|
RITUXIMAB 10 MG/ML IV CONC
|
Facility
IP
|
$3,758.08
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,818.56 |
| Max. Negotiated Rate |
$3,495.01 |
| Rate for Payer: Aetna Commercial |
$3,246.98
|
| Rate for Payer: Aetna Commercial |
$14,205.54
|
| Rate for Payer: Cash Price |
$10,193.79
|
| Rate for Payer: Cash Price |
$2,330.01
|
| Rate for Payer: Cigna All Commercial |
$14,189.10
|
| Rate for Payer: Cigna All Commercial |
$3,243.22
|
| Rate for Payer: CORVEL All Commercial |
$3,495.01
|
| Rate for Payer: CORVEL All Commercial |
$15,290.69
|
| Rate for Payer: Coventry All Commercial |
$3,307.11
|
| Rate for Payer: Coventry All Commercial |
$14,468.61
|
| Rate for Payer: Encore All Commercial |
$15,134.49
|
| Rate for Payer: Encore All Commercial |
$3,459.31
|
| Rate for Payer: Frontpath All Commercial |
$15,126.27
|
| Rate for Payer: Frontpath All Commercial |
$3,457.43
|
| Rate for Payer: Humana ChoiceCare |
$3,245.85
|
| Rate for Payer: Humana ChoiceCare |
$14,200.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,797.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,382.27
|
| Rate for Payer: PHCS All Commercial |
$12,331.20
|
| Rate for Payer: PHCS All Commercial |
$2,818.56
|
| Rate for Payer: PHP All Commercial |
$2,850.13
|
| Rate for Payer: PHP All Commercial |
$12,469.31
|
| Rate for Payer: Sagamore Health Network All Products |
$12,692.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,901.24
|
| Rate for Payer: Signature Care EPO |
$13,646.53
|
| Rate for Payer: Signature Care EPO |
$3,119.21
|
| Rate for Payer: Signature Care PPO |
$14,468.61
|
| Rate for Payer: Signature Care PPO |
$3,307.11
|
| Rate for Payer: United Healthcare Commercial |
$2,961.37
|
| Rate for Payer: United Healthcare Commercial |
$12,955.98
|
|
|
RITUXIMAB 10 MG/ML IV CONC
|
Facility
OP
|
$16,441.60
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$15,290.69 |
| Rate for Payer: Aetna Commercial |
$13,876.71
|
| Rate for Payer: Aetna Commercial |
$3,171.82
|
| Rate for Payer: Aetna Medicare |
$5,425.73
|
| Rate for Payer: Aetna Medicare |
$1,240.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,240.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,425.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,158.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9,442.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,349.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,277.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$98.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$98.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,426.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,239.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,364.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,968.30
|
| Rate for Payer: Cash Price |
$2,330.01
|
| Rate for Payer: Cash Price |
$10,193.79
|
| Rate for Payer: Cash Price |
$10,193.79
|
| Rate for Payer: Cash Price |
$2,330.01
|
| Rate for Payer: Centivo All Commercial |
$8,385.22
|
| Rate for Payer: Centivo All Commercial |
$1,916.62
|
| Rate for Payer: Cigna All Commercial |
$14,189.10
|
| Rate for Payer: Cigna All Commercial |
$3,243.22
|
| Rate for Payer: CORVEL All Commercial |
$15,290.69
|
| Rate for Payer: CORVEL All Commercial |
$3,495.01
|
| Rate for Payer: Coventry All Commercial |
$3,307.11
|
| Rate for Payer: Coventry All Commercial |
$14,468.61
|
| Rate for Payer: Encore All Commercial |
$3,459.31
|
| Rate for Payer: Encore All Commercial |
$15,134.49
|
| Rate for Payer: Frontpath All Commercial |
$15,126.27
|
| Rate for Payer: Frontpath All Commercial |
$3,457.43
|
| Rate for Payer: Humana ChoiceCare |
$3,245.85
|
| Rate for Payer: Humana ChoiceCare |
$14,200.61
|
| Rate for Payer: Humana Medicare |
$8,385.22
|
| Rate for Payer: Humana Medicare |
$1,916.62
|
| Rate for Payer: Lucent All Commercial |
$8,385.22
|
| Rate for Payer: Lucent All Commercial |
