$102.27
|
|
|
RIFAXIMIN 550 MG ORAL TAB
|
Facility
IP
|
$309.89
|
|
|
Service Code
|
NDC 65649030302
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$232.42 |
| Max. Negotiated Rate |
$288.20 |
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Cash Price |
$192.13
|
| Rate for Payer: Cigna All Commercial |
$267.44
|
| Rate for Payer: CORVEL All Commercial |
$288.20
|
| Rate for Payer: Coventry All Commercial |
$272.71
|
| Rate for Payer: Encore All Commercial |
$285.26
|
| Rate for Payer: Frontpath All Commercial |
$285.10
|
| Rate for Payer: Humana ChoiceCare |
$267.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.90
|
| Rate for Payer: PHCS All Commercial |
$232.42
|
| Rate for Payer: PHP All Commercial |
$235.02
|
| Rate for Payer: Sagamore Health Network All Products |
$239.24
|
| Rate for Payer: Signature Care EPO |
$257.21
|
| Rate for Payer: Signature Care PPO |
$272.71
|
| Rate for Payer: United Healthcare Commercial |
$244.20
|
|
|
RIMANTADINE 100 MG ORAL TAB
|
Facility
IP
|
$18.97
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Cigna All Commercial |
$16.37
|
| Rate for Payer: CORVEL All Commercial |
$17.64
|
| Rate for Payer: Coventry All Commercial |
$16.69
|
| Rate for Payer: Encore All Commercial |
$17.46
|
| Rate for Payer: Frontpath All Commercial |
$17.45
|
| Rate for Payer: Humana ChoiceCare |
$16.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.07
|
| Rate for Payer: PHCS All Commercial |
$14.23
|
| Rate for Payer: PHP All Commercial |
$14.39
|
| Rate for Payer: Sagamore Health Network All Products |
$14.64
|
| Rate for Payer: Signature Care EPO |
$15.75
|
| Rate for Payer: Signature Care PPO |
$16.69
|
| Rate for Payer: United Healthcare Commercial |
$14.95
|
|
|
RIMANTADINE 100 MG ORAL TAB
|
Facility
OP
|
$18.97
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Centivo All Commercial |
$9.67
|
| Rate for Payer: Cigna All Commercial |
$16.37
|
| Rate for Payer: CORVEL All Commercial |
$17.64
|
| Rate for Payer: Coventry All Commercial |
$16.69
|
| Rate for Payer: Encore All Commercial |
$17.46
|
| Rate for Payer: Frontpath All Commercial |
$17.45
|
| Rate for Payer: Humana ChoiceCare |
$16.38
|
| Rate for Payer: Humana Medicare |
$9.67
|
| Rate for Payer: Lucent All Commercial |
$9.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.07
|
| Rate for Payer: PHCS All Commercial |
$14.23
|
| Rate for Payer: PHP All Commercial |
$14.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.40
|
| Rate for Payer: Sagamore Health Network All Products |
$14.64
|
| Rate for Payer: Signature Care EPO |
$15.75
|
| Rate for Payer: Signature Care PPO |
$16.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$14.95
|
| Rate for Payer: United Healthcare Medicare |
$6.26
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML IV SOLN
|
Facility
OP
|
$35,418.99
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
198293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$32,939.66 |
| Rate for Payer: Aetna Commercial |
$29,893.62
|
| Rate for Payer: Aetna Medicare |
$11,688.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11,688.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20,341.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22,140.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13,441.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12,857.09
|
| Rate for Payer: Cash Price |
$21,959.77
|
| Rate for Payer: Cash Price |
$21,959.77
|
| Rate for Payer: Centivo All Commercial |
$18,063.68
|
| Rate for Payer: Cigna All Commercial |
$30,566.58
|
| Rate for Payer: CORVEL All Commercial |
$32,939.66
|
| Rate for Payer: Coventry All Commercial |
$31,168.71
|
| Rate for Payer: Encore All Commercial |
$32,603.18
|
| Rate for Payer: Frontpath All Commercial |
$32,585.47
|
| Rate for Payer: Humana ChoiceCare |
$30,591.38
|
| Rate for Payer: Humana Medicare |
$18,063.68
|
| Rate for Payer: Lucent All Commercial |
$18,063.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,877.09
|
| Rate for Payer: Managed Health Services Medicaid |
$16.63
|
| Rate for Payer: MDWise Medicaid |
$16.63
|
| Rate for Payer: PHCS All Commercial |
$26,564.24
|
| Rate for Payer: PHP All Commercial |
$26,861.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13,813.40
|
| Rate for Payer: Sagamore Health Network All Products |
$27,343.46
|
| Rate for Payer: Signature Care EPO |
$29,397.76
|
| Rate for Payer: Signature Care PPO |
$31,168.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30,106.14
|
| Rate for Payer: United Healthcare Commercial |
$27,910.16
|
| Rate for Payer: United Healthcare Medicare |
$11,688.27
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML IV SOLN
|
Facility
IP
|
$35,418.99