$1,916.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,382.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,797.44
|
| Rate for Payer: Managed Health Services Medicaid |
$98.65
|
| Rate for Payer: Managed Health Services Medicaid |
$98.65
|
| Rate for Payer: MDWise Medicaid |
$98.65
|
| Rate for Payer: MDWise Medicaid |
$98.65
|
| Rate for Payer: PHCS All Commercial |
$2,818.56
|
| Rate for Payer: PHCS All Commercial |
$12,331.20
|
| Rate for Payer: PHP All Commercial |
$12,469.31
|
| Rate for Payer: PHP All Commercial |
$2,850.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,465.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,412.22
|
| Rate for Payer: Sagamore Health Network All Products |
$2,901.24
|
| Rate for Payer: Sagamore Health Network All Products |
$12,692.92
|
| Rate for Payer: Signature Care EPO |
$13,646.53
|
| Rate for Payer: Signature Care EPO |
$3,119.21
|
| Rate for Payer: Signature Care PPO |
$3,307.11
|
| Rate for Payer: Signature Care PPO |
$14,468.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,975.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,194.37
|
| Rate for Payer: United Healthcare Commercial |
$12,955.98
|
| Rate for Payer: United Healthcare Commercial |
$2,961.37
|
| Rate for Payer: United Healthcare Medicare |
$1,240.17
|
| Rate for Payer: United Healthcare Medicare |
$5,425.73
|
|
|
RITUXIMAB-PVVR 10 MG/ML IV SOLN
|
Facility
IP
|
$10,616.03
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
190336
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,962.02 |
| Max. Negotiated Rate |
$9,872.90 |
| Rate for Payer: Aetna Commercial |
$9,172.25
|
| Rate for Payer: Cash Price |
$6,581.94
|
| Rate for Payer: Cigna All Commercial |
$9,161.63
|
| Rate for Payer: CORVEL All Commercial |
$9,872.90
|
| Rate for Payer: Coventry All Commercial |
$9,342.10
|
| Rate for Payer: Encore All Commercial |
$9,772.05
|
| Rate for Payer: Frontpath All Commercial |
$9,766.74
|
| Rate for Payer: Humana ChoiceCare |
$9,169.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,554.42
|
| Rate for Payer: PHCS All Commercial |
$7,962.02
|
| Rate for Payer: PHP All Commercial |
$8,051.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8,195.57
|
| Rate for Payer: Signature Care EPO |
$8,811.30
|
| Rate for Payer: Signature Care PPO |
$9,342.10
|
| Rate for Payer: United Healthcare Commercial |
$8,365.43
|
|
|
RITUXIMAB-PVVR 10 MG/ML IV SOLN
|
Facility
OP
|
$10,616.03
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
190336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.26 |
| Max. Negotiated Rate |
$9,872.90 |
| Rate for Payer: Aetna Commercial |
$8,959.93
|
| Rate for Payer: Aetna Medicare |
$3,503.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,503.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,096.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,636.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$75.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,028.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,853.62
|
| Rate for Payer: Cash Price |
$6,581.94
|
| Rate for Payer: Cash Price |
$6,581.94
|
| Rate for Payer: Centivo All Commercial |
$5,414.17
|
| Rate for Payer: Cigna All Commercial |
$9,161.63
|
| Rate for Payer: CORVEL All Commercial |
$9,872.90
|
| Rate for Payer: Coventry All Commercial |
$9,342.10
|
| Rate for Payer: Encore All Commercial |
$9,772.05
|
| Rate for Payer: Frontpath All Commercial |
$9,766.74
|
| Rate for Payer: Humana ChoiceCare |
$9,169.06
|
| Rate for Payer: Humana Medicare |
$5,414.17
|
| Rate for Payer: Lucent All Commercial |
$5,414.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,554.42
|
| Rate for Payer: Managed Health Services Medicaid |
$75.26
|
| Rate for Payer: MDWise Medicaid |
$75.26
|
| Rate for Payer: PHCS All Commercial |
$7,962.02
|
| Rate for Payer: PHP All Commercial |
$8,051.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,140.25