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
198293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26,564.24 |
| Max. Negotiated Rate |
$32,939.66 |
| Rate for Payer: Aetna Commercial |
$30,602.00
|
| Rate for Payer: Cash Price |
$21,959.77
|
| Rate for Payer: Cigna All Commercial |
$30,566.58
|
| Rate for Payer: CORVEL All Commercial |
$32,939.66
|
| Rate for Payer: Coventry All Commercial |
$31,168.71
|
| Rate for Payer: Encore All Commercial |
$32,603.18
|
| Rate for Payer: Frontpath All Commercial |
$32,585.47
|
| Rate for Payer: Humana ChoiceCare |
$30,591.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,877.09
|
| Rate for Payer: PHCS All Commercial |
$26,564.24
|
| Rate for Payer: PHP All Commercial |
$26,861.76
|
| Rate for Payer: Sagamore Health Network All Products |
$27,343.46
|
| Rate for Payer: Signature Care EPO |
$29,397.76
|
| Rate for Payer: Signature Care PPO |
$31,168.71
|
| Rate for Payer: United Healthcare Commercial |
$27,910.16
|
|
|
RISPERIDONE 0.25 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
25519
|
|
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
|
|
|
RISPERIDONE 0.25 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
25519
|
|
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
|
|
|
RISPERIDONE 0.5 MG ORAL TAB
|
Facility
OP
|
$1.21
|
|
|
Service Code
|
NDC 00904635861
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.13 |
| 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 |
$0.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.76
|
| 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 |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$1.05
|
| Rate for Payer: CORVEL All Commercial |
$1.13
|
| Rate for Payer: Coventry All Commercial |
$1.07
|
| Rate for Payer: Encore All Commercial |
$1.11
|
| Rate for Payer: Frontpath All Commercial |
$1.11
|
| Rate for Payer: Humana ChoiceCare |
$1.05
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Lucent All Commercial |
$0.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.09
|
| Rate for Payer: PHCS All Commercial |
$0.91
|
| Rate for Payer: PHP All Commercial |
$0.92
|
| 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 |
$1.01
|
| Rate for Payer: Signature Care PPO |
$1.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
|
|
RISPERIDONE 0.5 MG ORAL TAB
|
Facility
IP
|
$1.21
|
|
|
Service Code
|
NDC 00904635861
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cigna All Commercial |
$1.05
|
| Rate for Payer: CORVEL All Commercial |
$1.13
|
| Rate for Payer: Coventry All Commercial |
$1.07
|
| Rate for Payer: Encore All Commercial |
$1.11
|
| Rate for Payer: Frontpath All Commercial |
$1.11
|
| Rate for Payer: Humana ChoiceCare |
$1.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.09
|
| Rate for Payer: PHCS All Commercial |
$0.91
|
| Rate for Payer: PHP All Commercial |
$0.92
|
| Rate for Payer: Sagamore Health Network All Products |
$0.93
|
| Rate for Payer: Signature Care EPO |
$1.01
|
| Rate for Payer: Signature Care PPO |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
RISPERIDONE 1 MG ORAL TAB
|
Facility
OP
|
$1.03
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Centivo All Commercial |
$0.52
|
| Rate for Payer: Cigna All Commercial |
$0.89
|
| Rate for Payer: CORVEL All Commercial |
$0.96
|
| Rate for Payer: Coventry All Commercial |
$0.91
|
| Rate for Payer: Encore All Commercial |
$0.95
|
| Rate for Payer: Frontpath All Commercial |
$0.95
|
| Rate for Payer: Humana ChoiceCare |
$0.89
|
| Rate for Payer: Humana Medicare |
$0.52
|
| Rate for Payer: Lucent All Commercial |
$0.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.93
|
| Rate for Payer: PHCS All Commercial |
$0.77
|
| Rate for Payer: PHP All Commercial |
$0.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.40
|
| Rate for Payer: Sagamore Health Network All Products |
$0.79
|
| Rate for Payer: Signature Care EPO |
$0.85
|
| Rate for Payer: Signature Care PPO |
$0.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
|
|
RISPERIDONE 1 MG ORAL TAB
|
Facility
IP
|
$1.03
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna All Commercial |
$0.89
|
| Rate for Payer: CORVEL All Commercial |
$0.96
|
| Rate for Payer: Coventry All Commercial |
$0.91
|
| Rate for Payer: Encore All Commercial |
$0.95
|
| Rate for Payer: Frontpath All Commercial |
$0.95
|
| Rate for Payer: Humana ChoiceCare |
$0.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.93
|
| Rate for Payer: PHCS All Commercial |
$0.77
|
| Rate for Payer: PHP All Commercial |
$0.78
|
| Rate for Payer: Sagamore Health Network All Products |
$0.79
|
| Rate for Payer: Signature Care EPO |
$0.85
|
| Rate for Payer: Signature Care PPO |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
|