|
| Rate for Payer: Sagamore Health Network All Products |
$8,195.57
|
| Rate for Payer: Signature Care EPO |
$8,811.30
|
| Rate for Payer: Signature Care PPO |
$9,342.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,023.62
|
| Rate for Payer: United Healthcare Commercial |
$8,365.43
|
| Rate for Payer: United Healthcare Medicare |
$3,503.29
|
|
|
RIVAROXABAN 10 MG ORAL TAB
|
Facility
IP
|
$94.54
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
152539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.91 |
| Max. Negotiated Rate |
$87.92 |
| Rate for Payer: Aetna Commercial |
$81.68
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna All Commercial |
$81.59
|
| Rate for Payer: CORVEL All Commercial |
$87.92
|
| Rate for Payer: Coventry All Commercial |
$83.20
|
| Rate for Payer: Encore All Commercial |
$87.03
|
| Rate for Payer: Frontpath All Commercial |
$86.98
|
| Rate for Payer: Humana ChoiceCare |
$81.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.09
|
| Rate for Payer: PHCS All Commercial |
$70.91
|
| Rate for Payer: PHP All Commercial |
$71.70
|
| Rate for Payer: Sagamore Health Network All Products |
$72.99
|
| Rate for Payer: Signature Care EPO |
$78.47
|
| Rate for Payer: Signature Care PPO |
$83.20
|
| Rate for Payer: United Healthcare Commercial |
$74.50
|
|
|
RIVAROXABAN 10 MG ORAL TAB
|
Facility
OP
|
$94.54
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
152539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$87.92 |
| Rate for Payer: Aetna Commercial |
$79.79
|
| Rate for Payer: Aetna Medicare |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.32
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Centivo All Commercial |
$48.22
|
| Rate for Payer: Cigna All Commercial |
$81.59
|
| Rate for Payer: CORVEL All Commercial |
$87.92
|
| Rate for Payer: Coventry All Commercial |
$83.20
|
| Rate for Payer: Encore All Commercial |
$87.03
|
| Rate for Payer: Frontpath All Commercial |
$86.98
|
| Rate for Payer: Humana ChoiceCare |
$81.66
|
| Rate for Payer: Humana Medicare |
$48.22
|
| Rate for Payer: Lucent All Commercial |
$48.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.09
|
| Rate for Payer: PHCS All Commercial |
$70.91
|
| Rate for Payer: PHP All Commercial |
$71.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.87
|
| Rate for Payer: Sagamore Health Network All Products |
$72.99
|
| Rate for Payer: Signature Care EPO |
$78.47
|
| Rate for Payer: Signature Care PPO |
$83.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.36
|
| Rate for Payer: United Healthcare Commercial |
$74.50
|
| Rate for Payer: United Healthcare Medicare |
$31.20
|
|
|
RIVAROXABAN 15 MG ORAL TAB
|
Facility
OP
|
$94.54
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
153451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$87.92 |
| Rate for Payer: Aetna Commercial |
$79.79
|
| Rate for Payer: Aetna Medicare |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.32
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Centivo All Commercial |
$48.22
|
| Rate for Payer: Cigna All Commercial |
$81.59
|
| Rate for Payer: CORVEL All Commercial |
$87.92
|
| Rate for Payer: Coventry All Commercial |
$83.20
|
| Rate for Payer: Encore All Commercial |
$87.03
|
| Rate for Payer: Frontpath All Commercial |
$86.98
|
| Rate for Payer: Humana ChoiceCare |
$81.66
|
| Rate for Payer: Humana Medicare |
$48.22
|
| Rate for Payer: Lucent All Commercial |
$48.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.09
|
| Rate for Payer: PHCS All Commercial |
$70.91
|
| Rate for Payer: PHP All Commercial |
$71.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.87
|
| Rate for Payer: Sagamore Health Network All Products |
$72.99
|
| Rate for Payer: Signature Care EPO |
$78.47
|
| Rate for Payer: Signature Care PPO |
$83.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.36
|
| Rate for Payer: United Healthcare Commercial |
$74.50
|
| Rate for Payer: United Healthcare Medicare |
$31.20
|
|
|
RIVAROXABAN 15 MG ORAL TAB
|
Facility
IP
|
$94.54
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
153451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.91 |
| Max. Negotiated Rate |
$87.92 |
| Rate for Payer: Aetna Commercial |
$81.68
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna All Commercial |
$81.59
|
| Rate for Payer: CORVEL All Commercial |
$87.92
|
| Rate for Payer: Coventry All Commercial |
$83.20
|
| Rate for Payer: Encore All Commercial |
$87.03
|
| Rate for Payer: Frontpath All Commercial |
$86.98
|
| Rate for Payer: Humana ChoiceCare |
$81.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.09
|
| Rate for Payer: PHCS All Commercial |
$70.91
|
| Rate for Payer: PHP All Commercial |
$71.70
|
| Rate for Payer: Sagamore Health Network All Products |
$72.99
|
| Rate for Payer: Signature Care EPO |
$78.47
|
| Rate for Payer: Signature Care PPO |
$83.20
|
| Rate for Payer: United Healthcare Commercial |
$74.50
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24
|
Facility
IP
|
$16.05
|
|
|
Service Code
|
NDC 65162082534
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Cash Price |
$9.95
|
| Rate for Payer: Cigna All Commercial |
$13.85
|
| Rate for Payer: CORVEL All Commercial |
$14.93
|
| Rate for Payer: Coventry All Commercial |
$14.12
|
| Rate for Payer: Encore All Commercial |
$14.77
|
| Rate for Payer: Frontpath All Commercial |
$14.77
|
| Rate for Payer: Humana ChoiceCare |
$13.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.45
|
| Rate for Payer: PHCS All Commercial |
$12.04
|
| Rate for Payer: PHP All Commercial |
$12.17
|
| Rate for Payer: Sagamore Health Network All Products |
$12.39
|
| Rate for Payer: Signature Care EPO |
$13.32
|
| Rate for Payer: Signature Care PPO |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$12.65
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24
|
Facility
OP
|
$16.05
|
|
|
Service Code
|
NDC 65162082534
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.83
|
| Rate for Payer: Cash Price |
$9.95
|
| Rate for Payer: Centivo All Commercial |
$8.19
|
| Rate for Payer: Cigna All Commercial |
$13.85
|
| Rate for Payer: CORVEL All Commercial |
$14.93
|
| Rate for Payer: Coventry All Commercial |
$14.12
|
| Rate for Payer: Encore All Commercial |
$14.77
|
| Rate for Payer: Frontpath All Commercial |
$14.77
|
| Rate for Payer: Humana ChoiceCare |
$13.86
|
| Rate for Payer: Humana Medicare |
$8.19
|
| Rate for Payer: Lucent All Commercial |
$8.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.45
|
| Rate for Payer: PHCS All Commercial |
$12.04
|
| Rate for Payer: PHP All Commercial |
$12.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.26
|
| Rate for Payer: Sagamore Health Network All Products |
$12.39
|
| Rate for Payer: Signature Care EPO |
$13.32
|
| Rate for Payer: Signature Care PPO |
$14.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.64
|
| Rate for Payer: United Healthcare Commercial |
$12.65
|
| Rate for Payer: United Healthcare Medicare |
$5.30
|
|
|
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP
|
Facility
IP
|
$3.80
|
|
|
Service Code
|
NDC 62756014586
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna All Commercial |
$3.28
|
| Rate for Payer: CORVEL All Commercial |
$3.53
|
| Rate for Payer: Coventry All Commercial |
$3.34
|
| Rate for Payer: Encore All Commercial |
$3.50
|
| Rate for Payer: Frontpath All Commercial |
$3.50
|
| Rate for Payer: Humana ChoiceCare |
$3.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.42
|
| Rate for Payer: PHCS All Commercial |
$2.85
|
| Rate for Payer: PHP All Commercial |
$2.88
|
| Rate for Payer: Sagamore Health Network All Products |
$2.93
|
| Rate for Payer: Signature Care EPO |
$3.15
|
| Rate for Payer: Signature Care PPO |
$3.34
|
| Rate for Payer: United Healthcare Commercial |
$3.00
|
|
|
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP
|
Facility
OP
|
$3.80
|
|
|
Service Code
|
NDC 62756014586
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.38
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Centivo All Commercial |
$1.94
|
| Rate for Payer: Cigna All Commercial |
$3.28
|
| Rate for Payer: CORVEL All Commercial |
$3.53
|
| Rate for Payer: Coventry All Commercial |
$3.34
|
| Rate for Payer: Encore All Commercial |
$3.50
|
| Rate for Payer: Frontpath All Commercial |
$3.50
|
| Rate for Payer: Humana ChoiceCare |
$3.28
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Lucent All Commercial |
$1.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.42
|
| Rate for Payer: PHCS All Commercial |
$2.85
|
| Rate for Payer: PHP All Commercial |
$2.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2.93
|
| Rate for Payer: Signature Care EPO |
$3.15
|
| Rate for Payer: Signature Care PPO |
$3.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.23
|
| Rate for Payer: United Healthcare Commercial |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
OP
|
$9.74
|
|
|
Service Code
|
NDC 00093747143
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.53
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Centivo All Commercial |
$4.97
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Humana Medicare |
$4.97
|
| Rate for Payer: Lucent All Commercial |
$4.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.80
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
| Rate for Payer: United Healthcare Medicare |
$3.21
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
OP
|
$9.74
|
|
|
Service Code
|
NDC 00093747119
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.53
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Centivo All Commercial |
$4.97
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Humana Medicare |
$4.97
|
| Rate for Payer: Lucent All Commercial |
$4.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.80
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
| Rate for Payer: United Healthcare Medicare |
$3.21
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
IP
|
$9.74
|
|
|
Service Code
|
NDC 00093747119
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
IP
|
$9.74
|
|
|
Service Code
|
NDC 00093747143
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
|
|
ROCURONIUM 10 MG/ML IV S.O.
|
Facility
OP
|
$26.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
42095812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: Aetna Commercial |
$21.95
|
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna Medicare |
$8.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Centivo All Commercial |
$17.85
|
| Rate for Payer: Centivo All Commercial |
$13.26
|
| Rate for Payer: Cigna All Commercial |
$22.44
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$24.18
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$22.88
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Encore All Commercial |
$23.94
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Frontpath All Commercial |
$23.92
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Humana ChoiceCare |
$22.46
|
| Rate for Payer: Humana Medicare |
$17.85
|
| Rate for Payer: Humana Medicare |
$13.26
|
| Rate for Payer: Lucent All Commercial |
$13.26
|
| Rate for Payer: Lucent All Commercial |
$17.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.40
|
| Rate for Payer: PHCS All Commercial |
$19.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: PHP All Commercial |
$19.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$20.08
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care EPO |
$21.58
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: Signature Care PPO |
$22.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$20.49
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
|
|
ROCURONIUM 10 MG/ML IV S.O.
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
42095812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$30.24
|
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: Cigna All Commercial |
$22.44
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: CORVEL All Commercial |
$24.18
|
| Rate for Payer: Coventry All Commercial |
$22.88
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Encore All Commercial |
$23.94
|
| Rate for Payer: Frontpath All Commercial |
$23.92
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$22.46
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHCS All Commercial |
$19.50
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: PHP All Commercial |
$19.72
|
| Rate for Payer: Sagamore Health Network All Products |
$20.08
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care EPO |
$21.58
|
| Rate for Payer: Signature Care PPO |
$22.88
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Commercial |
$20.49
|
|
|
ROCURONIUM 10 MG/ML IV SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
95812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| 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
|
|
|
ROCURONIUM 10 MG/ML IV SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
95812
|
|
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
|
|
|
ROCURONIUM 50 MG/5 ML (10 MG/ML) IV SYRG
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
120775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$29.54
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Centivo All Commercial |
$17.85
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Humana Medicare |
$17.85
|
| Rate for Payer: Lucent All Commercial |
$17.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
|
|
ROCURONIUM 50 MG/5 ML (10 MG/ML) IV SYRG
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
120775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cigna All Commercial |
$30.20
|
| Rate for Payer: CORVEL All Commercial |
$32.55
|
| Rate for Payer: Coventry All Commercial |
$30.80
|
| Rate for Payer: Encore All Commercial |
$32.22
|
| Rate for Payer: Frontpath All Commercial |
$32.20
|
| Rate for Payer: Humana ChoiceCare |
$30.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.50
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: PHP All Commercial |
$26.54
|
| Rate for Payer: Sagamore Health Network All Products |
$27.02
|
| Rate for Payer: Signature Care EPO |
$29.05
|
| Rate for Payer: Signature Care PPO |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
|
|
ROFLUMILAST 500 MCG ORAL TAB
|
Facility
OP
|
$2.91
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
109401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Centivo All Commercial |
$1.49
|
| Rate for Payer: Cigna All Commercial |
$2.51
|
| Rate for Payer: CORVEL All Commercial |
$2.71
|
| Rate for Payer: Coventry All Commercial |
$2.56
|
| Rate for Payer: Encore All Commercial |
$2.68
|
| Rate for Payer: Frontpath All Commercial |
$2.68
|
| Rate for Payer: Humana ChoiceCare |
$2.52
|
| Rate for Payer: Humana Medicare |
$1.49
|
| Rate for Payer: Lucent All Commercial |
$1.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.62
|
| Rate for Payer: PHCS All Commercial |
$2.18
|
| Rate for Payer: PHP All Commercial |
$2.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.14
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.42
|
| Rate for Payer: Signature Care PPO |
$2.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.48
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$0.96
|
|
|
ROFLUMILAST 500 MCG ORAL TAB
|
Facility
IP
|
$2.91
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
109401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna All Commercial |
$2.51
|
| Rate for Payer: CORVEL All Commercial |
$2.71
|
| Rate for Payer: Coventry All Commercial |
$2.56
|
| Rate for Payer: Encore All Commercial |
$2.68
|
| Rate for Payer: Frontpath All Commercial |
$2.68
|
| Rate for Payer: Humana ChoiceCare |
$2.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.62
|
| Rate for Payer: PHCS All Commercial |
$2.18
|
| Rate for Payer: PHP All Commercial |
$2.21
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.42
|
| Rate for Payer: Signature Care PPO |
$2.56
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR
|
Facility
OP
|
$4,588.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
189827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$4,266.90 |
| Rate for Payer: Aetna Commercial |
$3,872.33
|
| Rate for Payer: Aetna Medicare |
$1,514.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,514.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,634.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,868.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$100.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,741.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,665.47
|
| Rate for Payer: Cash Price |
$2,844.60
|
| Rate for Payer: Cash Price |
$2,844.60
|
| Rate for Payer: Centivo All Commercial |
$2,339.91
|
| Rate for Payer: Cigna All Commercial |
$3,959.50
|
| Rate for Payer: CORVEL All Commercial |
$4,266.90
|
| Rate for Payer: Coventry All Commercial |
$4,037.50
|
| Rate for Payer: Encore All Commercial |
$4,223.31
|
| Rate for Payer: Frontpath All Commercial |
$4,221.02
|
| Rate for Payer: Humana ChoiceCare |
$3,962.71
|
| Rate for Payer: Humana Medicare |
$2,339.91
|
| Rate for Payer: Lucent All Commercial |
$2,339.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,129.26
|
| Rate for Payer: Managed Health Services Medicaid |
$100.17
|
| Rate for Payer: MDWise Medicaid |
$100.17
|
| Rate for Payer: PHCS All Commercial |
$3,441.05
|
| Rate for Payer: PHP All Commercial |
$3,479.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,789.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,541.98
|
| Rate for Payer: Signature Care EPO |
$3,808.09
|
| Rate for Payer: Signature Care PPO |
$4,037.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,899.85
|
| Rate for Payer: United Healthcare Commercial |
$3,615.39
|
| Rate for Payer: United Healthcare Medicare |
$1,514.06
|
|
